Urography how this procedure is performed. In what cases is urography prescribed?

Kidney diseases are common. Ultrasound, magnetic resonance imaging and kidney urography are used to diagnose them. This allows you to find out which external disturbances happened to the organ, as well as what changes there are in its structure. Urography is most often used in the diagnosis of urolithiasis. It is necessary in order to make the correct diagnosis and, accordingly, prescribe the correct treatment. How is the procedure performed and what are the features of diagnosis in children?

Kidney urography is performed to identify stones in the organ.

General information

Urography is performed under the close supervision of doctors.

Urography or cystography is an x-ray whose purpose is to study changes in the kidneys or identify urolithiasis. A substance is injected into the kidney, which begins to glow under x-rays. When the kidney begins to excrete it, it enters the urinary tract, and they become clearly visible on x-rays. Thus, urography shows all genitourinary system. This method was very popular in the past due to the lack of other technologies. The procedure is very unpleasant and does not guarantee 100% results. That's why I'm replacing it alternative methods diagnostics

What does it show?

Using this technique, we evaluate:

• size;
• circuit;
• position;
• shape;
• state Bladder and ureters.

These indicators are very important for establishing correct diagnosis, the main thing for prescribing the correct treatment. The advantage is that it is possible to see other organs located in abdominal cavity. This allows you to exclude other diseases or add to the list of existing ones. Thus, the doctor prescribes medications that correctly complement each other and do not lead to an exacerbation of other diseases.

The following methods are distinguished:

• survey urography;
• intravenous urography (excretory (excretory) urography, compression, infusion);
• retrograde (ascending) urography;
• antegrade percutaneous urography.

Survey diagnostics

This is the first research technique that is prescribed to a patient if there is a hint of kidney disease. This is a regular x-ray of the area of ​​the body where the kidneys are located. It is the least informative. But with its help they look at the location of the organ, and also detect very large stones. The peculiarity of this method is that it does not require any special additional equipment. The diagnostic procedure is carried out in any clinic. This diagnosis will help track other diseases. internal organs.

Intravenous diagnostics

Intravenous urography, which involves diagnosing the kidneys with a contrast agent. Often the latter contains an iodine-containing solution of water and glucose. It is administered through a vein when the bladder is empty. Then a few shots are taken. Preparation for intravenous urography consists of emptying the bladder and for a long time do not take liquid. There are three methods of intravenous urography:

• excretory;
• compression;
• infusion

Excretory or excretory

Overview and excretory urography kidneys have several similarities. The only difference is that during the survey procedure, a contrast agent is not injected into a person’s vein. The results are just as blurry. The algorithm of actions for excretory diagnostics is more complicated. After administering the substance, it is necessary to take 3 pictures: the first after 1-2 minutes, the second after 4-5 minutes and the third after 7 minutes. This way you can evaluate the work and speed of the kidneys. Identify any violations in their appearance, and also detect stones. Preparation for excretory urography is simple: an enema and plenty of fluids.

Compression

A feature of compression urography is that during its implementation the ureters are artificially compressed. This occurs through the abdominal cavity. The examination is performed standing. The images are clear, but they cannot assess the condition of the ureters, since they are deformed during the shooting process. Therefore, they advise the first and last photo done using the excretory method. The combination of 2 methods will give correct result. The solution is injected using a syringe.

The technique is very complicated, and the procedure is painful, but to achieve results you need to be patient.

Infusion

Infusion urography differs from previous methods in that the substance is administered through a catheter. Using an enema system, contrast is introduced into the human body within 4-6 minutes. X-rays are taken lying down while the patient is on a drip. Infusion urography provides good results. It is prescribed to people who are unable to move, as well as those with limited abilities.

Retrograde or ascending

Retrograde urography differs in that contrast is injected directly into the ureters. Cystoscopy or catheterization is performed under general anesthesia. With their help, the substance reaches the ureters and rises through them. After this, a urogram is done. Sometimes this method replaces CT urography, as well as MRI urography. But more often it’s the other way around. An ascending urogram allows you to clearly see the ducts. Preparation is required only for anesthesia: do not eat 12 hours before the procedure and do not drink liquids 4 hours before.

Antegrade percutaneous

Antegrade urography involves injecting a substance directly up the ureters through skin. The substance descends down the ureters, which allows you to clearly see them. This is an alternative to the retrograde technique. Carried out at emergency situation, as well as to monitor the patient’s condition after surgery on an internal organ. Detects ureteral ruptures, severe inflammatory processes, neoplasms. Does not require additional preparation.

Advantages and disadvantages

Each diagnostic research method has its own advantages and disadvantages, presented in the table below:

Urography is reliable way to determine the disease and control in the postoperative period.

Indications

Often a person may not know about the diseases that he has in his body. But as soon as the patient feels any disturbances in the functioning of the internal organs, he consults a doctor. Indications for examination are:

• all types of pain in the kidney area (including renal colic);
• blood in urine;
• signs of inflammatory or viral diseases;
• checking the postoperative condition.

The practitioner knows that there are many kidney diseases: pathologies, viral and inflammatory diseases. This examination is prescribed in the case. if you suspect the following diseases:

• anomalies urinary tract;
• urolithiasis disease;
• benign and malignant neoplasms;
• viral, inflammatory diseases;
• kidney tuberculosis.

Contraindications

Contraindications to excretory urography include iodine intolerance. Also diagnostic procedure Contraindicated for the following conditions and pathologies:

• pregnancy;
• acute glomerulonephritis;
• kidney disease;
• diabetes mellitus;
• poor blood clotting.

It is important to understand that contraindications should not be neglected. This will lead to irreparable consequences or fatal outcome. All risks must be taken into account by the doctor. It is important to tell your doctor about your pregnancy or suspicion of it. This will help preserve the life and health of the unborn baby.

Survey urography of the kidneys is used in urology to identify stones and formations of the renal collecting system.

On the urogram, urate stones are clearly visible, oxalate stones are less visible. Phosphate stones are rarely detected by plain urography.

The image obtained during the study is recorded on a 30x40 cm radiograph.
This film size allows you to visualize the following anatomical formations:

• Ilia;
• Spine;
• Small pelvis;
• Kidneys;
• Bladder;
• Dense foreign bodies.

The urogram shows intestinal loops. If they are filled with gas or feces, the visibility of the kidneys is impaired. Qualitative interpretation of the results depends on the preliminary preparation of the patient, the degree of cleansing gastrointestinal tract.

The overview image shows the shadow of enlarged kidneys with expansion collecting system. An attentive radiologist will detect an enlargement of the renal hilum. The shadow of the kidneys on the x-ray may be shifted to the side, and its lower part faces outward.

Coral stone right kidney on urogram

Dilation (expansion) of the kidneys is characterized by spherical protrusions on the surface. The display of formations is not clear. Gentle renal darkening in pathology looks more massive than normal. Can move beyond midline belly.

All of the above changes are not clearly visible on an x-ray. The definition of pathology during urography depends on the qualifications of the radiologist.

The essence of the method

The urogram shows skeletal system, soft fabrics, spine, which should also be assessed by a doctor.

The study has many other subtleties, but it is always performed before intravenous urography.

Most often, after undergoing a survey urography, the doctor prescribes deeper X-ray examinations. and possible allergic reactions to a contrast agent - read here.

About treatment renal colic at home, as well as in a hospital setting, read.

And here is everything about how hydronephrosis is diagnosed in children and what treatment methods are used. How dangerous is the operation and is it possible? full recovery renal function.

Indications

Indications for survey and excretory urography:

Hydronephrosis of the right kidney on x-ray

• Tumor stones;
• Foreign bodies;
• Kidney and ureteral stones;
• Injuries of the lower back and abdomen;
• Renal colic.

There is an emergency surgical indications for conducting survey urography.

If there is severe pain in the lower back that lasts several hours, an examination is performed to establish the location of the stone and assess its size.

Contraindications

The examination is contraindicated for pregnant women (as are all types of x-ray examinations).

A relative contraindication is performing the study on patients who have recently undergone a contrast gastroscopy procedure, passage of barium through the intestines.

Contrast material in the gastrointestinal tract will make it difficult to visualize the kidneys. Such patients need several days to clear the intestines of excess barium.

Absolute contraindications to survey urography:

1. Conceiving and bearing a child;
2. Absence of one kidney;
3. Chronic radiation sickness.

Regarding urography it works general rule for all x-ray examinations: the benefit of the procedure must be greater than the harm.

Preparation

The basis of preparation for survey urography of the kidneys is diet therapy to cleanse the gastrointestinal tract. Basic principles of diet before an x-ray of the kidneys:

1. Exclusion of products causing flatulence(sugar, bread, milk, legumes, potatoes);
2. Colon cleansing with sorbents (activated carbon, polyphepane, carbolene);
3. Refusal to eat in the evening and morning before the procedure;
4. Breakfast with tea without sugar.

An example of an overview urogram of a patient with kidney stones

Classic urography requires checking the condition of the patient's intestines using fluoroscopy. In practice, in order to reduce the patient's exposure to radiation, a survey X-ray is taken immediately after the person visits the X-ray room.

To prevent flatulence, you should not drink a lot of water.

According to European requirements - any X-ray examination must be carried out with the consent of the patient or his relatives.

For suspicious and impressionable patients it is recommended sedatives, painkillers, analgesics.

There are 2 ways to prepare the intestines for a urogram:

• Dissolve a packet of fortrans in 2 liters of water. Drink the solution a day;
• Take 4 tablets 4 times daily activated carbon. Before the procedure, you need to do cleansing enemas with water;
• In children, espumizan is used to eliminate intestinal gasification.

In infants, urography is performed according to emergency indications. In a small child, due to the constant contraction of the smooth muscles of the gastrointestinal tract, the risk of accumulation of feces and gases in the intestine increases.

How is survey urography performed?

The procedure involves recording images of the kidneys and pelvis on X-ray film (30x40 cm).

Urography is an effective, safe diagnostic method. The study is prescribed if the development is suspected renal pathologies, damage to the bladder, with problems with filtration and urine output. The technique allows you to identify stones, tumors, cysts, and determine the structure of the kidney tissue.

Before undergoing the procedure, patients should understand that the doctor did not accidentally choose a method such as urography. What it is? What does the study show? How contrast urography different from the review? How to properly prepare for the procedure? The answers are in the article.

general information

X-ray examination allows you to identify operational irregularities important organs, performing excretory, filtration and excretory functions. For a more complete picture of negative changes, the doctor first introduces contrast agent, then undergoes an examination. During survey urography, intravenous administration of drugs is not performed. The examination is permitted at any age; there are no complications or serious discomfort during the procedure.

Advantages of the modern technique:

• provides reliable data on the degree of kidney damage and the type of pathology;
• The image clearly shows parenchymal structures, stones, and the pyelocaliceal system;
• shows the stage of the disease, the quality of kidney function;
• does not cause pain to the patient;
• there is no tissue injury;
• suitable for identifying various pathologies, including congenital ones;
• adverse reactions pass quickly enough, severe complications No;
• foci of inflammation are clearly visible;
• the procedure is prescribed for both adults and children;
• Several types of examination allow the doctor to select best option to clarify the nature of the pathology in a particular patient;
• the preparation is simple, no expensive medications are needed;
• During the study, the patient receives a minimal dose of radiation;
• Urography is a highly informative diagnostic method with reliable results.

Indications for the study

X-ray examination is prescribed to identify:

• small and large;
• benign and malignant tumors;
• hypertension arising against the background of renal pathologies;
• causes of hematuria;
• congenital pathologies of the structure of the urinary tract excretory system;
• infectious diseases occurring in the organs of the genitourinary system;
• structural disorders in the tissues of important organs;
• control of problem areas during;
• to clarify the condition of organs after kidney surgery.

Contraindications

Survey, excretory and contrast urography are not suitable for all patients. Before the examination, the doctor finds out whether there are restrictions for specific person. The patient is obliged to inform the urologist about all chronic pathologies, intolerance certain substances, pregnancy.

Urography is not performed in the following cases:

• acute or chronic;
• pheochromocytoma;
• tendency to bleed;
• thyrotoxicosis, other pathologies of the thyroid gland;
• low blood clotting;
• pregnancy;
• severe forms of kidney or liver diseases;
• taking Glucophage medication during diabetes therapy;
• allergic reactions to iodine contrast agents;
• bleeding of various kinds;
• breastfeeding period.

What to do if the doctor forbids you to do urography? The alternative is more safe methods studies: CT, MRI, . These techniques give reliable results, although the information content of urography is higher.

Types of X-ray examination

X-ray examination is carried out different ways. The choice of method is the competence of the urologist. The doctor selects the optimal way to study the tissues and functionality of the kidneys, depending on the nature of the disorders. Survey urography is often prescribed before a contrast study to clarify the data and obtain a more detailed picture of the internal renal structures.

Survey urography

Characteristics:

• majority x-rays doctors do it at the time of removal of the contrast agent;
• the method allows you to reliably assess the excretory function of important organs, determine the rate of filling of the bladder and renal pelvis;
• during the examination, the stones, their size, shape, location are clearly visible;
• excretory type of examination is prescribed to identify tumors;
• The method gives an idea of ​​the structure of the organs of the urinary system.

Contrasting

Features of kidney urography using a contrast agent:

• to study the kidneys and bladder, a contrast agent is used, which is administered intravenously;
• the technique is based on renal filtration capacity, removal of processed materials, and release of metabolic products;
• the drugs chosen as X-ray contrast agents are Vizipak, Urografin, Cardiotrast;
• after the administration of the components, the patient often feels heat in the body, a burning sensation in the vein, nausea, and a metallic taste in the mouth. Side effects disappear after a few minutes;
• contrast urography is performed with an empty bladder. Pictures are taken during the period of accumulation of contrast agent from the blood at certain intervals: in the first 2 minutes, then after 5 minutes, 7 minutes after intravenous administration special drug;
• the technique shows the pelvis, ureters, kidneys, prostate, stones, cysts, tumors. The photographs show hydronephrosis, prostatic hyperplasia, pathological stretching or wrinkling of the genitourinary system.

How to prepare: basic rules

Basic rules for preparing for urography:

• three days before urography, the patient should refuse food that provokes increased gas formation: legumes, fresh cabbage, carbonated drinks, fresh bread, baked goods, raw vegetables;
• If you are prone to flatulence, it is important to take activated charcoal once a day. required quantity(per kilogram of weight - 1 tablet);
• It is necessary to do a test to determine if you are allergic to the X-ray contrast agent: Urografin, Triombrast, Vizipak, Cardiotrust and others. If there have been previous cases of a negative response to the listed drugs, then the patient is obliged to warn doctors about undesirable manifestations;
• no later than 8 hours before the X-ray examination, you need to eat; you should not drink too much liquid during the day;
• You should not eat food in the morning on the day of the procedure;
• in the office, the patient removes metal items, jewelry, and, as directed by the doctor, empties the bladder;
• If you are nervous or afraid of unpleasant sensations, you may take a sedative (sedative) shortly before urography.

Learn how to collect and what the results show.

There is a page written about how to treat urolithiasis in men with diet.

How is the procedure performed?

Features of the study:

• How is urography performed? The first stage is survey urography, then excretory;
• The duration of the procedure depends on the severity of the pathology, detection of stones, number of stones, and other factors ( individual characteristics person);
• Survey urography is done in the standing position. To protect the chest and genitals, these areas are covered with heavy aprons with protective plates. The doctor directs a beam of X-rays to the zone of 3 and 4 vertebrae;
• To perform intravenous urography with an X-ray contrast agent, the patient lies on a special table, and the doctor injects the drug into the vein. The beginning of the procedure is sometimes accompanied by unpleasant sensations, after a short time the discomfort disappears;
• gradually the contrast penetrates into the renal tissue and ureters. During excretory urography, images are taken at a certain interval. One shot must be taken “standing”, the rest - in the “lying” position;
• if indicated, delayed images are taken several hours after filling the tissues with a contrast agent;
• the standard duration of the procedure is from 30 to 60 minutes;
• After the study, the patient can do his usual activities, eat, and drink fluids.

Important point! To conduct any type of study, the patient must empty not only the bladder, but also the intestines. Air bubbles and accumulation of processed products interfere with renal visualization and reduce the effectiveness of the method. If a person cannot cleanse the intestines on his own, an enema is performed to remove as much food and gases as possible.

Side effects

During survey urography, discomfort does not appear, discomfort occur for a short period at the time of administration of a radiocontrast agent. After a few minutes, the side effects disappear.

The doctor is obliged to warn the patient about possible negative sensations:

• burning in the vein in the first minute;
• nausea;
• unpleasant taste in the mouth;
• dizziness;
• feeling of heat in the body.

To quickly remove the X-ray contrast agent, the patient after the procedure should drink more milk, natural fruit juices, and weak green tea.

results

After the procedure, the doctor analyzes the images, clarifies and identifies:

• shape, size, location of the kidneys;
• condition of parenchymal structures;
• functionality of the collecting system;
• quality of filling of the pelvis with urine;
• rate of urine outflow;
• presence of stones;
• consequences of injuries in the urinary tract;
• kidney malformations;
• severe degree of hydronephrosis.

Urography - modern research to assess the condition of the urinary tract, renal parenchyma, identify inflammatory foci, problem areas, interfering with the free flow of urine. X-ray examination is safe for patients of any age. Proper preparation to contrast, excretory and survey urography increases the effectiveness of the method.

Learn more about kidney examination using urography after watching the following video:

Urography is a radiopaque study of kidney and urinary tract function, which is used to diagnose most urological diseases.

The resulting urogram perfectly visualizes the anatomical position of the kidneys, their shape and size, allows you to assess the degree of functionality of the urinary organs, and detect various pathologies (neoplasms, stones, foci of inflammation).

Urography happens:

• survey - without the introduction of contrast, in fact it is an x-ray of the kidneys and urinary tract;
• excretory (intravenous) - a contrast agent is used, which is administered intravenously. This is done for better visualization.

Iodine-containing preparations are used as a contrast in excretory urography. Iodine is a substance that can cause allergic reaction varying degrees gravity. Therefore, 1-2 days before the examination, a test for individual sensitivity to iodine must be carried out. Testing is performed in an outpatient setting under the supervision of medical staff. If an allergy develops (hives, runny nose, swelling), the patient immediately receives qualified assistance. In this case, the administration of a contrast agent is strictly contraindicated.

Preparation for urography

For 3 days before urography, you must follow a diet that excludes foods that cause fermentation and gas formation in the intestines (vegetables, fruits, dairy products, carbonated drinks, black bread, etc.).

If necessary, a cleansing enema and activated charcoal may be prescribed on the eve of the procedure.

8 hours before the examination, you should not eat or drink much liquid.

Immediately before urography, the bladder and stomach should be empty.

Indications

Urography is used to diagnose diseases of the urinary system and is prescribed by a urologist if there are certain indications:

• chronic infections of the urinary system;
• hematuria (blood in the urine);
• urolithiasis disease;
• obstruction (blockage) of the ureter;
• congenital kidney anomalies;
• pathological kidney mobility;
• traumatic injuries;
• control after surgical treatment.

Contraindications

Conditions in which urography is not advisable or is completely contraindicated include:

• allergy to iodine-containing drugs;
• pregnancy at any stage;
• various bleedings;
• decreased blood clotting;
• renal failure (acute or chronic form);
• glomerulonephritis (acute course);
• thyrotoxicosis;
• therapy diabetes mellitus the drug "Glucophage";
• pheochromocytoma (hormonally active tumor of the adrenal medulla).

If it is not possible to perform urography (if there are contraindications) this method can be replaced by other, less informative, but safer for a particular person studies: ultrasound kidneys and bladder, CT or MRI.

The decision on the advisability of replacing or supplementing one diagnostic method with another is made by the attending physician, based on the individual characteristics of the patient. In any case, all examinations are aimed at obtaining as much reliable information as possible about the condition of the kidneys and urinary tract.

The accuracy of the diagnosis and the effectiveness of the prescribed treatment depend on the completeness and quality of the information.

Urography technique

It is better to undergo urography in those clinics that specialize in the diagnosis and treatment of urological pathologies.

Before the examination, you must sign an official consent to perform urography. This can be done by the patient himself or his relatives. Then you need to remove all metal objects and change into disposable medical clothing. If the patient is worried severe pain or feeling of fear, sedatives and painkillers may be offered.

Before administering a contrast agent, a survey urography is performed - an x-ray of the kidneys and urinary tract.

Carrying out excretory (intravenous) urography

Filming begins in the first minutes after the contrast has entered the blood and lasts from 45 to 60 minutes. During this time, several pictures are taken at regular intervals, for example, 5-7 minutes, then 12-15, 20-25, etc.

When the contrast is released slowly, it is possible to perform delayed shooting (at 45, 60 minutes). How many images need to be taken is determined by the radiologist, taking into account the characteristics of the disease.

Side effects

Often, during the administration of a contrast agent, patients feel a burning sensation along the vein, nausea, dizziness, or a feeling of heat throughout the body. These reactions are considered normal unpleasant symptoms pass on their own.

On a note: to speed up the process of removing contrast and neutralizing the received radiation dose, it is recommended to drink more fluids on the first day after the examination, milk is better and fruit juices.

Since a sensitivity test was performed before the full dose of radiopaque contrast agent was administered, an allergy to it is extremely rare.

If the preliminary examination of the patient is carried out competently and does not reveal any contraindications to urography, then these and other side effects usually not observed.