Intravenous urography

Intravenous urography is one of the main radiographic studies performed by patients with lesions of the urinary system. Intravenous urography is based on the physiological ability of the kidneys to capture iodinated organic compounds from the blood, concentrate them and excrete them in the urine. In case of usual urography, the patient, on an empty stomach, after preliminary cleansing of the intestine and emptying the bladder, 20-60 ml of one of the urotropic contrast substances, ionic or, more preferably, neuronal ones, are intravenously administered. Within the first minute after intravenous injection, 1-2 pictures are taken, on which the nephrographic phase of the drug removal is displayed. To improve the visualization of the renal parenchyma, it is recommended at this time to perform a linear tomography, i.e. Get a nephrotomogram. In the absence of contraindications (for example, an aortic aneurysm or an extensive abdominal tumor), the patient is undergoing abdominal compression. This leads to a delay in urine and contrast agent in the renal pelvis and ureter. On the urograms performed after 4-5 minutes, a clear image of the renal pelvis and ureter is obtained. Then the compression is removed and several delayed images are produced - after 10-15 minutes, sometimes after 1-2 hours. Simultaneously, tomograms, sighting radiographs, including the bladder, are performed simultaneously. If there is a suspicion of nephroptosis (omission of the kidney), radiographs are obtained both in the horizontal and in the vertical position of the patient.

With reduced excretory function of the kidneys, which is observed, for example, in patients with pyelonephritis or nephrosclerosis, infusion urography is used. In this case, a patient slowly, through a system for drip-pouring fluids, intravenously injected a large amount of contrast agent (up to 100 ml) in a 5% solution of glucose. During the introduction of contrast, take pictures. It should be emphasized that urofafia is basically a method of morphological investigation. On the function of the kidneys, it allows us to obtain only the most general representation and in this respect is much inferior to radionuclide techniques.

Kidneys on urograms look the same as in the survey picture, but their shadow is somewhat more intense. The size and especially the shape of the calyx and pelvis are very diverse. Usually three large cups are distinguished: upper, middle and lower. Small calyxes leave the top of each of them. In each small calyx, one or more renal papillae protrude, so its outer contour is concave. Large cups merge into the pelvis. As stated above, the size and shape of the pelvis are normally different: from an ampullar loch with underdeveloped cups to a narrow pelvis with elongated calyxes (branching 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 an obtuse angle with the axis of the pelvis.

The ureter forms a shadow in the form of a narrow band. Normally, in connection with the contractions and relaxation of the cystoids, this band is interrupted in places. The ventral part of the ureter is projected almost parallel to the spine, the pelvic part is superimposed on the ileum-sacral articulation, then describes a convex arcuate arch and passes into the short intramural department.

The bladder gives a shadow in the form of a transversely located oval, the lower contour of which lies at the level of the upper edge of the bones. With urography, the shadow of the bladder reaches an average intensity, its outlines are even. Contrast substance can be introduced 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 (stones, tumors) in the bladder, its shadow is completely homogeneous. Indications for cystography is traumatic or postoperative urinary extravasation, suspicion of the diverticulum of the bladder and vesicoureteral reflux.

At the time of urination, contrast material comes from the bladder to the urethra. The shooting in the process of urination was called "microcysteraphy". It allows you to get an image of the urethra (urethrography). However, a more precise image of the urethra is obtained by injecting a contrast agent retrograde, through its outer orifice. At the same time, the internal opening of the urethra is blocked by a catheter inserted into it with a balloon (retrograde urethrography). With the help of urethrography it is possible to diagnose urethral strictures, tumors, diverticula, traumatic damages of the urethra.

The main advantages of intravenous urography are accessibility, low cost, non-invasiveness, the ability to study the structure of the cup-and-pelvis system and to reveal calcifications of various types. With its help, one can also to a certain extent judge the excretory function of the kidneys. The disadvantages of urography are limited information on the structure of the renal parenchyma and perineal areas, the lack of data on the functional parameters of urination, the inability to perform the procedure in the absence of kidney function and, finally, the use of iodine preparations and ionizing radiation in this study. Urography is contraindicated in cases of severe failure of the heart, liver, kidneys and intolerance to iodine preparations.

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