1. Nico Rogelio

2. 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

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

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

5. 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

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

7. 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

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

9. SCOUT FILM  Normal Kidney: 1. Bean-shaped 2. 3 to 4 lumbar vertebral bodies in length / 12-14 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

10. SCOUT FILM  Normal Ureter: 1. 1 cm in diameter 2. 25 cm long 3. 3 normal narrowings 1. Pelvo-ureteric jxn 2. Ureter at pelvic brim 3. Vesico-ureteric jxn

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

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

13. INJECTION OF CONTRAST  Ionic vs. non-ionic  Remember to ask about allergic history  50 mL of 350-370 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

14. 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

15. 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

16. 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

17. 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

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

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

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

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