Excretory urography

Excretory urography is one of the types of X-ray examination aimed at obtaining a detailed visualization of the condition of the urine.excretoryoh system.

Plain radiography, which is prescribed to monitor the condition of the abdominal cavity, cannot provide such data. This is due to the fact that in the picture kidney area, the bladder and ureters are very poorly visible.

In order to improve the quality of a black and white “photo” it is supposed pathologically altered zones, specialists came up with an advanced X-ray technique, includingI’m eobhodimawn to add contrast agents.

The essence of diagnostics

Main challenge diagnosis is determination of the functionality of the kidneys and organs included in the urinary system of the body. But besides this, diagnostics also allows you to get a general idea of ​​the morphological features of these organs. This approach greatly simplifies the diagnosis of diseases of the excretory system, if they have a large area of ​​damage.

Than worse functional condition kidneys, those weaker the density of the shadow from the contrast agent is visible on the urogram. When kidney activity is completely suppressed, shadows cannot be seen at all, so an alternative approach will have to be sought.

Polyatomic iodine preparations are taken as a basis to improve visualization.

Because of this, before finding out the final cost of the examination, it is better to first check with the research center which drug is used for administration. If we are talking about a proven iodine-containing solution, then it will be safe for the body.

Often doctors use urography not only to confirm dubious diagnoses, but also to for tracking recovery dynamics. When long-term treatment is required, it is better to find out in advance where the procedure can be done in order to bring conclusions from one diagnostician to the specialist.

This will minimize possible errors due to different settings of the device, the approach of medical personnel and the characteristics of different types of contrast agent.

But sometimes functional testing indicates relatively stable renal function, while urography shows frankly weak penumbra. There are several explanations for this, which are not directly related to the functionality of the problematic internal organ.

The main reason covers the wrong algorithm for injecting the drug. It means that one-time a person was immediately injected with too much highly concentrated liquid, which became a provocateur of forcing a load on the kidneys. Due to overload their secretory and concentration abilities gradually fade away.

Excessive amounts are toxic. But here is the exact limit, the intersection of whichrotates contrast in kidney toxic substanceeach patient has his own. As soon as this line is crossed, the liver will join the work, trying to unload the natural “filters” of the urinary system that are working for wear and tear. The substance will cease to stand out in a timely manner.

Another likely scenario is liver blockade with a subsequent decrease in the neutralizing function.

Because of this, aerocolia occurs, due to which many shadows of the intestines, instead of a detailed picture of the urinary tract. To prevent this from happening, you need to carefully prepare for the study.

Classification of excretory diagnostics

Before assigning aagentIn carrying out such an intervention, the urologist will necessarily conduct a number of additional explovations. They will help determine exactly which of the two types of urography is ideal:

• survey;
• contrast.

Despite the fact that the first variation is gradually becoming obsolete, it is still actively used in many public hospitals. The examination is aimed at taking a standard x-ray of a potentially affected area. But such an approach will not be able to provide a detailed description of the inflammatory processes of soft tissues., as well as the functional state of the study area.

Instead, it is useful for determining the exact location and sometimes the extent of the lesion:

• stones;
• foreign bodies;
• parasitic foci type Echinococcuskovic cysts;
• some types of tumors.

Much more accurate excretory intravenous urographywhich uses the attraction of contrast agents. It is in her competence to assess the speed and quality of excretion contrasting means, as well as the structure of the abdominal renal system, the patency of the ureters. All of the above allows you to find pathologies such as problems with the prostate gland, neoplasms, hydronephrosis, diverticulum hydroureter, cystitis, pathological wrinkling, which is characteristic of atrophy with a subsequent decrease in functional volume, excessive stretching, hyperplasia.

Urography allows monitoring in the sitting and lying position of the patient. By changing the position, it is possible to assess the mobility and abnormal structure of a number of organs. This is necessary to confirm the following diagnoses:

• polycystic;
• doubling of the kidneys;
• dystopia.

The technique is used as an auxiliary analysis before the planned surgical intervention on the specified area.

preliminaries

In order for the manipulation to be as productive as possible, you need to try to prepare well a few days before the date of the examination. The most important preparation of the patient is to cleanse the intestines from accumulated feces and gases. This can be done in two ways: pharmacy means и cleansing enema.

It is necessary to get rid of feces the night before, and also approximately 2,5 hours before the scheduled procedure.

You also need to take care of proper nutrition, which you need to switch to a couple of days before the specified date. This contributes to reduced gas formation, which can be avoided if excluded from the menu:

• fresh baked goods;
• sweets;
• raw fruits and vegetables;
• dairy;
• cabbage

Otherwise, due to abundant gas formation, visibility will be significantly reduced. Another step towards successful analysis is the increased volume of fluid consumed.

How is urography performed?

Before sending aagent go through survey, the doctor should explain to him how urography is done. This will mitigate the risks of developing panic, which covers people with a weak nervous system in an unfamiliar environment.

First pThe patient is given a panoramic x-ray, then a contrast agent is injected into the peripheral vein of the elbow bend. If this is not possible, then the introduction into any other large venous vessel is allowed. You need to inject the solution very slowly, over a couple of minutes., since excessively rapid administration of the drug can provoke dizziness, nausea, vomiting, hot flashes.

The protocol of manipulation provides for the mandatory presence in the diagnostic room the presence of certain emergency medicines: antiallergic, cardiovascular medicines, as well as drugs to stimulate breathing and a number of tools from the list of necessary first aid devices. Usually they are not needed, but with the development of collapse without visible prerequisites, the doctor must have pharmacological agents on hand to relieve dangerous symptoms.

To reduce the likelihood of developing anaphylactic shock due to contrast intolerance to zero, a person is given a preliminary allergic test. This is prescribed by official rules.

It is impossible to say exactly how long the study will last. Here you need to take into account several nuances:

• functional renal potential;
• age;
• the presence of chronic diseases;
• specific tasks.

All manipulation should take place under the strict guidance of a specialist who will determine the start of fixing the control sections.

Orthostatic and continuous approach

In addition to the division into general and contrast urography, there is one more differentiation this diagnostic. More than 80 years have passed since the first official use of diagnostics. Over such a long period of time, experts have developed many modifications to it, allowing more accurate identification of various anomalies.

An orthostatic test is performed with the patient in an upright position. It helps to assess the mobility of the kidneys. If, when in a horizontal plane, the body’s natural “filters” shift with each inhalation and exhalation by approximately 2 cm, then in a vertical position, the displacement can reach 5 cm.

The larger the organ is shifting from the standard position, the higher the chance of developing pathological mobility, which is simply called omission. Moreover, their limitation mobility – also a warning sign.

It indicates the possible presence of cicatricial or inflammatory changes with localization in the perirenal tissue. Most often the patient show signs pyelonephritis, or tumors of the perinephric zone.

The continuous technique is considered separately, which is based on the need to introduce contrast several times. Its phases include taking pictures every five minutes, while the introduction of the substance can be repeated after 20 minutes. Rarely allowedee introduction 20-40 minutes after the second. This option is used if the first two times it was not possible to achieve sufficiently high-quality visualization.

On hit contrast medium into the pelvis, it dissolves in the urine, which guarantees a weak display on snapshot. When contrast gets there a second time, then visibility on the film improves.

Separately, the situation is considered when it is required to study the condition of newborns. They do infusion urography. It is needed to check the bladder, determine the presence of uropathy, and also to enhance the clarity of the pathological area of ​​the urinary system. The doctor will explain the mechanism of how the intervention is carried out. He is also obliged to warn that the technology will bear fruit only under the condition of at least the relative functioning of the kidneys.

Medical Contraindications

Despite the effectiveness of the technique, it has some contraindications:

• shock;
• collapse;
• severe renal ailments, previously detected;
• azotemia;
• profound impairment of concentration ability;
• liver disease and liver failure;
• Graves’ disease;
• hypersensitivity to iodine;
• hypertension in the stage of decompensation.

If these restrictions are ignored, then serious complications. So, with destabilization of functionality, along with azotemia, the urea content increases. In this scenario, the released processed material will not be sufficient for satisfactory imaging, although azotemia as such is not a contraindication. Just because of it, productivity drops by an order of magnitude.

Separately, situations are considered when in adults the specific gravity of urine is from 1008 to 1010 units. This suggests that hypostenuria will not be able to establish well-defined shadows.

Limits of diagnostic possibilities

Like any branch of classical radiography, the urogram has some diagnostic limitations. So, with urolithiasis, the excretory approach helps to determine the specific location of the calculus, and also provides information about the state of the diseased organ.

And with a closed injury, urography determines the degree of damage.

The procedure helps with tuberculosis of the kidneys, when it is necessary to identify the possible presence of cavities. They are usually not found using standard retrograde pyelography.

If you need to undergo a nephrectomy, then you can not do without urography. Using the method, it is possible to clearly determine the contours of neoplasms, as well as the functionality of a healthy kidney.

Pregnancy stands apart, which is classified as an absolute contraindication.

Not without Surveyif it is impossible for some reason to do a standard cystoscopy, and checking the health of the bladder and prostate is vital.

The image will provide data suggesting the exact location of the tumor growth, as well as possible defects in the filling of the bladder. When the neoplasm has grown to a sufficiently large size, it is this radiography format that makes it possible to reliably judge whether the orifice of the ureter is involved in the pathological process. Based on the information collected, it will be much easier to choose the right operational manual.

With prostate adenoma, it will also turn out well to follow the filling defect.

Information will be valuable in cases where it is not possible to identify a diverticulum or bladder stones due to a mild shadow. The method copes even with the diagnosis of minor damage to the bladder. This is evidenced by streaks of contrast. And when the picture shows an abnormal elevation of the shadow above the symphysis, the doctor will first of all suspect a urohematoma in the patient. It is a direct consequence of trauma to the urethra.

Advantages and disadvantages

If you do a preliminary allergic test and be prepared for some discomfort due to the effect of the iodine-containing composition on the body, then everything usually goes smoothly. Minimally invasive intervention does not provide for a significant pain syndrome, which cannot be said about retrograde pyelography.

Another outstanding advantage is the ability to apply the method even to children if necessary. Although modern cystoscopic techniques offer an identical lack of restrictions, doctors still bring excretory urography to the forefront when it comes to children.

It is worth remembering that the procedure is not omnipotent. Even taking into account the ability to detect urethral injuries, it is not ready to guarantee one hundred percent high-quality image. This is especially true of the urinary tract, which is difficult to capture even with modern X-ray machines. It is very important to follow the recommendations for the preparatory phase.

Another important point of the value of the urogram is the need to necessarily involve additional types of analyzes. Only an integrated approach can provide an overall clinical picture, which will become a platform for drawing up a treatment program.

In no case should you assign such a study to yourself, having read reviews on the Internet. Despite the fact that this is only a diagnostic measure, it will not add health.

When the risks for this are justified, then nothing serious will happen to the patient. But just to expose the already weakened by the underlying disease immunity with an extra load in the form of X-rays, extremely recklessly.

Only the attending physician can send to the diagnostic room after studying the information from the patient’s medical record, a list of his chronic diseases, and heredity. Often before urography to confirmnecessary its implementation is assigned a package of traditional analyzes such as analysis blood, urine, ultrasound.