Urography refers to the X-ray examination of the urinary tract. For this purpose, the doctor uses a contrast medium that allows the anatomical structures to be seen more clearly. The image produced during urography is called a urogram. Read all about urography, how it works and what risks it involves.
What is an urography?
In urography, the doctor uses an X-ray examination to show the urinary tract. These include:
Kidneys and ureters are called the upper urinary tract, bladder and urethra the lower urinary tract. These organs cannot be seen on a normal X-ray. The doctor needs a so-called contrast medium, which he gives the patient either directly via the urinary tract or via a vein.
If only the kidneys are examined during the examination, it is a so-called pyelography.
In retrograde urography, the contrast medium is introduced directly into the urethra via a thin tube and from there spreads to the rest of the urinary system. To view the urethra and bladder, the doctor uses a cystoscope, a special instrument with a camera, which he introduces into the urethra.
In excretory urography, the doctor does not administer the contrast medium directly to the patient via the urinary tract, but injects it into a vein. For this reason, this examination is also called i.v. urography (intravenous urography). The kidney filters the contrast medium from the blood and excretes it via the urinary tract. The doctor can assess this process in an X-ray image.
When do you perform an urography?
Urography is used to diagnose the following clinical pictures:
-Cancer of the urinary tract
-constrictions (stenoses) of the kidney or urinary tract
-Injuries of the renal pelvis
-Congenital malformations of the urinary tract
In addition, the course and success of the selected treatment can be checked in the urogram by means of urography (follow-up).
Caution is advised in patients with a known contrast agent intolerance: Since these tend to have serious side effects, the doctor must carefully weigh up whether the benefits of the examination outweigh the risks.
What do you do in an urography?
On the evening before the urography the patient is already prepared: So that no intestinal gases or intestinal contents falsify the X-ray image, the patient must not eat anything the evening before. He is also given a laxative and flatulence-reducing medication. Directly before the urography, the patient should empty his bladder once again.
Before the urography, the doctor usually gives the patient a mild sedative and painkilling medication. Then the patient is placed in a supine position with legs slightly bent and spread outwards, disinfected and covered with a sterile cloth.
Using a syringe, the doctor now injects a local anesthetic lubricant into the urethra so that he can insert the cystoscope more easily and assess the urethra and bladder. The contrast medium is now distributed from the urethra into the other urinary tracts and the x-rays are taken.
Before the actual i.v. program, the radiologist takes a so-called blank image for comparison, i.e. an image without contrast medium. The patient is administered a contrast medium via a venous access, which spreads through the blood vessels into the kidneys. After a few minutes, the doctor takes another image, which he uses to assess the upper urinary tract. About a quarter of an hour after the administration of the contrast agent, the third image is taken, in which the spread of the contrast agent in the ureter and bladder can be seen. The entire examination usually takes about half an hour
What are the risks involved in urography?
As with many invasive diagnostic measures, urography also involves certain risks, which the doctor informs the patient about in advance. Possible complications are injuries to the urethra, bladder, ureter or kidney, which can be caused either by the instruments or – in the case of retrograde urography – also by pressure from the contrast medium.
In addition, there are certain risks associated with the use of X-ray contrast medium. Although the substances used today are considered very safe and are used routinely, complications may occur in rare cases. These range from mild intolerance reactions to severe general reactions to cardiovascular arrest. The use of contrast agents containing iodine can also lead to severe hyperthyroidism. To ensure that such reactions can be detected in good time and treated immediately, the patient is carefully observed during the examination.
What do I have to consider after an urography?
After the urography you should drink enough water or tea. This will help your kidneys to excrete the contrast medium remaining in the body.
If necessary, your doctor will prescribe an antibiotic. This is to prevent germs that may have entered the urethra with the cystoscope from spreading and causing ascending urinary tract infections.
Depending on the findings of the urography, the doctor will then discuss further therapy with you.