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PubMedDate not supplied

Relationship between renal lymph flow and changes in kidney size during urography.

Using direct cannulation of renal lymphatic vessels and simultaneous photography of the exposed dog kidney during urography, the time schedule of variations in lymph flow and kidney size was established. The intravenous contrast injection produced heavy increase of renal lymph flow during the first 8 minutes of urography. Peak values were observed 3--4 minutes after injection. From 8 to 11 minutes after injection the lymph flow was depressed below the baseline, followed by a tendency of reestablishment. Generally after 25 minutes the lymph flow returned to its baseline level. The earliest response of kidney size upon intravenous contrast injection was a rapid, short-lived decreased, followed by a distension during the first 3 minutes. Thereafter a tendency to return to the preurographic size was observed. However none of the kidneys returned entirely to the baseline size during one hour of observation. The possible physiologic explanations of the observations are discussed.

Animals↗
PubMed1992

The estimate of glomerular filtration rate during urography. Acceptability of a nonionic contrast medium as a marker of renal function.

RATIONALE AND OBJECTIVES: An estimate of glomerular filtration rate (GFR) may be obtained at the same time as urography by measuring the plasma clearance of the radiographic contrast medium using an x-ray fluorescence technique. It must be established whether the function measured or one modified by an effect of the contrast medium itself represents a true value. METHODS: Technetium 99m-DTPA (99mTc-DTPA) plasma clearance was measured in 21 patients using a single-injection technique, before, during, and after an intravenous injection of 50 mL of 350 mg I/mL iohexol. Iohexol clearance also was determined using an alternative single-injection, two-sample technique. RESULTS: The mean 99mTc-DTPA clearances before, during, and after contrast were 71.2, 71.5, and 70.7 mL/minute, respectively. The within-patient standard deviation in clearance values was 3.84 mL/minute. One factor repeat measures analysis of variance indicated no significant difference between the three measurements (F ratio = 0.24). Contrast and 99mTc-DTPA clearances performed simultaneously agreed closely (r = .976; ClDTPA = 1.02ClCon - 1.35). CONCLUSION: The authors conclude that no change in function is observed during or 48 hours after contrast injection. Imaging doses of iohexol can be used for GFR measurement during urography.

Aged↗
PubMed1994

Efficacy and safety of iopromide for excretory urography.

RATIONALE AND OBJECTIVES: Iopromide is a nonionic monomeric contrast agent. Initial laboratory and clinical data have shown that it is relatively safe. Efficacy for excretory urography has been shown to be good, comparable with other low-osmolality agents. The authors attempted to confirm these impressions in a randomized, double-blind comparison with equivalent doses of ioversol and iopamidol. METHODS: Two hundred adult patients undergoing excretory urography were studied. One hundred received iopromide, 40 received ioversol, and 60 received iopamidol (300 mg I/kg) as an intravenous bolus. Urographic films (obtained 1, 5, 15, and 20 minutes after the bolus, and postvoid) were interpreted by an observer blinded to contrast type. Visualization of renal parenchyma, pelvis and calyces, ureters, and bladder was independently assessed as excellent, good, poor, or nonvisualized. Vital signs were recorded before, 30 to 60 minutes after, and 24 hours after injection. Adverse reactions were sought, physical examinations were performed, and standard hematology and serum chemistry values were measured before and 1 day after injection; a 72-hour serum creatinine level was also measured. RESULTS: Ninety-eight percent of visualization scores were good or excellent; no significant differences among iopromide, iopamidol, and ioversol were found, nor were there any significant differences among groups in vital signs. Only one patient experienced a contrast-related physical examination change (subcutaneous extravasation). No significant changes with regard to hematology or serum chemistry values were observed; there was no contrast-induced nephropathy. Mild adverse reactions were experienced by 10% of patients; there were no significant differences in reaction rates among contrast agents. CONCLUSIONS: Iopromide at a dose of approximately 300 mg I/kg is safe and effective as an excretory urographic agent and is comparable in performance with ioversol and iopamidol.

Adult↗
PubMedDate not supplied

Evaluation of RARE-MR urography in the assessment of ureterohydronephrosis.

OBJECTIVE: The goal of this prospective study was to evaluate the value of the fast imaging sequence called RARE-MR urography (RMU) for the diagnosis of ureterohydronephrosis. MATERIALS AND METHODS: Sixty-nine patients underwent this procedure. The results were compared with those obtained by intravenous urography (IVU) and ultrasonography (US). RESULTS: The accuracy of RMU in the detection of urinary tract dilatation and the localization of the level of obstruction was excellent (100%). The determination of the type of obstruction, intrinsic versus extrinsic, was 80% by IVU and 60% for RMU. The RMU sequence alone could not specify the nature of the obstruction. Functional information about the obstructed collecting system could not be obtained. CONCLUSION: The RMU technique may be considered in the following circumstances: contraindications to IVU (allergy to contrast medium, severe renal failure), impairment of renal excretion, and failure to locate the level of obstruction by US. The absence of ionizing radiations favors the promotion of this procedure to study ureterohydronephrosis during pregnancy.

Adult↗
PubMed2002

Computed tomography urography, three-dimensional computed tomography and virtual endoscopy.

Spiral computed tomography technology allows an entire body region to be imaged as a continuous volume of computed tomography data. The acquisition of genitourinary images can be performed at different intervals after intravenous contrast injection in order to characterize the renal vasculature, the renal parenchyma or the collecting system. Computed tomography scanning as contrast is excreted into the collecting system is termed a 'computed tomography urogram'. Volumetric data from spiral computed tomography can be rendered into conventional two-dimensional images or even reformatted into three-dimensional views of organ systems or hollow structures, as in 'fly-through' virtual endoscopy. Although virtual endoscopy of the urinary tract remains in its infancy, three-dimensional imaging is currently a useful adjunct in the evaluation of renal transplant and donor patients and partial nephrectomy candidates. The role of computed tomography urography compared with intravenous urography in the evaluation of hematuria is discussed.

Humans↗
PubMedDate not supplied

Computed tomography urography with 16-channel multidetector computed tomography: a pictorial review.

Excretory phase computed tomography (CT) urography obtained with a 16-slice multidetector CT scanner using thin-section images (slice thickness = 0.75 mm, reconstruction increment = 0.5 mm) combined with interactive reformatted and 3-dimensional reconstruction techniques, high spatial resolution images of the urinary tract similar to those of classic intravenous urography can be produced. The purpose of this pictorial essay is to review the early experience of the authors and to show the wide range of abnormalities of the urinary tract detected with this technique.

Humans↗
PubMed1993

Hydralazine predisposes to acute cutaneous vasculitis following urography with iopamidol.

We report a 60-year-old woman with renovascular hypertension who developed a severe cutaneous vasculitis 24 h after the injection of iopamidol during urography. A review of the literature suggests that her concomitant hydralazine therapy probably predisposed her to this reaction, as similar reactions have occurred in systemic lupus erythematosus, and hydralazine can induce a LE-like syndrome. We recommend that urography should be avoided in patients receiving hydralazine.

Contraindications↗
PubMed1991

Upper tract tumours following cystectomy for bladder cancer. Is routine intravenous urography worthwhile?

The incidence and presentation of upper tract tumours were studied in 180 patients who had previously undergone cystectomy for transitional cell carcinoma of the bladder. Intravenous urography was performed routinely 3 months after cystectomy, 1 year later and at 3-yearly intervals thereafter. Ten patients developed upper tract tumours; 1 presented with loin pain and the remainder with haematuria. Six patients underwent nephroureterectomy and 5 of them lived for at least 4 years; 4 were inoperable and only 1 survived longer than 6 months. In this series, all patients with upper tract tumours presented with symptoms and routine intravenous urography failed to detect any asymptomatic lesions. Routine radiological assessment of the upper tracts to detect tumours is not justified following cystectomy.

Adult↗
PubMed1994

The diagnostic yield of intravenous urography: a demographic study.

OBJECTIVE: To examine the impact of intravenous urography (IVU) on patient management in unselected patients in an effort to identify groups in which the use of urography could be reduced. PATIENTS AND METHODS: The results of IVU in 235 consecutive unselected patients were assessed prospectively to establish the value of IVU in patient management. Patients were divided into subgroups on the basis of age, sex, presenting symptoms and source of referral. The percentage of examinations with findings affecting patient management was taken as the 'positive diagnostic yield.' Differences between the positive diagnostic yields of IVU in the various groups were examined using the chi 2 test. RESULTS: For all patients the diagnostic yield was 37.4%. In patients over 50 years of age the yield was 46% while below that age the yield fell to 20%. This difference was significant (chi 2 = 13.88, P < 0.001). There were no significant differences between the other defined groups. Specifically, patients referred by general practitioners were as likely to have an IVU abnormality as were patients referred by a hospital practitioner. Patients with painless microscopic haematuria had a lower diagnostic yield (20%) than the other groups examined but this was not significant. CONCLUSION: IVU has a high diagnostic yield in an unselected population. Although the yield is lower in younger patients IVU offers advantages over other techniques in the investigation of urolithiasis--the commonest positive diagnosis in this study. We argue that it should retain its position as the primary investigation for the majority of patients with urological disease, particularly those suffering loin pain or haematuria.

Adolescent↗
PubMed1986

Urography prior to prostatectomy.

As part of the pre-operative assessment for prostatectomy, the routine intravenous urogram continues to be requested by many practitioners. One hundred and ten patients being considered for prostatectomy underwent, prospectively, intravenous urography and trans-abdominal ultrasound. This paper specifically examines the respective contribution to management of these investigations. In 34% of patients, management was influenced in some way. This could have been achieved by ultrasound and plain abdominal radiograph alone. Additional intravenous urography would not have affected the clinical management of any patient.

Aged↗
PubMed1976

Unilateral absence of excretion at urography after abdominal trauma.

The unilateral absence of excretion at urography is particularly significant in the context of prior abdominal trauma. Of 23 such cases studied, 17 involved traumatic main renal artery occlusion; only 1 of these 17 kidneys was salvaged. Since earlier diagnosis may improve surgical results, urography should be abbreviated in favor of renal angiography, to differentiate renal artery occlusion from other renal injuries, agenesis, and preexisting renal disease. Clinical and plain radiographic features provide few clues. Renal venography, ultrasonography, and retrograde ureteropyelography should be used only as secondary procedures. The role of renal scintiangiography remains to be determined.

Abdominal Injuries↗
PubMed1977

The caudad angle view: a helpful adjunct in excretory urography.

The caudad angle view is a useful ancillary projection for evaluating renal morphology during excretory urography. This view, easily obtained during routine urography, often adds important information about renal anatomy and patholgoy which is not apparent on conventional radiographs.

Humans↗
PubMed1977

Evaluation of bronchospasm during excretory urography.

Mean pulmonary function was significantly decreased in 57 patients during excretory urography. Patients with a history of allergy had significantly greater mean decreases in flow rates than those without. Twelve did not have significant decreases in pulmonary function after needle puncture and intravenous injection of 5% dextrose in water. Eight healthy subjects did not have significant mean decreases after intravenous injection of 5% saline. Most patients undergoing excretory urography have bronchospasm that is greater in magnitude in those with a history of allergy.

Adolescent↗
PubMed2005

Optimization of multi-detector row CT urography: effect of compression, saline administration, and prolongation of acquisition delay.

PURPOSE: To retrospectively compare the effects of abdominal compression, intravenous saline hydration, and two imaging delays on both distention and opacification of the intrarenal collecting system and ureter during multi-detector row computed tomographic (CT) urography. MATERIALS AND METHODS: Institutional review board approval for reviewing images and medical records of the patients was obtained; informed patient consent was not required. Excretory phase images obtained from multi-detector row CT urography in 85 patients (57 men, 28 women) were reviewed. Examinations were performed by using one of four techniques: abdominal compression and intravenous hydration with 250 mL of normal saline, compression only, intravenous hydration with saline only, and neither compression nor saline hydration. Excretory phase imaging was performed at 300 and 450 seconds for each patient. Two reviewers measured urinary tract distention on transverse images and graded opacification and image quality on volume-rendered images. Effects were compared by using statistical mixed models with repeated-measures analysis of variance. RESULTS: Saline hydration significantly improved opacification (P = .02) and overall image quality (P < .001) of the intrarenal collecting system and proximal ureter. Delayed excretory phase image acquisition of 450 seconds significantly increased distention of the intrarenal collecting system and proximal ureter (P < .001). No significant effects involving the lower segment of the ureter were seen with any technique; however, there were fewer nonvisualized distal ureteral segments with the longer imaging delay. CONCLUSION: Compression does not significantly improve distention or opacification of the urinary tract. Saline hydration is effective in improving opacification of the proximal urinary tract. Longer imaging delays improve distention of the proximal urinary tract and may aid in visualization of the lower segment of the ureter.

Adolescent↗
PubMed1980

Excretory urography with glucagon.

Glucagon administered to ten children during excretory urography showed only a transient dilution of contrast material without any other change in the appearance of the urinary tract. No beneficial role for glucagon in routine excretory urography was demonstrated.

Adolescent↗
PubMed1980

Nuclear imaging supplementary to urography in obstructive uropathy.

In 50 patients with obstructive uropathy, nuclear imaging supplementary to excretory urography did not improve the detection of obstruction or the determination of the site or etiology of the lesion. However, rapid sequential radionuclide images showed decreased renal perfusion in 64%, more frequently than did an obstructive nephrogram (40%); this finding appeared to occur with more severe degrees of obstruction. Functional impairment of the obstructed kidney was demonstrated more often with 131I Hippuran (o-iodohippurate sodium) (91%) than with 99mTc glucoheptonate (68%) or excretory urography (66%). Neither nuclear nor urographic studies could predict the degree of functional recovery of the kidney until the increased intrapelvic pressures was relieved.

Adolescent↗
PubMed1982

Frequency of anaphylactoid reactions during intravenous urography with radiographic contrast media at two different temperatures.

One hundred randomly selected patients undergoing routine excretory urography were assigned in double-blind fashion by alternate entry pairs to receive radiographic contrast media at 37 degrees C (Group I) or room temperature (Group II). There were three anaphylactoid reactions and five nonanaphylactoid reactions in Group I, and five anaphylactoid and eight nonanaphylactoid reactions in Group II, differences that were not statistically significant. No differences were detected between reactors and nonreactors. Thus, in this study, infusion temperature had no effect on the frequency of adverse reactions to radiographic contrast media during excretory urography.

Adolescent↗