Intravenous Pyelogram (cont.)
What happens during the intravenous pyelogram procedure?
You will go to the X-ray department for the IVP test. While you are lying face up on the X-ray table, dye is injected through an IV placed in a vein.
- The X-rays are taken at several intervals, such as at 0, 5, 10, and 20 minutes. Zero time is the time of injection of the dye. The test is completed when the kidneys, ureters, and bladder show up on the X-ray. Although the dye is colorless, it makes the kidneys and ureters appear white on the X-ray so that they contrast with the background of the rest of the abdomen.
- If, for example, the kidneys, ureters, and bladder can be seen after the 5-minute film is taken, then one last film will be taken immediately after you have urinated. If only one kidney and its ureter are seen after the 5-, 10-, and 20-minute pictures are taken, then the doctor will decide when further films should be taken. As a general rule, the interval for further films is determined by doubling the time from the last film. The time will be doubled until both kidneys and ureters can be seen.
- For example, if only one kidney and its ureter are seen after the 20-minute picture is taken, then the next film will be done 40 minutes later. If the X-ray technician is still unable to see the kidneys after the 40-minute film, then the next test will be taken 80 minutes later.
- Between X-rays, you are usually taken back to the emergency department to rest on a stretcher.
- While you are waiting for the X-rays to be taken, the nurses will check frequently to ensure that you are not experiencing any pain, nausea, or vomiting and, at the same time, will check your blood pressure, pulse, and breathing to make sure that these vital signs remain normal. If you have pain, nausea, or vomiting, the nurse can give appropriate medicines through the IV to help these symptoms.
- Most hospitals allow you to be joined by family and friends during the waiting period.
What happens after the intravenous pyelogram 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 kidney or 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" or laser 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.
Medically Reviewed by a Doctor on 11/20/2017
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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