Intravenous pyelography (IVP) involves injecting iodinated contrast into a patient's veins and using x-rays to image their urinary tract. It can detect abnormalities in the kidneys, ureters, and bladder. While commonly used in the past, IVP is now less frequent due to superior alternatives like ultrasound, CT, and MRI that have fewer limitations. The test requires contrast material, x-ray equipment, and involves obtaining multiple images over the course of an hour to fully visualize the urinary system.

1. Intravenous Pyelogram

2. • Intravenous pyelography (IVP), or intravenous
urography, is a diagnostic test that involves
the administration of intravenous contrast and
X-ray imaging of the urinary tract.
• The iodinated contrast flows through the
renal vasculature and filtered into the
collecting system highlighting the anatomic
structures on the X-ray image.

3. • It is often useful for the evaluation of
hematuria, and renal stone disease, and as a
follow-up after the intervention.
• The urographic imaging sequence is designed
to depict specific parts of the urinary tract
optimally.
• Portions of the urinary system appear opaque
when filled with contrast material.

4. • In modern times, ultrasonography, computed
tomography (CT), and magnetic resonance
imaging (MRI) are commonly used for the
evaluation of urinary tract diseases owing to
the limitations of intravenous pyelography.

5. Procedures
• Contrast material, radiologic table, X-ray tubes, monitor,
fluoroscope, and detector are required to perform the test.
• A set of preliminary images (Kidney-ureter-bladder [KUB]
radiograph) is necessary before contrast administration.
• Next, a bolus of contrast should be administered.
• After 1 to 3 minutes of contrast administration, nephrographic
images should be obtained. (Oblique images are also an
option.)
• A KUB radiograph should follow five minutes after contrast
administration.
• Apply abdominal compression immediately after getting a
KUB radiograph.

6. • Five minutes after compression, obtain
pyelographic images during early bladder
filling.
• Immediately after the release of compression,
obtain a KUB radiograph and fluoroscopic spot
images of ureters.
• Obtain the radiographic image of the bladder.

9. Indications
• IVP is a tool in the assessment of flank and
lower back pain and hematuria.
• It is useful in diagnosing congenital anomalies
of the urinary tract, urinary calculi, enlarged
prostate, neoplasms of kidney, ureter, bladder,
and scars and strictures of the urinary tract.

10. Potential Diagnosis
Assessment of both kidneys
• Size
• Position
• Vertical axis
• Renal contour and symmetry
• Renal parenchyma and parenchymal
thickening
• Scarring of the parenchyma
• Calyceal distortion
• Cyst
Assessment of the urinary bladder
• Physiologic distention
• Position of the bladder
• Bladder wall thickening
• Irregularity of the lumen
• Contour abnormalities
• Diverticula
• Neoplasms
Assessment of the ureters
• Symmetry of both the ureter(s)
• Diverticulum/diverticula of ureter(s)
• Ureteral obstruction
• Medial and lateral deviation of the ureter(s)
• Obstructive and non-obstructive dilatation
of ureter(s)
• Asymmetry of the ureteral caliber

11. Normal and Critical Findings
• The average length of the kidney ranges from
9 to 13 cms.
• The average renal parenchymal thickness in
the polar regions is 3 to 3.5 cms, and in the
interpolar regions is 2 to 2.5 cms.
• The upper pole of the right kidney is usually at
the level of the 12th rib, and the left kidney is
slightly higher than the right one.

12. Complications
• Adverse reaction to the contrast material can
present as hives, skin rash, and sometimes
may even produce anaphylactic shock

13. Patient Safety and Education
Preparing the patient
• Fasting is recommended for the patient before the procedure.
• The patient must empty their bladder before the procedure.
• Mild laxatives may be prescribed.
• Explain the procedure to the patient.
• Carefully note the history of patient’s allergies, comorbidities,
previous illnesses, and drug history.
• Ask the patient to remove all jewelry and other metal objects
before the procedure.
• If the patient is a female, ensure that she is not pregnant at
the time of the procedure. If she is pregnant, take
precautionary measures to shelter the fetus from radiation
exposure.

14. • This examination is usually performed on an
outpatient basis.
• The patient must lie still on the table while the
procedure is taking place.
• The procedure usually takes 1 hour, but it might
take longer if the kidneys are functioning at a
slower rate.
• Compression bands may be applied to properly
visualize the lower segments of the urinary tract