Excretory urography of the kidneys, ureters and bladder - Causes, symptoms and treatment. MF.
Mar 21, 2018
Excretory urography is a common method for diagnosing diseases of the genitourinary system, which is based on the ability of the kidneys to remove contrast agents from the blood. After intravenous administration of the same contrast agent, an X-ray examination of the kidneys and urinary tracts is performed, so you can see their anatomical picture and determine the pathology.
Indications for excretory urography
Until the invention of the ultrasound device, excretory urography was considered a true "gold standard" in urological practice. It was performed in all cases of admission of a patient to a urological hospital, regardless of the patient's illness. After the invention of ultrasound, the range of readings has narrowed somewhat, but still it remains wide enough to treat excretory urography as one of the most common diagnostic methods in urology.
One of the most common indications for excretory urography is the admixture of blood in the urine. The reasons for this clinical condition can be many and to determine at least an approximate cause of the disease, it is necessary to conduct excretory urography immediately.
Pain syndrome associated with kidney and urinary tract pathology is also an absolute indication for excretory urography.
In addition, any traumatic lesion of the lumbar region or any infectious pathology of the urinary tract also requires mandatory excretory urography.
Also, despite the invention of ultrasound, there are still pathologies in which excretory urography remains the most reliable method of diagnosis. This may be a suspicion of ureteral obstruction or urolithiasis. The point is that ultrasound does not allow you to visualize the cavity organs, such as the ureter and bladder, and with excretory urography you can quite easily see their anatomical picture and the presence of pathology.
In addition to all of the above, excretory urography is used to diagnose congenital developmental anomalies or complications after surgical interventions.
Contraindications to the excretory urography
In part, one of the reasons for the more frequent use of ultrasound instead of excretory urography is the large number of contraindications to this diagnostic method. Naturally, the procedure is categorically forbidden with increased sensitivity to iodinated contrast agents. At the same time, the method is generally discarded or recommended to be carried out using other contrast agents that do not contain iodine.
Earlier it was said that any infectious diseases of the genitourinary system are indications for excretory urography. In this case, it is necessary to remember that autoimmune inflammations, on the contrary, are considered contraindications for performing this diagnostic method. Therefore, before performing excretory urography for inflammatory pathology, the patient should be given a list of laboratory tests to determine the cause of the pathology.
For the same reasons, it is not possible to perform the procedure for renal failure, regardless of whether it is acute or chronic. Contrast substance can become an additional burden for a diseased kidney, so for this pathology it is better to limit only to ultrasound.
With such diseases as pheochromocytoma and thyrotoxicosis, the introduction of iodine-containing contrast may cause a sharp rise in blood pressure, so such patients are strictly forbidden to perform excretory urography.
procedure In principle, there is no preliminary preparation for excretory urography. The entire procedure, from the beginning to the end, is performed directly in the medical institution. The only preparation for excretory urography can be a psychological mood for those who are afraid of intravenous drippers and injections.
In addition, in domestic health care institutions, supplies for the procedure are rarely provided. Therefore, if you were prescribed excretory urography, then be prepared for the fact that you need to buy a syringe and iodine-containing contrast in the pharmacy. To not twice return to the same place, go to the pharmacy better before going to the clinic.
Excretory urography with the eyes of the patient
For a patient, the procedure starts with an intravenous injection, when he injects a contrast agent. The amount of contrast does not depend on the age or disease of the patient, but on the body weight. After the introduction of contrast medium, the patient waits about five minutes, then goes to the radiology room, where he takes a series of pictures. The first picture is performed in the 5-7 minute, when the contrast material is in the cavity of the calyxal-calculous kidney system. The second roentgenogram is carried out at 10-15 minutes. She is responsible for filling the ureters with contrast. And the last third picture should be taken at the 20-25 minute, when the contrast falls into the bladder cavity.
In some cases, for example, with obstruction of the ureter, when there is a delay in removing the contrast medium, the patient needs to "shoot" himself two more times - 45 and 60 minutes. In principle, this ends all actions on the part of the patient. Patients need to remember that after intravenous introduction of contrast, urine can change its normal color to a darker color, which should not be feared.
Doctor's tasks for excretory urography
The urologist does not directly participate in the excretory urography. This is done by a nurse who introduces a contrast agent and an X-ray technician who is engaged in taking pictures. A completely different task falls on the doctor - he needs to correctly interpret radiographic images and make a medical report on them.
When describing pictures, the urologist assesses the shape, position, size and contours of the kidneys, on the basis of which a conclusion is made about the functional state of the organ. In addition, the contours and shapes of the ureters and bladder are evaluated. A positive quality of excretory urography is the fact that it is possible to evaluate not only the state of the urinary tract, but also the organs of the small pelvis. This is how often random medical findings are detected, such as oncological diseases of internal organs.
Normal excretory urograph
Duration of procedure and duration of stay in hospital
As a rule, no more than half an hour passes from the moment of administration of the contrast medium to the time of the last X-ray photograph. In rare cases, for the reasons mentioned above, this procedure can last 45 or 60 minutes. At the same time, stay in the hospital is not necessary for this procedure. On the contrary, it is often performed on an outpatient basis.
The literature also describes cases when the procedure itself caused the hospitalization of a patient in a hospital. This is a serious allergic reaction to the injection of contrast medium. As practice shows, the length of stay in a hospital in such situations does not exceed two weeks, during which patients undergo thorough allergological research and give further recommendations on the treatment and prevention of the disease. Also, to prevent such situations in the office for excretory urography should be all that is necessary to provide first aid.
Possible complications in excretory urography
The most common complication in excretory urography is allergic reactions to iodine-containing contrast. They manifest themselves in the form of a runny nose, sneezing, shortness of breath, redness and the appearance of edema on the skin of the face. The first medical aid in this case consists in the introduction of hormonal drugs, such as prednisolone or hydrocortisone. To prevent such situations, you need to carefully collect allergic anamnesis. The risk group is patients with allergic reactions to the introduction of contrasts, with other severe allergies, as well as patients with bronchial asthma.
In addition, cases of local complications when performing intravenous injection are not uncommon. The most common complication is post-injection hematoma, which occurs because of poor pressure of the cotton wool to the punctured vein at the injection site. As a consequence, the blood in large quantities goes into the subcutaneous fat, where the hematoma is formed. In principle, it is prone to self-resolution even without using any specific treatment.
But sometimes there can be festering with bruises. Then, the redness and swelling of the skin around the injection site is revealed in the patients. As for the general symptoms, patients may complain of a fever, weakness, malaise and an eating disorder. In such cases, immediate surgical intervention is necessary, which consists in opening and draining the cavity of the hematoma.
In addition, a local complication such as thrombophlebitis can often occur. It is an inflammation of the inner wall of the vein at the site of its puncture. In addition, redness in the area of injection is also noted, only it has the form of an elongated strand that coincides with the subcutaneous direction of the vein. Unlike hematoma, thrombophlebitis needs not in operative, but in conservative treatment with the help of anti-inflammatory and antibacterial agents.
The most common complications in this procedure for patients who have contraindications to excretory urography. For example, when a contrast medium is administered to patients with glomerulonephritis or renal insufficiency, the function of this organ may be impaired. Patients then complain of pain in the lumbar region and worsening of the general condition. In laboratory parameters, they sharply increase the level of urea and creatinine, as well as the amount of total protein decreases. This has a very unfavorable prognosis and may result in uremic coma. Therefore, all patients before excretory urography should be carefully examined.
Rev.the doctor the urologist, the sexologist-andrologist Plotnikov А.N.