Intravenous urography

Intravenous urography is one of the main radiological studies conducted by patients with lesions of the urinary system. Intravenous urography is based on the physiological ability of the kidneys to grab iodized organic compounds from the blood, concentrate them and secrete in urine. During conventional urography, a patient on an empty stomach, after preliminary cleansing of the intestine and emptying of the bladder, intravenously administered 20-60 ml of one of the urotropic contrasting substances - ion or, more preferably, neion. During the first minute after intravenous injection, 1-2 pictures are taken, which display the nephrographic phase of the removal of the drug. To improve the visualization of the renal parenchyma, it is recommended to produce linear tomography at this time, i.e. Get a nephrotomogram. In the absence of contraindications (for example, aneurysms of aorta or an extensive tumor of the abdominal cavity), the patient is performed by an abdominal compression. This leads to a delay in urine and contrast media in the renal pelvis and ureter. On the urograms made after 4-5 minutes, a clear image of renal pelvis and ureters is obtained. Then, the compression is removed and several delayed pictures are removed-after 10-15 minutes, sometimes after 1-2 hours. At the same time, they are also performed, according to indications, tomograms, aiming radiographs, including the bladder. In case of suspicion of nephroptosis (kidney veneration), radiograms are obtained both in the horizontal and in the vertical position of the patient.

With a reduced excretory function of the kidneys, which is observed, for example, in patients with pyelonephritis or nephrosclerosis, infusion urography is used. At the same time, the patient slowly, by means of a system for dripping fluids, intravenously administers a large amount of contrast medium (up to 100 ml) in a 5 % glucose solution. In the course of the introduction of contrast, pictures are taken. It should be emphasized that urofaphia is mainly the method of morphological research. It allows you to get only the most general representation about the function of the kidney function and in this respect is significantly inferior to radionuclide methods.

The kidneys in the urograms look the same as in a sighted picture, but their shadow is somewhat more intense. The size and especially the shape of cups and pelvis is very diverse. Typically, three large cups are distinguished: upper, middle and lower. Small cups depart from the top of each of them. In each small cup, one or more renal papillae go, so its outer circuit is concave. Large cups merge into a pelvis. As indicated above, the size and shape of the pelvis is normal: from the ampular pelvis with poorly developed cups to a narrow pelvis with elongated cups (branched type of pelvis). However, in any case, the outlines of the normal pelvis are even and sharp. Its contours smoothly pass into the shape of the ureter, which forms a dumb angle with the axis of the pelvis.

The ureter determines the shadow in the form of a narrow strip. Normally, due to the reductions and relaxations of cystoids, this strip is interrupted in places. The abdominal part of the ureter is projected almost parallel to the spine, the pelvic part is superimposed on the shadow of the iliac art, then it describes the convex arreas and goes into a short intramural department.

The bladder gives a shadow in the form of a transversely located oval, the lower circuit of which lies at the level of the upper edge of the long bones. In urography, the shadow of the bubble reaches average intensity, its contours are even. The contrast agent can be inserted into the bladder through the urethra (this technique is called cystography). Then the shadow of the bubble becomes very intense. In the absence of pathological formations in the bubble (stones, tumors), its shadow is completely homogeneous. Indications for cystography are traumatic or postoperative urinary extravasia, suspicion of the diverticulum of the bubble and a bubble-hub reflux.

At the time of urination, the contrast matter comes from the bladder to the urethra. The shooting in the process of urination was called "Myting cystoherfia." It allows you to get an image of the urethra (urethrography). However, a more clear image of the urethra is obtained by introducing a contrast agent retrograde, through its external hole. At the same time, the inner hole of the urethra is blocked by a catheter with a cylinder introduced into it (retrograde urethrography). Using urethrography, it is possible to diagnose strictures of urethra, tumors, diverticula, traumatic damage to the urethra.

The main advantages of intravenous urography are accessibility, low cost, non-invasiveness, the ability to study the structure of the cup-lobe system and identify the calcifications of various nature. With its help, you can also judge the excretory function of the kidneys to a certain extent. The disadvantages of the urography are limited information about the structure of the kidney parenchyma and periposs spaces, the lack of data on the functional parameters of urinary, the inability to perform the procedure with insufficiency of the kidney function and, finally, the use of iodine preparations and ionizing radiation. Urography is contraindicated in pronounced deficiency of the heart, liver, kidneys and intolerance of iodine drugs.

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