Pyelography

Pyelography

Pyelography is a radiological procedure used to visualize the anatomy of the renal pelvis and ureter. It is primarily used to diagnose conditions affecting the urinary tract, such as kidney stones, tumors, or structural abnormalities. There are two main types of pyelography: intravenous pyelography (IVP) and retrograde pyelography.

Types of Pyelography

Intravenous Pyelography (IVP)

Intravenous pyelography, also known as intravenous urography, involves the injection of a contrast medium into a vein. The contrast medium travels through the bloodstream and is filtered by the kidneys, allowing for the visualization of the renal pelvis, ureters, and bladder on X-ray images. This procedure is useful for detecting kidney stones, tumors, and other abnormalities in the urinary tract.

Retrograde Pyelography

Retrograde pyelography is performed by introducing a contrast medium directly into the ureters via a cystoscope inserted through the urethra. This method is often used when intravenous pyelography is contraindicated or when more detailed images of the ureters and renal pelvis are required. It is particularly useful in cases where there is a blockage or obstruction that prevents the normal flow of urine.

Indications

Pyelography is indicated in the following situations:

• Evaluation of hematuria (blood in urine)
• Investigation of recurrent urinary tract infections
• Assessment of kidney stones
• Detection of tumors or cysts in the urinary tract
• Evaluation of congenital abnormalities of the urinary system

Contraindications

Contraindications for pyelography include:

• Allergy to iodine-based contrast media
• Severe renal impairment
• Pregnancy, due to the risk of radiation exposure

Procedure

The procedure for intravenous pyelography involves the following steps: 1. The patient is positioned on an X-ray table. 2. A contrast medium is injected into a vein, usually in the arm. 3. X-ray images are taken at intervals to track the passage of the contrast medium through the urinary tract. 4. The patient may be asked to change positions to obtain different views. 5. The procedure typically takes about 30 to 60 minutes.

For retrograde pyelography, the steps include: 1. The patient is placed in a lithotomy position. 2. A cystoscope is inserted through the urethra into the bladder. 3. A catheter is passed through the cystoscope into the ureter. 4. Contrast medium is injected directly into the ureter. 5. X-ray images are taken to visualize the ureters and renal pelvis.

Risks and Complications

Potential risks and complications of pyelography include:

• Allergic reaction to the contrast medium
• Infection
• Bleeding
• Radiation exposure

History

Pyelography was first developed in the early 20th century and has evolved with advancements in imaging technology. Initially, it was one of the few methods available for visualizing the urinary tract, but with the advent of computed tomography (CT) and magnetic resonance imaging (MRI), its use has declined.

Also see

• Urology
• Radiology
• Kidney stone
• Urinary tract infection
• Contrast medium