Intravenous Pyelogram (cont.)
After the Procedure
After the x-rays are completed for the intravenous pyelogram, the doctor will review the films and discuss the findings with you and family members. If, for example, the doctor is unable to see both kidneys after a 4-hour picture, then you may have to be admitted to the hospital to continue further studies.
- The most common cause of obstruction to the flow of urine is a kidney stone. Other causes include masses, tumors, or cancers in adjacent tissues pressing against the ureter. Sometimes, bleeding from the kidney can produce a blood clot that can obstruct urine flow in the ureter. In older men, prostate enlargement can obstruct the flow of urine from the bladder as well as through the ureters.
- Following the test, the doctor might propose one of two courses of action: either waiting a few days for the stone to pass in the urine or referring to a urologist-a surgeon who specializes in diseases of the urinary tract.
- If the IVP demonstrates a large obstructive stone located in the upper or middle part of the ureter, the urologist may use a lithotriptor-a machine that delivers sound waves-to shatter the stone into smaller particles that can pass through the ureter freely and out of the body in the urine.
- Stones located in the lower part of the ureter above the bladder might need to be removed by a "basket" technique. This requires that an instrument be inserted through the urethra (which is in the penis or above the vagina), through the bladder and then into the ureter where the stone can be snared with a small instrument and pulled into the bladder. Candidates for this procedure are people who have had the stone for many days and continue to have symptoms. The urologist's role is to ensure that the obstruction does not produce any kidney damage.
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD