Nico Rogelio

WHAT IS IVP?  A series of plain films taken after administration of an intravenous injection of water-soluble iodine- containing contrast medium  To visualize kidney, bladder and especially the pelvocalyceal system and ureter

INDICATIONS for IVP 1. Persistent or frank hematuria 2. Renal and ureteric calculi 3. Ureteric fistulas and stricutres 4. Complex urinary tract infection

PREPARATIONS  History Previous reaction to contrast media Diabetes mellitus, myeloma, hyperuricemia, sickle-cell disease  Glomerular Function Assess if patient can excrete the dye

PREPARATIONS  Bowel Preparation Previously 4 hour starvation, purge with laxative To eliminate fecal material and reduce amount of gas in the bowel Controversial  Dehydration Traditionally dehydrated to improve opacification Has increased risk of nephrotoxicity

PROCEDURE OVERVIEW Scout FilmInjection of Contrast3-minute Film5-minute Film15-minute FilmFull Bladder FilmPost-void Film

SCOUT FILM  Used as baseline  Diagnosis of abnormalities seen without contrast Calcific densities Abnormal soft tissue Air within urinary tract Bony abnormalities  Determine if a contraindication to abdominal compression exists

SCOUT FILM  Performed SUPINE  Should extend from upper renal poles to 2 cm below the inferior margin of pubic symphysis

SCOUT FILM  Normal Kidney: 1. Bean-shaped 2. 3 to 4 lumbar vertebral bodies in length / cm long 3. Size shouldn’t vary more than 1 cm 4. R kidney is 1-2 cm lower and more lateral 5. Renal axis parallels psoas muscles

SCOUT FILM  Normal Ureter: 1. 1 cm in diameter cm long 3. 3 normal narrowings 1. Pelvo-ureteric jxn 2. Ureter at pelvic brim 3. Vesico-ureteric jxn

SCOUT FILM  Normal Bladder Smooth walls Ovoid Pelvic organ when not filled Top: ○ Males: round ○ Females: flat due to uterus

SCOUT FILM  Normal Bladder Smooth walls Ovoid Pelvic organ when not filled Top: ○ Males: round ○ Females: flat due to uterus

INJECTION OF CONTRAST  Ionic vs. non-ionic  Remember to ask about allergic history  50 mL of strength water-soluble contrast  Administered by hand, relatively rapidly (30-60 seconds), IV usually  Injection made thru indwelling canula or needle For emergency treatment For future injection of contrast if inadequate

3-MINUTE  Window period for contrast to reach renal cortex and medulla  Kidneys already visualized  nephrogram Assess size (3-4 vertebrae) Contrast in vascular compartment dominates Cortex is more enhanced Fine linear opacities (collecting ducts)  Renal pelvis and upper portion of ureters also seen Medullary pyramid blush  along the meduallary pyramids towards the calyxes

5-MINUTE  Upper collecting system and ureters are already visualized well  pyelogram  It is normal not to see the whole ureter (discontinuous), due to peristalsis

COMPRESSION CompressionDistentionRelease Flow  Full Visualization of length  Normal peristalsis may leave portions of ureters empty of contrast  To inhibit ureteric drainage and promote distension of pelvicalyceal systems, optimising visualization  Proximal ureters and intrarenal collecting system optimally distended  With contraindications

15-MINUTE  After compression is released, there is transient increase in flow down the ureters  TAKE RADIOGRAPH  Peristalsis makes visualization of entire length uncommon  Kidneys and ureters still visualized, although less clearly  Bladder begins to light up

FULL BLADDER FILM  Bladder should appear smooth, balloon-like, globular structure above the pelvic rim  Kidneys, ureters less visible

FULL BLADDER FILM  Bladder should appear smooth, balloon-like, globular structure above the pelvic rim  Kidneys, ureters less visible

POST-VOID FILM  Visualize residual urine  < 50cc of fluid

POST-VOID FILM  Visualize residual urine  < 50cc of fluid