IVU.pptx by Dr Shahariar Hossain Shawon.

IVU procedure and important things.

1. IVU PREASENTED BY DR. MD. SHAHARIAR HOSSAIN DMRD-23 Radiology and Imaging Department. Comilla Medical Collage.

2. IVU Intravenous urography (IVU)  is a radiographic study of the renal parenchyma, pelvicalyceal system, ureters and urinary bladder using intravenous contrast medium.

3. Indications : An intravenous urography is used to look for problems relating the urinary tract. These may be included blockages or narrowing. It can be provide important information about : Ureteric obstruction. Synchronous or metachronous upper tract tumour . Papillary necrosis. Anatomical variants – such as, horseshoe kidney, ectopic kidney. The course of the ureters. Some sorts of renal functions.

4. Contraindications Contrast allergy Patient with significantly decreased kidney functions.( S. Cr : 2.00mg/ml or more). Hepatorenal Syndrome. Severe history of anaphylaxis previously, carries 30% risk. Multiple myeloma Pregnency Infancy Diabetic complications.

5. Technique. Patients Preparation : Low residual diet for 3 days. Fasting for 5 hours prior to examination is preferred. Laxative to reduce fecal loading .But it is not much helpful to improve image quality. Estimation of serum Creatinine. Check for contrast allergies.

6. Equipment: Intravenous administration equipment: 50 ml syringe 18G OR 19G needle Alcohol Patch Sticky tape Tourniquet

7. Contrast media doses: Non ionic contrast media: For adults : 300mg I/ml - 40-80 ml 350mg I/ml -40-80 ml For Children: 240mgI/ml Below 7 kg – 4ml/kg Above 7 kg – 3ml/kg 300mg I/ml Below 7 kg -3ml/kg Above 7 kg-2ml/kg

8. Ionic Contrast media: In adult: 300-600 mg iodine equivalently/ kg body weight. Maximum 40 gm of iodine. In Children: Meglumine iothalamate or diatrizoate ,60% containing equivalent of 280 mgI /ml of iodine. dose – 1.0-2 ml/kg body wt. Below 6 months : 10 ml 6 month to 2 year: 20 ml 2 to 10 year: 20-40 ml.

9. Steps: Patient is placed in supine position with pelvis at cathode side of the tube. A film is taken including kidneys ,ureters ,bladder & urethral regions on a large film. Contrast media then injected I/V into a prominent vein. Test injection of 1ml contrast is given & patient is observed for 1 min to look for any reaction. Then the rest of contrast is rapidly injected within 30-60 seconds. Then series of film taken on several intervals.

10. Films :

11. 1. Plain X ray/Scout film/Control film. Plain X ray of control film provide valuable information and sometimes indicates provable diagnosis. -Calculus -Calcification -Mass -Foreign body -Incidental abdominal findings sometimes.

12. 1 minute film or Nephrogram . 1 minute film shows nephrogram . This radiograph is often omitted has the renal outlines are usually adequately visualized on 5 minute film.

13. 5 minute film 5 minute film shows nephrogram ,renal pelvis & upper part of the ureter. Compression band is now applied on patients abdomen. This is to produce better pelvicalyceal distension. If 5 minute film shows dilated calyces or if calyces & pelvis are not adequately opacified , obstruction exists and compression band not to be appied .

14. 15 minute film Visualization of ureter is better on this film. Prone position is better to visualize the ureter.

15. 30 minute film It gives the complete over view of urinary tract, Kidneys , Ureters, Bladder. Mainly bladder distension can be evaluated .

16. Post voidal film; Taken immediately after voiding it is used to asses for : -Residual urine volume -Bladder mucosal condition -Bladder mass -Outlet obstruction.

17. Complications: Contrast causing: Minor reactions (5%) – Nausea -Vomiting -Mild rash -Light head Intermediate reactions (1%) -Extensive urticarial -Facial oedema -Bronchospasm - Laryneal oedema -Hypotension

18. Complications….. Severe reactions(0.05 %) -Circulatory collapse -Pulmonary oedema -Severe angina -MI -Convulsion -Coma -Cardiac arrest. Due to technique: -Pain on injection site. -Extravasation of contrast ,causing tissue injury.

19. Special films in IVU : Oblique view : -To project the ureter away to supine and to separate overlying radio opaque shadows mimicking calculi. -Oblique views are also used for visualization of posterolateral aspects of bladder and doubtfull bladder mass. Erect film : -Provoke emptying of urinary tract. -Demonstrate layering of calculi in cysts and abscesses. -Have optimum demonstration of renal ptosis, bladder hernia, etc.

20. Special films in IVU…. Prone film : When viewing of urethral areas not seen in supine films. Demonstration of renal ptosis and bladder hernia. Delayed film : Delayed film in IVU are taken 1-24 hours after injection. Patients should always be instructed to void prior to delayed films so that a calculus in the distal ureter seen in the well. Usual sequence of delayed films is after 1 hours, 3 hours, 6 hours ,12 hours and 24 hours. Delayed films are used in: -Case of obstruction where early nephrogram is seen but collecting system is not. -Long standing hydronephrosis where renal parenchyma is seen but collecting system is not. - Congenital lesions like non visualized upper calyceal system with obstructed uretr .

21. Modified urogram : Diuretic U rogram : Administration of 20mg I/V frusemide is used to induce dieresis which distends the renal pelvis. Film is taken after 5-10 min after i /v frusemide . It is useful when intermittent obstruction is suspected but cannot confirmed by standard IVU. Hypertensive Urogram : It is also called minute sequence urogram . The films are taken 1,2,3,5 minutes after injection of contrast media. Although the findings are of value ,IVU cannot be used for screening of hypertensives as there are any many positive and false negative results.

22. Modified urogram : Drip Infusion Urography: Contrast is given in 500 ml normal saline. This procedure is not widely used. Limited Urography : This procedure is used for follow up to earlier pathology. Film taken – KUB 15 min A/P Post Voi d Emergency Urography: It is done in cases of urinary colic Film Taken- KUB 15 min A/P

23. Thank You All.