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PubMedDate not supplied

Cardiovascular radiology. Cardiac alterations during intravenous urography.

Electrocardiographic monitoring of 406 patients undergoing intravenous urography was performed before, during, and after the examination. Major cardiac arrhythmias and ischemia were encountered frequently (18%) in those with cardiac disease but also occurred (5%) in the healthy individual with no history of heart disease. Rapid higher dose (28-g iodine) bolus injections result in more cardiac alterations than the slower but larger (42-g iodine) infusion method, whereas the smaller (14-g iodine) bolus injections have the least cardiac effect. Ectopic ventricular beats, the most common abnormality, are usually transient but remain the most potentially lethal of the effects of intravenous contrast media on the heart.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Tamm-Horsfall glycoprotein excretion and aggregation during intravenous urography. Relevance to acute renal failure.

The effect of intravenous urography (IVU) on the excretion rate and precipitation of Tamm-Horsfall glycoprotein (THG) has been evaluated in 19 patients. Urine samples were collected immediately before the administration of contrast medium (U1) and then during the period of the excretion urogram (U2). The urinary THG: creatinine clearance ratio decreased in 15 patients by a mean of 28.2% (range 2.9-70.8) and increased in four by a mean of 22.8% (range 13.5-36.4). In 18 of 19 patients the amount of THG precipitated following the IVU decreased from an average of 75.6% of the total in U1 (range 2.2-100) to 19.5% (range 2.0-59) in U2. In the one exception the fraction precipitated was only 2.2% in U1 and 2.5% in U2. It is concluded that during routine IVU there is no marked increase in the excretion rate of THG. More importantly, the percentage of THG precipitated actually decreases.

Acute Kidney Injury↗
PubMedDate not supplied

Iohexol and metrizamide for urography in infants and children.

The new nonionic contrast medium iohexol, was compared with metrizamide in a double blind investigation. Urography was performed in 40 children below 6 years of age. Adverse reactions were negligible. A small decrease in erythrocyte volume fraction (hematocrit) values after the injection was found in both groups. Excellent films were obtained in most patients and no difference in diagnostic quality between the two media was observed.

Child, Preschool↗
PubMed1992

Quality of urography and renal clearance of ionic and nonionic contrast media.

The authors evaluated whether urographic quality correlated with patient hydration and the level of their renal function, depending on whether they received ionic or nonionic contrast media. One hundred patients with normal serum creatinine levels were randomly assigned to receive intravenous urography with either an ionic high-osmolar or a nonionic low-osmolar contrast medium. Patient hydration was evaluated by measuring urine osmolality in a sample voided just before the examination. The plasma concentration of iodine was determined in a single blood sample drawn approximately 3 hours later. From these determinations the plasma clearance of contrast medium was calculated. The urograms were assessed blindly with regard to nephrographic and pyelographic opacification, as well as overall diagnostic quality. The clearance varied between 42 and 115 mL x minutes-1 x 1.73 m-2. No systematic correlation of practical significance was found between the clearances and the urogram quality. A high urinary osmolality before the examination tended to improve quality with both media. It is not possible to assess glomerular filtration rate from nephrographic and pyelographic opacification, or from overall quality of routine urograms in patients with normal serum creatinine levels.

Adult↗
PubMed1985

DIgital intravenous subtraction angiography for investigating renovascular hypertension: comparison with hypertensive urography.

We used digital intravenous subtraction angiography (DSA) to evaluate 105 patients with suspected renovascular hypertension. Unilateral renal artery stenoses were identified in 14 patients, two of whom had previously had contralateral nephrectomy. In addition, one of three renal transplant recipients was found to have stenosis of the nutrient artery. Bilateral renal artery stenosis was demonstrated by DSA in three patients. Of the 88 patients who had concomitant minute sequence (hypertensive) urography (HIVP) delayed excretion suggested a renal artery lesion in only 8 patients. In the group of 88 patients, HIVP was able to detect renal artery stenosis in only 50% (eight of the 16) of patients whose stenosis was detected by DSA. When the patients with a single kidney are excluded, HIVP showed 62% (eight of 13) of the lesions detected by DSA. There were no significant complications in the patients examined by either modality. DSA has replaced HIVP as the screening examination for renovascular causes of hypertension in our institution.

Adolescent↗
PubMed1994

Cost-effective filming sequence for intravenous urography.

To define an intravenous urography (IVU) film sequence that maximizes sensitivity and minimizes filming costs, we evaluated the effect of omitting films from a standard IVU sequence. We reviewed 82 IVU series that demonstrated abnormalities. Each series comprised 11 films: preliminary abdominal radiograph and nephrotomogram, three 1-minute nephrotomograms, 5-minute abdominal film, 10-minute radiograph with abdominal compression, one frontal and two oblique 15-minute films, and postvoid film. Sensitivity was determined for each film. Eighty-two standard IVUs showed 120 abnormalities. Omitting any one film from the sequence decreased sensitivity by 0% to 12%. Omitting the preliminary film resulted in failure to detect 15 abnormalities (12%). Omitting any nephrotomogram, the 10-minute compression view, or either 15-minute oblique film did not decrease sensitivity. Omitting combinations of these films lowered overall sensitivity. The postvoid film was essential in only one case. We conclude that a sequence of nine radiographs decreases film and processing expenses by 18% without sacrificing sensitivity. Sequences with fewer films substantially reduce detection of common urinary tract abnormalities.

Cost-Benefit Analysis↗
PubMed1999

Intravenous urography in the emergency department: when do we need it?

Intravenous urography (IVU) is a useful radiographic study in the detection of renal and ureteral calculi. However, it is time consuming, expensive, and exposes the patient to i.v. contrast and radiation. To determine the impact of utilizing IVU less for the detection of renal calculi, criteria for ordering IVU in the emergency department (ED) were evaluated, and patients with high probability of positive IVU were identified. Variables included presence of acute flank pain with haematuria, prior history of renal calculus, degree of haematuria, and uncontrolled pain. We reviewed patients presenting with acute flank and abdominal pain with haematuria from May 1995 to May 1996 at a large urban university hospital. Charts were abstracted for prior history, reason for ordering IVU, time in the ED, laboratory results, IVU result, final diagnosis, and disposition. Data was analysed with Student's t-test, Wilcoxon rank-sum and receiver operating characteristic (ROC) analysis. A total of 302 patients were identified, and 185 underwent IVU during the study period. For patients with prior history of renal calculi 82% had positive IVU (sensitivity 51%, specificity 87%). For patients with both acute flank pain and haematuria, 92% had a positive IVU (sensitivity 93%, specificity 43%), and 19% of patients with abdominal pain of unclear aetiology with haematuria had a positive IVU. All patients with uncontrolled pain had evidence of high-grade obstruction on IVU. Degree of haematuria was not predictive of a positive IVU from ROC curve derivation. IVU is a useful study in the ED but may be overutilized, leading to lengthy patient stays. The combined objective findings of acute flank pain and haematuria are sensitive, and prior history is specific in identifying patients with renal calculi. Degree of haematuria was not useful in predicting renal calculi. By utilizing the criteria of acute flank pain and haematuria as a decision aid, 66% of all IVUs ordered could have been avoided.

Abdominal Pain↗
PubMed2003

Imaging findings of urinary tuberculosis on excretory urography and computerized tomography.

PURPOSE: We performed a retrospective study to analyze findings on excretory urography (IVP) and computerized tomography (CT) in patients with urinary tuberculosis. MATERIALS AND METHODS: In a 16-year period 53 patients with a total of 47 IVP and 33 CT examinations were diagnosed with urinary tuberculosis at our hospital. IVP and CT were reviewed and compared for certain imaging findings, including moth-eaten calices, renal parenchymal masses, an amputated infundibulum, autonephrectomy, thick urinary tract walls, urinary tract calcifications, renal parenchymal cavities, hydrocalycosis, hydronephrosis or hydroureter due to stricture, extra-urinary tubercular manifestations and renal parenchymal scarring. RESULTS: The most common finding on IVP was hydrocalycosis, hydronephrosis or hydroureter due to stricture, whereas renal parenchymal scarring was the most common finding on CT. Imaging findings of renal parenchymal masses and scarring, thick urinary tract walls and extra-urinary tubercular manifestations were significantly more common on CT than on IVP. Three imaging patterns were noted on all 44 IVPs (100%) and 31 of 33 CTs (94%) with multiple imaging findings, including multiple stricture sites, a single stricture with 1 other imaging finding and autonephrectomy with another imaging finding other than stricture. CONCLUSIONS: When the 3 imaging patterns are shown on IVP and CT, tubercular cultures or biopsies are suggested to make the definite diagnosis of urinary tuberculosis. Thus, treatment can be initiated as early as possible.

Adult↗
PubMed2005

Patients at high risk for upper tract urothelial cancer: evaluation of hydronephrosis using high resolution magnetic resonance urography.

PURPOSE: We assessed the potential of magnetic resonance urography (MRU) in the evaluation of hydronephrosis not explained by standard investigation in patients at high risk for upper tract urothelial cancer. MATERIALS AND METHODS: A total of 23 consecutive patients in a specialist urological unit with unexplained hydronephrosis prospectively underwent MRU which comprised overview heavily T2-weighted MR urographic images followed by focused high resolution turbo spin echo T2-weighted sequences obtained in an axial and coronal oblique plane through the level of urinary obstruction. All were at high risk for urothelial cancer and had either contraindications to or problems with standard investigations including poor contrast excretion due to obstruction or renal failure, failed ureteral cannulation or contrast allergy. Clinical events and imaging followup, subsequent endoscopic/surgical findings and histopathology validated MR findings. RESULTS: In 23 patients with a high clinical suspicion of upper tract transitional cell tumors (TCC), 8 ureteral and 5 renal pelvic TCCs (2 bilateral) were diagnosed by MR, and confirmed histologically. In a further 5 patients benign causes for the hydronephrosis were found. No intrinsic or extrinsic pathology was demonstrable in 5 patients whose imaging findings were stable during 1 year of followup. CONCLUSIONS: MRU is a valuable noninvasive investigation for evaluating hydronephrosis in this group of patients with suspected urothelial cancer in which routine investigation had failed to provide clinically important information. Focused high resolution T2-weighted images were reliable in the diagnosis of ureteral and renal pelvic TCCs, and were valuable in excluding these and other mass lesions as the cause of hydronephrosis.

Aged↗
PubMed1990

Low dose intravenous urography: results and technique modifications.

100 consecutive patients routinely referred for intravenous urography were examined using low doses of the low osmolar contrast medium Iohexol (Omnipaque 350mgl/ml). Their dosage schedule was based on the physiological parameters of age, sex, body weight and renal function. Comparison with a control group using standard contrast doses revealed a 42% reduction in contrast could be used, and still produce diagnostic studies. Nephrographic quality was reduced in the low dose group requiring technique modification, in particular a delayed film sequence. Further reductions in contrast use are envisaged in patients over the age of 40 years.

Costs and Cost Analysis↗
PubMed1993

Imaging of the ureters on intravenous urography: does a valsalva help?

A prospective trial, comparing filling of the ureters on routine urography with ureteric filling following a valsalva manoeuvre, was performed. A significantly greater length of ureter was filled by the study patients than controls, allowing this frequently poorly imaged structure to be visualized more consistently.

Adolescent↗
PubMed1997

Diagnostic magnetic resonance-urography in an infant girl with an ectopic ureter associated with a poorly functioning segment of a duplicated collecting system.

We report on a case of an ectopic ureter associated with a duplicated collecting system in a 6-month-old girl. Results of conventional imaging and endoscopic studies, including intravenous pyelography, ultrasonography of the kidneys, cystoscopy, vaginoscopy, and vaginogram, were unremarkable. An ectopic ureter, extending from a poorly functioning upper pole of the ipsilateral duplicated kidney to its vaginal opening, was visible on the magnetic resonance-urogram. The imaging time was not extensive, and the need for patient sedation was minimal. Respiratory motion and intestinal gas did not interfere with the quality of the images. Magnetic resonance-urography may possibly be used as a primary diagnostic method for this anomaly when it is not detected by standard imaging techniques, or as a noninvasive substitute for some interventional studies in infants.

Female↗
PubMed1975

Is urography necessary for patients with acute retention of urine before prostatectomy?

In 180 urograms performed on 203 patients admitted to hospital with acute or acute-on-chronic retention of urine 38 abnormalities were noted, most of them being related to upper tract obstruction. Of 4 diverticula detected only one needed treatment. Waiting for the urogram imposed an extra delay of more than 3 days between admission and operation and an equal prolongation of the whole hospital stay. There appears to be no justification for routine urography prior to prostatectomy in the patient admitted with urinary retention.

Cystoscopy↗
PubMed1982

Intravenous urography as a routine examination in epididymitis-a re-evaluation.

One hundred and twenty-seven intravenous urograms of patients with acute epididymitis were evaluated during a period of 9 years. The majority of these patients had normal urograms. A tuberculous renal lesion was found in only one case. Twenty-seven patients had prostatic enlargement and 10 of these were under 50 years of age. Other abnormalities which were found were not related to epididymitis. It is suggested that intravenous urography is indicated in patients with acute epididymitis only when there is evidence of previous tuberculosis or when laboratory findings arouse suspicion of genitourinary tuberculosis.

Adolescent↗
PubMed1983

Do intravenous urography and cystoscopy provide important information in otherwise healthy women with recurrent urinary tract infection?

An investigation of the influence on therapy of intravenous urography (IVU) and cystoscopy in a prospective study of 93 women with recurrent urinary tract infections is presented. The patients fulfilled the following criteria: a history of recurrent urinary tract infection (at least three episodes a year), a physical and gynaecological examination, determination of plasma creatinine, urine culture, microscopy, and uroflowmetry. It is concluded that IVU seldom reveals abnormalities that influence treatment in otherwise healthy women. On the other hand, uroflowmetry and cystoscopy occasionally yield helpful information.

Adolescent↗
PubMed2004

Intravenous urography-virtual cystoscopy is a better preliminary examination than air virtual cystoscopy.

OBJECTIVE: To describe a new technique of virtual cystoscopy (VC, used previously but with catheterization to drain residual urine and insufflation with air or carbon dioxide) with no invasive catheterization, used in parallel with intravenous urography (IVU), as conventional cystoscopy is an invasive but essential examination, and VC with multislice computed tomography (CT) was introduced to make preliminary examinations noninvasive. PATIENTS AND METHODS: Using multislice CT and a device with 16 rows of detectors, we examined five patients using VC that previously involved catheterization, termed 'air VC' and 16 using VC with the new technique, termed 'IVU VC'. We assessed the new technique by evaluating the tumour detection rate, and merits and demerits of both types of VC. RESULTS: The detection rate of bladder tumours by IVU VC was similar to that from air VC; moreover, IVU VC overcame two significant disadvantages of air VC, i.e. the appearance of the water surface and the need for catheterization. CONCLUSION: Conventional cystoscopy is still an essential examination but this new method of IVU VC may be ideal for preliminary examination of the bladder.

Aged↗
PubMed1987

Evaluation of renal parenchyma in children by DMSA scintigraphy, X-ray computed tomography and intravenous urography.

The demonstration of diminished or scarred renal parenchyma in children is often the decisive factor in determining the future management of children with urinary tract malformations. Renal scintigraphy using technetium 99m-labelled dimercaptosuccinic acid (DMSA), computed tomography (CT) and intravenous urography (IU) were used to evaluate the renal parenchyma prior to ureter re-implantation in a series of 13 children. Their ages ranged from 5 months to 3 years 8 months. The indication for operation was ureteric reflux in 8 children and distal ureteric stenosis in 5. CT was performed on a Toshiba TCT-80 scanner. Renal scintigraphy was performed 3 hours after intravenous injection of DMSA. Compared with IU, DMSA imaging gave more information about the renal parenchyma in 6 children, gave equal information in 6 and less in 1. Compared with CT, DMSA imaging gave more information in 2 children, was equally informative in 8 and less so in 3. Accordingly, DMSA imaging was judged to be more sensitive than IU and as sensitive as CT. DMSA imaging can be used both for the initial evaluation and for follow-up assessment of renal parenchymal damage.

Child, Preschool↗