The term "excretory urography" refers to a diagnostic method, during which the doctor gets the opportunity to visualize the organs of the urinary system and evaluate their work. The essence of the method is the introduction of a contrast agent into the human body, after which the specialist makes a series of x-rays.
Using the obtained images, it is possible to identify pathological processes at an early stage of their development, to draw up the most effective treatment regimen, and further evaluate the degree of its effectiveness. Another name for the study is "intravenous urography."
The essence of the method
In a standard X-ray, it is not possible to see and evaluate the functioning of the bladder, duct, and pelvis. That is why a contrast agent is introduced into the patient's body. Together with the bloodstream, it first enters the vessels of the kidneys, and then into the capillaries of the glomeruli. The next step is to filter the radiopaque substance in the urine. Together with urine, it enters the pelvis and calyx of the kidneys. The final stage is its movement into the bladder, from where it is excreted naturally.
Moving around the body, the contrast agent, as it were, illuminates it from the inside. During this, the doctor takes a series of x-rays at regular intervals.
In the images, structures filled with a contrast agent are white. Thanks to this, the doctor gets the opportunity to visualize the organs and identify the slightest pathological changes in them.
Indications
Intravenous (excretory) urography is prescribed in the following cases:
- When it is necessary to assess the degree of patency of the ureter. During the study, it is possible to detect calculi that impede the outflow of urine.
- In order to check the integrity of the urinary tract. As a rule, this is necessary after surgery or injury.
- In order to diagnose anomalies in the development of organs.
- When to determine the cause of hematuria.
In addition, excretory urography is advisable if the patient often has infectious pathologies of the urinary tract, with suspicion of the development of a tumor process, as well as if a person has constant pain in the lumbar region.
What allows you to identify
During the study, the doctor gets the opportunity to assess the degree of functioning of the urinary system. In addition, the presence of congenital malformations is confirmed or excluded, stones, cysts, and tumors are detected.
Excretory urography also allows you to detect tuberculosis, hydronephrosis, prostate adenoma.
Features of preparation
Before research, you need to follow certain rules for a while. Preparation for excretory urography is necessary so that the results are as reliable and informative as possible. In addition, compliance with all recommendations minimizes the risk of complications after the procedure.
Preparation for excretory urography of the kidneys, bladder and ducts implies that the patient performs the following items:
- 3 days before the study, you need to make adjustments to the diet. From the menu you need to exclude products, the use of which leads to excessive gas formation. These include: legumes, rye bread, fresh fruits and vegetables, pastries and pastries, milk, alcohol-containing drinks.
- If the patient has a tendency to increased gas formation, 3 days before the procedure, he needs to take activated charcoal. It is necessary to observe the dosage regimen indicated in the instructions for the drug.
- It is recommended to limit (but not exclude) the use of fluids per day. The last meal should take place 8 hours before the excretory urography.
- If the patient has problems with bowel movement, it is necessary to give him a cleansing enema the day before, the volume of which should be small. The procedure can be performed on the morning of the study day. Additionally, before bedtime, it is allowed to take a laxative, for example, Fortrans or Dufalac.
- Immediately before excretory urography of the kidneys and other organs of the urinary system, it is forbidden to eat any food. In case of deterioration of health on the background of hunger, it is allowed to drink up to 200 ml of weak tea without sugar.
- For some patients, thoughts of an upcoming procedure cause psychological discomfort. In such situations, it is recommended to take a mild sedative. As a rule, doctors prescribe herbal preparations, for example, Persen or Novo-Passit.
- It is necessary to notify a specialist in advance regarding the intake of any medications. In addition, if there is a tendency to allergic reactions, he also needs to be informed about this. Immediately before the study, it is worth checking with the doctor if there are any means in the office to eliminate acute complications.
During excretory urography, the patient should not have metal jewelry. For convenience, it is recommended not to wear them at all.
Algorithm
In most cases, the diagnostic procedure is standard. However, sometimes the doctor may make adjustments to it. It depends on the individual characteristics of each subject.
The procedure is carried out in several stages:
- Preparing the patient for excretory urography. A person needs to empty the bladder. If there are metal objects, he needs to remove them. In some cases, the patient is offered to change into a medical gown. After this, the person is laid on the couch of the X-ray unit. Then the doctor takes a standard overview picture.
- Getting the body a contrast agent. Initially, a test dose of 1 ml is administered to the patient. This need is due to the fact that you need to monitor the body's reaction to the drug, since in some cases undesirable reactions may occur. After the introduction of the test dose, you need to wait up to 10 minutes. If after this time no side effects develop, the doctor proceeds directly to the procedure.
- The patient is in a prone position. He is not recommended to move throughout the study. In some cases, several pictures are taken while the patient is standing. As a rule, this is necessary to confirm or exclude omission of the kidneys.
- The introduction of the main dose of contrast medium. The process takes several minutes (at least 3). The dosage is calculated by the doctor, it depends on the body weight of the subject. During the administration of the drug, the patient may feel slightly worse. The norm is if a metallic taste appears in the oral cavity, fever, dizziness, and nausea occur.
- Getting pictures. The doctor takes several images at regular intervals. The first - at 5-7 minutes, when the substance enters the renal pelvis. The second and third pictures are taken, respectively, at 15 and 25 minutes. In some cases, it is necessary to take delayed images (approximately 1 hour after the start of the study). At the discretion of the physician, the number of images may be increased.
- The final step is emptying the bladder. In most cases, the color of urine changes. The patient does not need to worry about this. A change in color indicates the presence of a contrast agent in the urine.
The duration of the procedure can be from 30 minutes to 1 hour. After it, the patient can begin to carry out their daily duties. On this day, it is recommended that drinks be preferred green tea, juices and milk. Their use accelerates the process of removing radiopaque substances from the body.
Possible complications
The occurrence of various side effects is associated with the introduction of the drug. Possible complications:
- An allergic reaction, which can manifest itself as a mild rash or anaphylactic shock.
- Renal failure in acute form.
- Soft tissue infiltration. It may occur when the contrast medium does not completely enter the vein.
The X-ray room is equipped with all the necessary medicines to help stop unwanted processes.
Contraindications
Like any other instrumental study, x-ray with contrast has a number of limitations to its implementation. The main contraindications for excretory urography:
- Ureter obstruction.
- Abdominal aortic aneurysm, presence of neoplasms in this area.
- Painful sensations in the abdomen.
- In the recent past, surgery was performed in the abdominal organs.
- Kidney transplant
- Allergy to iodine.
- Infectious pathologies during exacerbation.
- Diabetes.
- Circulatory and coagulation disorders.
- Tuberculosis.
- Acute glomerulonephritis.
- Hyperthyroidism
- Sepsis.
The study is also not conducted for people in a state of shock or who have lost a lot of blood.
Features in children
The procedure for carrying out the procedure is standard for babies. However, in addition, children are shown a preliminary intake of antihistamines. The doctor selects the contrast more carefully to minimize possible risks. The duration of the procedure in children is less. This is due to the fact that they are almost impossible to make to lie still.
Where to get research
Excretory urography can be done both in a budgetary medical institution and in a private clinic. In the first case, you must first obtain a referral from a therapist. In the second, it is enough to call the registry of the selected institution and select the most suitable date.
Cost
In Moscow, the minimum price for the study is 2500 rubles. In some clinics, the cost is many times higher and reaches 10,000 rubles. The price depends on the contrast agent used.
Finally
The term "excretory urography" refers to a diagnostic method related to radiological. It is prescribed for suspected presence of pathologies of the kidneys, bladder and ducts. The procedure is relatively safe. Side effects occur in isolated cases, as a rule, their appearance is associated with the introduction of a contrast drug.