An intravenous pyelogram (IVP) is an x-ray imaging procedure that outlines the kidneys, ureters, and bladder after injecting iodinated contrast medium intravenously. It is used to diagnose conditions of the urinary tract like kidney stones, tumors, infections, and structural abnormalities. The procedure involves bowel preparation, intravenous injection of contrast medium, and serial x-ray images over time to visualize the uptake and excretion of the contrast through the urinary tract. Potential risks are mild allergic reactions to the contrast medium, but severe reactions are rare. The images obtained can help diagnose both benign and malignant urinary tract conditions.

1. Radiological Importance Of Intravenous
Pyelography

2. Objectives:
1.Introduction
2.Indications and Contra-indications
3.Preparation
4.Contrast Media
5.Procedure
6.During the procedure
7.Pathology Cases
8.Short Notes

3. What is an Intravenous
Pyelogram?
An Intravenous Pyelogram (IVP) is a
radiological study of pathology in urinary tract
(kidney , ureter , baldder , urethra ) by giving a
contrast media intravenously. An IVP outlines the
kidneys, showing their size and internal structure.
This procedure can also show how the kidney is
working as well the urinary tract is working.

4. Benefits
• Imaging of the urinary tract with IVP is a minimally invasive
procedure.
• IVP images provide valuable, detailed information to assist physicians
in diagnosing and treating urinary tract conditions from kidney stones
to cancer.
• An IVP can often provide enough information about kidney stones and
urinary tract obstructions to direct treatment with medication and avoid
more invasive surgical procedures.
• No radiation remains in a patient's body after an x-ray examination.
• X-rays usually have no side effects in the typical diagnostic range for
this exam.

5. Indications:
1. Haematuria
2. Calculus in urinary tract
3. Tumour of kidney,Ureter,Bladder
4. Infection in urinary tract
e.g. Tuberculosis,Nephritis,Cystitis
5. Congenital anamolies of Urinary tract
e.g. Unilateral kidney,Bifid ureter,Ectopic kidney,
polycystic kidney
6. Suspected urinary tract pathology
7. To study kidney function
8. Post urinary tract surgery

6. Contra-Indications:
1. History Of allergy to iodinated contrast media.
2. Pregnancy
3. Cardiac and Renal failure.
4. Multiple Myeloma

7. Preparation:
1. Ask patient for history of bronchial asthma.
2. Bowel Preparation:. The bowel must be completely clear for the
procedure to be accurate and complete.
a) 2 days before :- Semisolid food .
b) 1 day before :- Gas absorbing tabletes. (2 tab. X 3 times)
c) Previous night :- laxatives 2 tablets
3. Patient must be NBM (nil by mouth) for 6 hrs. before the procedure
4. Morning walk for 2 hrs. is adviced.
5. An Intracath / IV Canula / Scalp vein in the vein of arm of patient to
inject contrst media.

8. Bowels preparation
Radiograph :

9. Contrast Media & Dose
1.Iodinated Contrast media
e.g. Urrograffin 76% (60 ml) for an adult.
2. Desired Dose :-
Patients up to 12 kg desired dose is 1.5 ml / kg.
Patients above 12- 15kg desired dose is 18ml +2ml / kg.

10. Contrast Reactions
The reactions vary from:
Mild – hives, sweating, sneezing, coughing, nausea.
Moderate – wide spread hives, headaches, facial
swelling, vomiting, shortness of breath.
Severe – Severe reactions are rare but include: life threatening heart
palpitations, very low blood pressure, throat swelling, fits and/or
cardiac arrest.Death as a result of Iodinated Contrast is very Rare.

11. Procedure
Preliminary Films :
i) A scout or full lenth KUB radiograph to review bowels
preparation and pathology.
Procedure :
i) Consent of the patient must be taken.
ii) 0.5 ml of contrast medium is injected into veins and waits for
allergic reactions.
iii) If there is no sign of any allergic reactions then inject the
contrast medium about 40-50 ml.

12. Procedure

13. Post Injection Films
i) Immidiate film : After complete injection of contrast media
within 10-15 sec. AP KUB radiograph is taken
known as “Nephrogram”.
ii) 5 minute film : An AP radiograph of renal area and ureters,
which shows the renal calyces and excretory
pyramids.
iii) 15 Minute film : AP KUB radiograph taken with compression
pad / band applied on abdomen below the
umbilicus for better visualisation of
pelvic-calcycal junction. After satisfactory
visualisation of pelvic-calcycal junction
compression band is released.
Note : Compression band is contra indicated in case of Stricture / Obstruction

14. Release film : After removal of compression band
(Full bladder) Supine AP KUB radiograph is taken to
show complete urinary tract.
After Micturation film : This film demonstrates residual
(Empty bladder) urine in bladder and bladder
emptying. Helpful in
demonstrating Cystitis.
Note : Delayed films can be taken in case obstruction and delayed function of kidney.

15. Preliminary Film :
Plain AP KUB radiograph

16. Post injection 5 min. film

17. 15 minutes film after
injection

18. Compression Film

19. Full Bladder film after 30 min. of
injection

20. Post void film
(Empty Bladder Film)

21. Pathology Films:
AP KUB radiograph showing
renal calculus

22. Bifid ureter

23. Staghorn Calculi

24. Duplicated Ureter

25. Urinary tract calculus

28. Cystitis

29. Normal IVP