intravenous pylogram (IVP/IVU) intravenous urogram

INTRAVENOUS UROGRAM
(I.V.U)/INTRAVENOUS
PYELOGRAM (I.V.P)
NAME: TSHERING WANGDI LEPCHA.
REGISTRATION NO: 202207021.
BSC. MEDICAL IMAGING TECHNOLOGY (5th
SEM)
DATE: 17.12.2024

CONTENT
• INTRODUCTION.
• DEFINITION.
• ANATOMY OF THE PART EXAMINED.
• INDICATION AND CONTRAINDICATIONS.
• PATIENT PREPARATION.
• INSTRUMENTAL REQUIRED.
• PROCEDURE IN DETAILS.
• FLIMING AND VIEWS TO BE TAKEN INCLUDING TECHNICAL FACTORS.
• POST PROCEDURAL COMPLICATIONS.
• POST PROCEDURAL CARE AND MANAGEMENT.
• REFERENCE.

INTRODUCTION
• Intravenous pyelogram is a
misnomer as it implies
visualisation of the pelvis and
calyces without the parenchyma.
• The term pyelogram is reserved
for retrograde studies visualising
only the collecting system.

DEFINITION
• It is the radiographic
examination of urinary tract
including renal parenchyma,
calyces and pelvis after
intravenous injection of
contrast media.

ANATOMY OF THE PART
EXAMINED
1. Kidneys.
2. Ureters.
3. Urinary Bladder.
4. Renal pelvis.
5. Calyx.

INDICATIONS
IN ADULTS
1. Screening of entire urinary tract especially in case of haematuria or pyuria.
2. Disease of renal collecting system and renal pelvis.
3. Differentiation of function of both kidneys.
4. Obstructive uropathy.
5. TB of the urinary tract.
6. Calculus disease.
7. Potential renal donors.
8. Suspected renal injury.

INDICATIONS
IN CHILDREN
1. VATER anomalies.
2. Malformation of urinary tract including polycystic disease, PUJ obstruction etc.
3. Neurological disorders affecting urinary tract.
4. Malformation of genitalia like bilateral cryptorchildism, III degree hypospadiasis.
5. Anorectal anomalies.

1. Haematuria. 2. Renal calculi.
3. Mi
3. Mid-ureteric
calculus.

4. Horse shoe
kidney
5. Left pelviureteral
junction obstruction
6. Right renal
cyst

CONTRA-INDICATIONS
1. Iodine sensitivity.
2. Pregnancy.
3. Severe history of anaphylaxis.
RISK FACTORS
1. Cardiac failure.
2. Dehydration.
3. Diabetes with Azotemia.
4. Previous allergic reaction.

PATIENT PREPRATION
FOR ADULTS
1. Ask for any history of Diabetes mellitus, Pheochromocytoma, Renal disease,
or allergy to drugs and any specific foods.
2. Fasting for 4 hrs.
3. Do not dehydrate the patient.
4. Ask for KFT test.
5. Bowel preparation.

PATIENT PREPARATION
FOR CHILDREN
1. Don’t dehydrate the paediatric patient.
2. Colon should be empty.
3. Child must not have a full stomach to avoid vomiting.
4. Avoid food 3-4 hrs prior to the procedure.

INSTRUMENTATION REQUIRED
1. X-ray tub.
2. Table.
3. Cannula.
4. Contrast media.
5. Gloves.
6. Fluoroscopy.

PROCEDURE
Patient is placed in supine position-pelvis at cathode side to reduce lordotic
curvature of lumbosacral spine.
• A scout film is take.
• Test injection of 1ml of contrast is given and patient is observed for 1 min
to look for any contrast reactions.
• Rest of the contrast is rapidly injected within 30-60 seconds.
• All films are taken in full expiratory phase only

• Cortical nephrogram is seen within 20 seconds.
•
• The nephrogram is made up of 2 phases-
•
• 1) Cortical phase- Vascular filling
•
• 2) tubular phase- Contrast within the lumen of renal tubule
•
The appearance of pyelogram is seen 2 minutes.

PROCEDURE
• IN CHILDREN
• In neonates- concentrating ability of the kidney is not fully developed.
• First film is taken 15 min after contrast media is introduced.
• Minimum number of films should be taken.
• Dose : 1-2ml/kg.
• Contrast: non-ionic best
• Gonadal protective shields should be used.
• Bowel gas prone position. Paddle compression technique should be used or prone position.

FLIMING TECHNIQUES
• Uses low KV (65-75)
• High mA (600-1000) and short exposure.
STANDARD FILMS TAKEN
• Plan X-ray KUB/Scout film – 14”×17”
useful for assessing:
1. Calculus.
2. Intestinal abnormalities.
3. Intestinal gas pattern.
4. Calcification.
5. Abdominal mass.
6. Foreign body.

• 1 Minute film shows nephrogram. – 10”×12”
• 5 minutes film shows nephrogram, renal pelvis, and upper part of the
ureter.- 10”×12”
• 10 minutes film shows distended collecting system and proximal ureters.-
15”×12”
• 15 minutes film : visualisation of ureter is better in prone position as they
fill better.- 15”×12”
• 35 minutes film : It gives complete overview of the urinary tract ; kidney,
ureter, bladder.-14”×17”
• Post void film : Taken immediately after voiding. – 10”×8”
• Used to asses for :
1. Residual urine.
2. Bladder mucosal lesions.
3. Diverticular.
4. Bladder tumour.

intravenous pylogram (IVP/IVU) intravenous urogram

SPECIAL FLIMS IN IVP
1. Oblique view : To project the ureter away from spine and to separate
overlying radio opaque shadows mimicking calculi.
2. Erect film is used to :
• Provoke emptying of urinary tract.
• Demonstration layering of urinary tract.
• Detect urinary tract gas not seen in other films

3. Prone film is used for
• Viewing of ureteral areas not seen in supine films,
• Demonstration of renal ptosis and bladder hernia.
4. Delayed films in IVP are taken 1-24 hrs after injection.
Usual sequence of delayed films is after 1hr, 3hrs, 6hrs, 12hrs, and
24hrs.
Delayed films are used in :
1. Cases of obstruction where early nephrogram is seen but not
collecting system is not seen.
2. Long standing hydronephrosis in which renal parenchyma is
seen but collecting system is not visualised until many hrs later.
3. Congenital lesions.

FLIMING IN CHILDREN
Films are taken at 2min. (supine) and 7 min. (prone) after contrast
administration.
Carbonated beverage- Improve visualisation of left kidney.
15-20 degree caudal tilt view - Right kidney can be well seen through the liver.
• In neonates- Excretion of contrast media is delayed because of the
immaturity of the tissue.

COMPLICATIONS
DUE TO CONTRAST
• Minor reaction (5%) : Nausea, vomiting,mild rash, light headache, mild
dyspnoea.
• Intermediate reactions (1%) : Extensive urticaria, facial oedema,
bronchospasm, laryngeal oedema, dyspnoea, hypotension.
• Severe reaction (0.05%) : Circulatory collapse, pulmonary oedema, severe
angina, myocardial infarction, convulsions, coma, cardiac or respiratory arrest.

COMPLICATIONS
DUE TO TECHNIQUE
• Upper arm or shoulder pain.
• Extravastion of contrast at the injection site.

INITIAL TREATMENT
• Elevation of affected extremity above the heart.
• Ice pack (15-60minutes application three times per day for 1-3 days).
• Close observation for 2-4hrs.
• Call refering physician ( for extravastion over 5ml).
• Local injection of hyaluronidase (15-259 IU) – controversial.

AFTER CARE
1. Observation for 6 hours.
2. Watch for late contrast reactions.
3. Prevention of dehydrate.
4. In high risk patients- renal function tests should be done to watch for
deterioration.

REFERENCES
1. Nicholae Papanicolau. Urinary tract imaging and intervention Basic principles In Walsh PC, Retik AB, Varghan
ED, Wein AJ (eds) Campbell's Urology, 7th ed. Philadelphia WB Saunders, 1998: 172-188.
2. 2 JS Dunbar Excretory urography In Pollack HM (ed). Clinical urography-An atlas and textbook of urological
imaging, Ist edition. Philadelphia WB Saunders, 1990: 101-2023.
3. Radiological investigation of the urinary tract In Elkin M (ed). Radiology of the urinary system, Ist ed Boston
Little, Brown, 1980.
4. Diagnostic uroradiologic techniques. In Alan 1. Davidson. David S. Hartman DS (eds). Radiology of the kidney
and urinary tract, 2nd ed Philadelphia: WB Saunders, 1994 3-19.
5. Williamson B Jr., Hartman GW Intravenous urographic technique Radiology 1988; 167 593-599.
6. M Noroozian, RH Cohan etal Multislice CT Urography: state of the art British Journal of Radiology (2004) 77,
S74-586.
7. Akira Kawashima, Terri J Vrtiska etal: CT Urography, Radio Graphics 2004, 24:535-554.
8. Verswijvel Geert, Oyen R. Magnetic Resonance Imaging in the Detection and Characterization of Renal Diseases.
Saudi Journal of Kidney Diseases and Transplantation Year 2004. Volume 15. Issue 3. Page 283-299

BIBLIOGRAPHY
• Lakhar,B.N.2022.Radiological Procedure,Arya.

intravenous pylogram (IVP/IVU) intravenous urogram

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