Excretory urography kidneys , ureters and bladder - Causes, Symptoms and Treatment .MF .
excretory urography - a common method for diagnosis of diseases of the genitourinary system, which is based on the ability of the kidneys remove from the blood contrast agents.After intravenous administration of contrast material that is carried out X-ray examination of the kidneys and urinary tract, so you can see their picture and to identify anatomic pathology.
indications for intravenous urography
Prior to the invention, the apparatus for ultrasound, excretory urography was considered a real "gold standard" in urological practice.It was performed in all cases the patient's admission to hospital urological, regardless of the patient's disease.After the invention of ultrasound readings circle narrowed somewhat, but he still remains wide enough to be considered excretory urography one of the most common diagnostic techniques in urology.
One of the most frequent indication for excretory urography is blood in the urine.The reasons for this clinical condition can be many and to determine at least the
Pain associated with kidney disease and urinary tract, and is an absolute indication for excretory urography.
addition, any traumatic injury to the lumbar region, or any infectious pathology of the urinary tract, also require that of excretory urography.
Also, despite the invention of ultrasound, yet left pathology, in which the excretory urography remains the most reliable method of diagnosis.This can be suspected ureteral obstruction or urolithiasis.The fact that ultrasound makes it impossible to visualize abdominal organs such as the bladder and ureter, while excretory urography can see them well enough picture anatomical pathology and availability.
In addition to all of the above, excretory urography is used for the diagnosis of congenital malformations or complications after surgery.
Contraindications to perform excretory urography
partly one of the reasons for more frequent use of ultrasound instead of excretory urography can be considered a large number of contraindications for this method of diagnosis.Naturally, that the execution of the procedure is strictly forbidden in case of hypersensitivity to iodinated contrast media.Thus, the method recommends or refuse to carry out it using other contrast agents which contain iodine in its composition.
previously stated that any infectious diseases of the genitourinary system are the indications for intravenous urography.At the same time, we must remember that autoimmune inflammation, on the contrary, are considered contraindications to perform this diagnostic method.Therefore, before performing the excretory urography in inflammatory disease patient list should be carried out laboratory investigations to clarify the causes of disease.
For the same reason you can not perform the procedure in renal failure, regardless of whether it is an acute or chronic form.The contrast agent may become an additional burden for the kidney patient, so in this pathology better confine ultrasound.
In diseases such as pheochromocytoma and hyperthyroidism, the introduction of iodine-containing contrast may cause a sharp rise in blood pressure, so these patients perform excretory urography is absolutely contraindicated.
procedure In principle, no prior preparation for excretory urography not.The entire procedure, from start to finish, is carried out directly in a medical facility.The only preparation for excretory urography may be the psychological attitude for those who are afraid of injections and intravenous drips.
addition, supplies for the procedure is very rarely available in local health institutions.Therefore, if you have been assigned to excretory urography, then be prepared for the fact that the pharmacy you have to buy a syringe, and iodine-containing contrast.To come back twice in the same place, go to the drugstore better before going to the clinic.
excretory urography eyes
patient to patient procedure begins with intravenous injection when it is introduced contrast agent.The amount of contrast does not depend on the patient's age or illness, and the body weight.After contrast injection the patient is waiting for about five minutes, and then is sent to the X-ray room, where he held a series of shots.The first picture is taken 5-7 minutes, when the contrast agent is in the cavity pyelocaliceal kidney system.The second X-ray is performed for 10-15 minutes.She is responsible for the content of the contrast of the ureters.And the last third shot should be carried out for 20-25 minutes, when the contrast enters the cavity of the bladder.
In some cases, for example, when ureteral obstruction when there is a delay in removal of contrast medium, the patient needs two more times "shoot" themselves - at 45 and 60 minutes.In principle, all this action on the part of the patient end.Patients must remember that after intravenous administration of contrast urine may change its usual color to a darker, which is not to be feared.
medical tasks at excretory urography
urologist itself is not directly involved in the conduct of excretory urography.This involved a nurse who enters the contrast agent and X-ray technician who has been taking pictures.At the doctor falls completely different task - it is necessary to correctly interpret the X-ray images and make them a medical report.
When describing pictures urologist estimated shape, position, size and contours of the kidneys, on the basis of which it is concluded that the functional state of the body.Besides, an evaluation circuit and forms the ureters and bladder.Positive quality excretory urography is the fact that in the photographs is possible to evaluate not only the state of the urinary tract, and pelvic organs.It is thus quite often detected incidentally medical discoveries, such as oncological diseases of internal organs.
normal excretory urogram
duration of the procedure and the length of stay in hospital
From the introduction of contrast material before the time of the last X-ray image usually takes no more than half an hour.On rare occasions, for the reasons mentioned above, this procedure may take 45 or 60 minutes.At the same time, hospital stay is not necessary for this procedure.On the contrary, often it is held in an outpatient setting.
The literature also describes cases where the procedure itself became the cause of hospitalization in a hospital.This is a severe allergic reaction to the contrast material.As practice shows, the length of stay in the hospital in such cases does not exceed two weeks, during which patients underwent a thorough study of allergy and provides further guidance on the treatment and prevention of disease.Also, in order to prevent similar situations in the office for excretory urography should be all you need for first aid.
Possible complications during excretory urography
most common complication during excretory urography is an allergic reaction to the iodine-containing contrast.They appear in the form of a runny nose, sneezing, shortness of breath, redness and swelling at the appearance of the skin.First aid for this is the introduction of hormonal drugs, such as prednisone or hydrocortisone.To avoid such situations should be carefully collected allergic history.Group risk are patients with allergic reactions to the introduction of contrasts, with other severe allergies and asthma sufferers.
In addition, there are cases of occurrence of local complications when performing intravenous injection.The most common complication is Postinjection hematoma, which occurs due to poor clamping fleece to the punctured vein at the injection site.Consequently, the blood comes out in large quantities into the subcutaneous fat, and where the formed hematoma.In principle, it is prone to samorazresheniyu even without the use of any specific treatment.
But sometimes can occur festering hematoma.Then patients revealed redness and swelling of the skin around the injection site.As regards the general symptoms, some patients may complain of fever, fatigue, malaise and appetite disorders.In such cases, immediate surgical intervention, which consists of incision and drainage of hematoma cavity.
In addition, a local complication can occur quite frequently as thrombophlebitis.It is an inflammation of the vein wall at the site of the puncture.Thus, as noted redness at the injection site, but it has the form of the elongated strand, which coincides with the direction of the subcutaneous vein.Unlike hematoma, thrombophlebitis needs not operational and conservative treatment with anti-inflammatory and antibacterial agents.
most frequently observed complications in the implementation of this procedure in patients who have contraindications to excretory urography.For example, the introduction of contrast agents in patients with glomerulonephritis or renal insufficiency, may interfere with the function of the organ.The patients then complain of pain in the lumbar region and the deterioration of the general condition.The laboratory values have dramatically increased levels of urea and creatinine, and reduced total protein.It has a very poor prognosis and may result in uremic coma.Therefore, all patients prior to excretory urography must be very carefully examined.
Ed.urologist, sexologist-andrologist Plotnikov AN