Excretory urography

Excretory urography is a type of X-ray examination aimed at obtaining a detailed visualization of the condition of the urinaryexcretorysystem.

Plain radiography, which is prescribed to monitor the condition of the abdominal cavity, cannot provide such data. This is due to the fact that in the picturethe area of ​​the kidneys, the bladder and ureters are very weakly visible.

In order to improve the quality of the black-and-white "photo" of the supposedlypathologically alteredarea, specialists came up with an advanced X-ray technique, including theneed toadd contrast agents.

The essence of diagnostics

The main taskof diagnostics isto determine the functionality of the kidneys and organs that make up the urinary system of the body. But besides this, diagnostics also allows you to get a general idea of ​​the morphological features of theseorgans. This approach greatly simplifies the diagnosis of diseases of the excretory system, if they have a large area of ​​damage.

Theworse is the functional stateof the kidneys, theweakeris the density of the shadow from the contrasting funds on the urogram. When kidney activity is completely suppressed, shadows cannot be seen at all, so an alternative approach will have to be sought.

Polyhydric iodide preparations were taken as a basis to improve visualization.

Because of this, before finding out the final cost of the examination, it is better to first check with the research center which drug is being administered. If we are talking about a proven iodine-containing solution, then it will be safe for the body.

Doctors often use urography not only to confirm doubtful diagnoses, but alsoto trackthe progress of recovery. When long-term treatment is required, it is better to find out in advance where the procedure can be done in order to bring conclusions from one diagnostician to the specialist.

This will minimize possible errors due to different settings of the device, the approach of medical personnel and the characteristics of different types of contrast agent.

But sometimes functional testing indicates relatively stable renal function, while urography shows frankly weak penumbra. There are several explanations for this, which are not directly related to the functionality of the problematic internal organ.

The main reason covers the wrong algorithm for injecting the drug. This means thatat one timea person was injected with too much highly concentrated liquid at once, which became a provocateur of forcing a load on the kidneys. Due toexcessive load, their secretory and concentration abilities gradually fade away.

Excessive amounts are toxic. But here is the exact limit, the intersection of which prerotatesthe contrast ina substance toxic to the kidneys, each patient has his own. As soon as this line is crossed, the liver will join the work, trying to unload the natural “filters” of the urinary system that are working for wear and tear. The substance will cease to stand out in a timely manner.

Another plausible scenario is liver blockage followed by detoxification.

This causes aerocolia,which producesmany bowel shadows instead of a detailed picture of the urinary tract. To prevent this from happening, you need to carefully prepare for the study.

Classification of excretory diagnostics

additionalstudies. They will help determine exactly which of the two types of urography is ideal:

  • survey;
  • contrast.

Despite the fact that the first variation is gradually becoming obsolete, it is still actively used in many public hospitals. The examination is aimed at taking a standard x-ray of a potentially affected area. But such an approach will not be able to provide a detailed description of the inflammatory processes of soft tissues , as well as the functional state of the area under study.

Instead, it is useful for determining the exact location and sometimes the extent of the lesion:

  • stones;
  • foreign bodies;
  • parasitic focitypeechinococcuscysts;
  • some types of tumors.

Much more accurate isexcretoryintravenousurographywhich uses the use of contrast agents. It is in her competence to assess the speed and quality of the excretionof the contrastagent, as well as the structure of the cavitary renal system, and the patency of the ureters. All of the above allows you to find pathologies such as prostate problems, neoplasms, hydronephrosis, diverticulum hydroureter, cystitis, pathological wrinkling, which is characteristic of atrophy with a subsequent decrease in functional volume, excessive stretching, hyperplasia.

Urography allows monitoring in the sitting and lying position of the patient. By changing the position, it is possible to assess the mobility and abnormal structure of a number of organs. This is necessary to confirm the following diagnoses:

  • polycystic;
  • doubling of the kidneys;
  • dystopia.

The technique is used as an auxiliary analysis before the planned surgical intervention on the specified area.

Preparations

For the manipulation to be as productive as possible, you should try to prepare well a few days before the date of the examination. The most important preparation of the patient is to cleanse the intestines from accumulated feces and gases. This can be done in two ways: pharmacy products and cleansing enema.

It is necessary to get rid of feces the night before, and also approximately 2.5 hours before the scheduled procedure.

You also need to take care of proper nutrition, which you need to switch to a couple of days before the specified date. This contributes to reduced gas formation, which can be avoided if you exclude from the menu:

  • fresh pastries;
  • sweets;
  • raw fruits and vegetables;
  • dairy products;
  • cabbage.

Otherwise, due to excessive gas formation, visibility will be significantly reduced. Another step towards successful analysis is the increased volume of fluid consumed.

How is urography performed?

Before sending apatientto undergo aexamination, the doctor should explain to him how urography is done. This will mitigate the risks of developing panic, which covers people with a weak nervous system in an unfamiliar environment.

First, a panoramic x-ray is taken of the patient , thena contrast agent is injected into the peripheral vein of the elbow. If this is not possible, then the introduction into any other large venous vessel is allowed. The solution must be administered very slowly, over a couple of minutes , as excessively rapid administration of the drug canprovoke dizziness, nausea, vomiting, and a flush of heat.

The manipulation protocol provides for the obligatory presence in the diagnostic room first aid devices. Usually they are not needed, but with the development of collapse without visible prerequisites, the doctor must have pharmacological agents on hand to relieve dangerous symptoms.

To reduce the likelihood of developing anaphylactic shock due to contrast intolerance to zero, a preliminary allergy test is performed on a person. This is prescribed by official rules.

It is impossible to say exactly how long the study will last. Here you will need to take into account several nuances:

  • functional renal potential;
  • age;
  • the presence of chronic diseases;
  • specific tasks.

All manipulation should be carried out under the strict guidance of a specialist who will determine the start of fixation of control sections.

Orthostatic and continuous approach

In addition to the division into general andcontrast urography,there is anotherdifferentiationof this diagnostics. More than 80 years have passed since the first official use of diagnostics. Over such a long period of time, experts have developed many modifications to it, allowing more accurate identification of various anomalies.

Orthostatic test is performed with the patient in an upright position. It helps to assess the mobility of the kidneys. If, when in a horizontal plane, the body's natural "filters" shift with each inhalation and exhalation by approximately 2 cm, then in a vertical position, the displacement can reach 5 cm.

The more the organis displacedfrom the standard position, the higher the chance of developing pathological mobility, which is simply called omission. Moreover, the restriction of theirmobilityis also an alarming sign.

It indicates the possible presence of cicatricial or inflammatory changes localized in the perirenal tissue. Most often, a patienthas signsof pyelonephritis or tumors of the perinephric zone.

The continuous technique is considered separately, which is based on the need to introduce contrast several times. Its phases include taking pictures every five minutes, while the introduction of the substance can be repeated after 20 minutes. Very rarely, a thirdinjection is allowed20–40 minutes after the second. This option is used if the first two times it was not possible to achieve sufficiently high-quality visualization.

When thecontrast agententers the pelvis, it dissolves in the urine, which guarantees a weak image on theimage. Whenthe contrasthits the same spot for the second time, the visibility on the film improves.

The situation when it is required to study the condition of newborns is considered separately. They do infusion urography. It is needed to check the bladder, determine the presence of uropathy, and also to enhance the clarity of the pathological area of ​​the urinary system. The doctor will explain the mechanism of how the intervention is carried out. He is also obliged to warn that the technology will bear fruit only under the condition of at least the relative functioning of the kidneys.

Medical contraindications

Despite the effectiveness of the technique, it has some contraindications:

  • shock;
  • collapse;
  • previously diagnosed severe kidney disease;
  • azotemia;
  • profound impairment of concentrating ability;
  • liver disease and liver failure;
  • Graves' disease;
  • hypersensitivity to iodine ;
  • hypertension in the stage of decompensation.

If these prohibitions are ignored, thenseriouscomplications are possible. So, with destabilization of functionality, along with azotemia, the urea content increases. In this scenario, the released processed material will not be sufficient for satisfactory imaging, although azotemia as such is not a contraindication. Just because of it, productivity drops by an order of magnitude.

Separately, situations are considered when the specific gravity of urine in adults is from 1008 to 1010 units. This suggests that hypostenuria will not be able to establish well-defined shadows.

Limits of diagnostic possibilities

Like any branch of classical radiography, the urogram has some diagnostic limitations. Thus, in urolithiasis, the excretory approach helps to determine the specific location of the calculus, and also providesinformationabout the condition of the diseased organ.

And with a closed injury, urography determines the extent of the lesion.

The procedure helps with kidney tuberculosis when it is necessary to identify the possible presence of caverns. They are usually not found using standard retrograde pyelography.

If a nephrectomy is required, then urography is indispensable. Using the method, it is possible to clearly determine the contours of neoplasms, as well as the functionality of a healthy kidney.

Pregnancy stands apart, which is classified as an absolute contraindication.

Not withoutexaminationif for some reason it is impossible to do a standard cystoscopy, and checking the health of the bladder and prostate is vital.

The image will provide data suggesting the exact location of the tumor growth, as well as possible bladder filling defects. When the neoplasm has grown to a sufficiently large size, it is this radiography format that makes it possible to reliably judge whether the orifice of the ureter is involved in the pathological process. Based on the information collected, it will be much easier to choose the right operational manual.

With prostate adenoma, it will also be good to follow the filling defect.

Information will be valuable in cases where a diverticulum or bladder stones cannot be detected because of a mild shadow. The method copes even with the diagnosis of minor damage to the bladder. This is evidenced by streaks of contrast. And when the picture shows an abnormal elevation of the shadow above the symphysis, the doctor will first of all suspect a urohematoma in the patient. It is a direct consequence of trauma to the urethra.

Advantages and disadvantages

If you do a preliminary allergy test and be prepared for some discomfort due to the effect of the iodine-containing composition on the body, then everything usually goes smoothly. Minimally invasive intervention does not provide for a significant pain syndrome, which cannot be said about retrograde pyelography.

Another outstanding advantage is the ability to apply the method even to children if necessary. Although modern cystoscopic techniques offer an identical lack of restrictions, doctors still bring excretory urography to the forefront when it comes to children.

It is worth remembering that the procedure is not omnipotent. Even taking into account the ability to detect urethral injuries, it is not ready to guarantee one hundred percent high-quality image. This is especially true of the urinary tract, which is difficult to capture even with modern X-ray machines. It is very important to follow the recommendations for the preparatory phase.

Another important point of the value of the urogram is the need to necessarily involve additional types of analyzes. Only an integrated approach can provide an overall clinical picture, which will become a platform for drawing up a treatment program.

In no case should you prescribe such a study yourself, after reading reviews on the Internet. Despite the fact that this is only a diagnostic measure, it will not add health.

When the risks are justified, nothing serious will happen to the patient. But it is extremely reckless to expose the already weakened by the underlying disease immunity to an extra loadin the form of X-rays.

Only the attending physician can send to the diagnostic room after studying the information from the patient's medical record, a list of his chronic diseases, heredity. Often, before urography, a package of traditional testssuch as analysisof blood, urine, and ultrasound is prescribed to confirm the needof the needfor urography.