How to do ureterography?

Strictly speaking, ureterography is called pyelography from a medical perspective. It uses medical imaging equipment to present the effects on the urinary system organs, mainly the bladder, ureters and renal pelvis. Ureterography can detect a variety of diseases, and is specifically a test method used for symptoms of urinary tract infection. Well, many people don’t know much about ureterography and don’t know how to do it, so here’s a brief overview.

1. Ureterography

There are two forms of ureterography. One is intravenous angiography, in which contrast agents are injected intravenously. After the contrast agents are excreted through the kidneys, the best time is chosen to take images of the renal pelvis and ureters under X-ray monitoring. Intravenous urography (IVP) is a diagnostic examination method that uses intravenous contrast agents to visualize the kidneys, ureters, and bladder. It is a commonly used examination method in urology, gynecology, etc. It is characterized by little pain and high diagnostic efficiency, especially for urinary stones and urinary excretion function. The second is retrograde angiography, in which contrast agent is retrogradely injected through the urethra, bladder, and ureter to show the location of the lesion.

2. How to perform ureterography

Retrograde pyelography: contrast agent is injected into the ureter through the bladder to visualize the renal calyces, renal pelvis, and ureter. Currently, retrograde pyelography can be performed under television monitoring, and the catheter tip can be placed at any desired location to obtain the most satisfactory filling.

Intravenous pyelography (IVP): Also called excretory urography. The iodine-containing contrast agent is injected intravenously. The contrast agent is mainly excreted through the kidneys. After being filtered by the glomeruli and concentrated by the renal tubules, it is discharged from the renal collecting ducts and then becomes visible. Urine containing contrast agent can be visualized when it is discharged from the renal calyx to the renal pelvis, ureter and bladder. For adults, after contrast medium injection, the ureter is compressed and an X-ray is taken at 7, 15, and 30 minutes. Children should reduce the number of photos. In addition to plain films, one kidney photo should be taken 3 to 5 minutes after injection, and a second photo should be taken 7 to 12 minutes later, including the kidneys, ureters, and bladder.

3. Advantages and Disadvantages

The advantages of retrograde pyelography are that the renal pelvis and calyces are well filled and clearly visualized, which is conducive to the observation of fine structural anatomy; cases with poor renal function can still be visualized; and when performing a bladder examination, the condition of the bladder and ureters can also be understood. The main disadvantage is that it is a traumatic examination that can cause cramps, renal colic, and the risk of ascending infection. Therefore, clinically, it is generally only used for cases where intravenous pyelography cannot achieve the diagnostic purpose.

In addition to understanding whether there are functional or organic abnormalities in the urinary tract, intravenous pyelography can also determine the excretion function of the kidneys, the size and shape of the renal shadow, and whether the renal pelvis and calyces have scars or deformations. It is also of certain significance in distinguishing pyelonephritis, renal tuberculosis, and renal tumors. Anyone who is clinically suspected of having urinary tract abnormalities, such as young and middle-aged men, children, female patients with recurrent attacks, patients with urinary tract infection and bacteremia, patients with renal colic, or patients with a history of kidney stones should undergo intravenous pyelography. It was previously believed that IVP was not suitable for patients with chronic pyelonephritis and renal insufficiency, but in recent years, practice has proved that it is not a contraindication and large-dose intravenous drip can be used for pyelography.