INTRAVENOUS PYELOGRAM (IVP)

What Is An Intravenous Pyelogram?

An intravenous pyelogram (IVP) is an x-ray examination of the urinary system to view and assess the anatomy and function of the kidneys, ureters and the bladder and to assess abnormalities in the urinary system.

When a contrast material is injected into a vein in the patient's arm, it travels through the bloodstream and collects in the kidneys and urinary tract, turning these areas bright white on the x-ray images.

These images allow the radiologist to help make a diagnosis in patients with symptoms such as blood in the urine or acute pain in the side or lower back. They detect problems within the urinary tract resulting from kidney stones, enlarged prostate, tumors in the kidney, ureters or urinary bladder or due to previous surgery to the urinary tract.

How Should I Prepare For The IVP?

Your doctor will give you detailed instructions on how to prepare for your IVP study. You will likely be instructed not to eat or drink anything after midnight on the night prior to your exam.

You should inform your doctor of any medications you are taking and if you have any allergies, especially to iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.

It is advisable to wear comfortable clothes as you may be asked to remove some or all of your clothes. Trouser zips, belts, jewelry, metal objects, underwired bra´s and sequined clothes will interfere with the quality of the x-ray images. A clean gown will be provided for your use during the IVP examination.

Women should always inform their physician and x-ray department if there is any possibility that they may be pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation.

An IVP is seldom done in pediatric patients – other tests, including ultrasound, can be used in most cases to evaluate the kidneys.

How Is The IVP Performed?

This examination is usually done on an outpatient basis.

The patient is positioned on the table and still x-ray images are taken. Contrast material (Iodine) is then injected, usually in a vein in the patient's arm, followed by additional still images. The number of images taken depends on the reason for the examination and the patient's anatomy.

You must hold very still and will be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. Near the end of the exam, you may be asked to empty your bladder so that an additional x-ray can be taken of your urinary bladder after it empties.

When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained. The radiologist will analyze the images and prepare a signed report for your referring physician, who will discuss the results with you.

Please keep your X Rays and other Imaging examinations in a cool, dry and safe place. Ensure that you always bring the previous examinations with follow up examinations.

An IVP study is usually completed within 60 minutes. However, the exam may last up to four hours if there a stone causing obstruction and delaying excretion of the contrast media from the kidney.

What Will I Experience During And After The IVP?

The IVP is usually a relatively comfortable procedure.

You will feel a minor sting as the contrast material is injected into your arm through a small needle. Some patients experience a warm flush, a mild itching sensation or a metallic taste in their mouth as the contrast begins to circulate throughout their body.

These common side effects usually disappear within a minute or two and are harmless. Rarely, some patients will experience an allergic reaction. Itching that persists or is accompanied by hives, can be easily treated with medication. In very rare cases, a patient may become short of breath or experience swelling in the throat or other parts of the body. These can be indications of a more serious reaction to the contrast material and should be treated promptly. Inform the radiographer or radiologist immediately if you experience any of these symptoms.

What Will The IVP Cost?

Most medical aids will cover the cost of an IVP provided that you have not exceeded your annual imaging limit. Pre- authorization is usually not required by medical aids, but please consult with your medical aid if you are uncertain.

Private patients who pay immediately with cash or with Master or Visa Cards will be charged medical aid rates.

The account remains your responsibility.

In the event of non – payment by your medical aid, you will be held liable for the account and it should be paid within 30 days.

What Is a Voiding Cysto–urethrogram?

A pediatric voiding cysto-urethrogram (VCU) is an x-ray examination of a child's bladder and lower urinary tract that uses a special form of x-ray called fluoroscopy and a contrast material.

Fluoroscopy makes it possible to see internal organs in motion – just like a video. When the bladder is filled with a water-soluble contrast material, and then emptied, the radiologist is able to detect abnormalities in the flow of urine through the urinary tract.

Urine is produced in the kidneys and flows through the ureters to the bladder. A valve mechanism prevents urine from flowing back into the kidneys as the bladder gets full. Urine leaves the bladder through the urethra and is eliminated from the body during urination.

In some children, an abnormality in the valve between the ureters and bladder allows urine to flow backwards from the bladder to the kidneys, a condition called Vesico Ureteric Reflux (VUR). In mild cases urine backs up into the lower ureter. In severe cases it can back up into the kidney, causing that kidney to swell.

Urine is normally sterile but when bacteria get into the bladder, a urinary tract infection (UTI) may result. In children with VUR, the bacteria can reach the kidneys more easily, resulting in a kidney infection. As a result, children with VUR are at risk for kidney infections and may develop kidney damage if not properly treated.

Usually, children with VUR are born with it and it affects about 1 percent of children. Many children will grow out of their VUR as they get older. However some children with VUR need surgery to correct the VUR, prevent infection and protect the kidneys.

A VCU examination is often recommended after a urinary tract infection to check for vesico ureteric reflux (VUR). Urinary tract infection may be the only symptom of Vesico Ureteric Reflux.

How should my child prepare for the VCU?

You should inform your physician if your child has any allergies, especially to iodine or contrast materials.

Also inform your doctor about urinary tract infections, recent illnesses or other medical conditions.

A voiding cysto–urethrogram should not be performed while an active, untreated urinary tract infection is present.

Your child does not need to fast or wear special clothing.

Explain to your child what will happen during the examination so that there will be no confusion about what is expected. Your child will have to remove all clothing and wear a gown.

Sedation is rarely needed.

How Is The Procedure Performed?

The equipment typically used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor.

Fluoroscopy, which converts x-rays into video images, is used to monitor and guide the progress of the procedure. When fluoroscopy is used with a contrast material, which clearly defines the area being examined by making it appear bright white on the screen, this special x-ray technique makes it possible for the radiologist to view the internal organs in motion. Still images are also captured and stored on film.

The examination is usually done on an outpatient basis.

The radiographer begins by positioning the child on the table. Infants and young children may be wrapped tightly in a blanket to assist them to lie still during the imaging.

An x-ray of the abdomen may be performed before the urinary bladder is catheterized. The bladder catheterization is performed by the sister or radiologist. After cleaning the genital area, a thin flexible catheter will be inserted through the urethra and will be used to fill the bladder with a water-soluble contrast material. The catheter may be taped to the skin to prevent it from being dislodged during the procedure.

When the bladder is full, the child will be asked to urinate into a urinal or absorbent pad while still on the x-ray table.

The radiologist will use fluoroscopy to monitor the filling and emptying of the bladder. X-ray images will be obtained during the monitoring. The radiologist will check to see if any of the liquid contrast material refluxes (pushes) backwards into one or both ureters and whether the shape and contour of the bladder and urethra are normal.

After the x-ray images have been checked to make sure the exam is complete, the catheter will be removed.

A voiding cysto–urethrogram is usually completed within 60 minutes.

What Will My Child Experience During And After The VCUG Procedure?

A voiding cysto-urethrogram is frightening to some children. The antiseptic solution used to clean and prepare for the insertion of the catheter into the urethra may feel cold. Some children may experience discomfort when the catheter is inserted and the bladder is filled with the liquid contrast material. Most children will accept the procedure if every step is explained to them.

A parent may remain in the fluoroscopy room to comfort her child. The parent will be required to wear a lead apron.

What Is Hysterosalpingography?

Hysterosalpingography, also called HSG, is an x-ray examination of a woman's uterus and fallopian tubes that uses a special form of x-ray called fluoroscopy and a contrast material.

Fluoroscopy is a special x-ray technique that makes it possible to see internal organs in motion. During a hysterosalpingogram, the uterus and fallopian tubes are filled with a water-soluble contrast material and the radiologist is able to use fluoroscopy to view and assess their anatomy and function.

Hysterosalpingography is primarily used to examine women who have difficulty becoming pregnant by allowing the radiologist to evaluate the shape and structure of the uterus, the openness of the fallopian tubes, and any scarring within the uterine or pelvic cavity.

How should I prepare for the HSG?

The hysterosalpingography procedure is best performed one week after menstruation.

This procedure should not be performed if you have an active inflammatory condition.

You should inform the Radiology Department if you are allergic to Iodine or iodinated contrast materials.

You may be asked to remove some or all of your clothes and to wear a gown during the exam.

Women should always inform their doctor and Radiology Department if there is any possibility that they may be pregnant.

How is the HSG performed?

The examination is usually done on an outpatient basis.

The equipment typically used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room. Fluoroscopy, which converts x-rays into video images, is used to monitor and guide progress of the procedure. The video is produced by the x-ray machine and an image intensifier that is suspended over a table on which the patient lies.

The procedure is like a gynecological exam. The patient is positioned on her back on the exam table, with her knees bent and a speculum is inserted into the vagina. The cervix is then cleansed, and a catheter is inserted into the cervix. The speculum is removed and the patient is carefully positioned underneath the fluoroscopy camera. The contrast material then begins to fill the uterine cavity, fallopian tubes and peritoneal cavity through the catheter and fluoroscopic images are taken.

In some cases, if certain abnormalities are encountered, the patient will be asked to rest and wait up to 30 minutes so that a delayed image can be obtained. This delayed image may provide clues to a patient's condition which the original images with contrast material did not.

When the procedure is complete, the catheter will be removed and the patient will be allowed to sit up.

When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained. The radiologist will analyze the images and prepare a signed report for your referring physician, who will discuss the results with you.

A hysterosalpingogram is usually completed within 30 - 60 minutes.

What will I experience during and after the HSG?

This exam should cause only minor discomfort.

There may be slight discomfort and cramping when the catheter is inserted and the contrast material is injected, but it should not last long. There may also be slight irritation of the peritoneum, the lining of the abdominal cavity, causing generalized lower abdominal pain, but this should also be minimal and not long lasting. Most women experience vaginal spotting for a few days after the examination, which is normal.

What will the HSG cost?

Your medical aid may not cover the cost of the hysterosalpingogram. Please consult with your medical aid if you are uncertain.

Private patients who pay immediately with cash or with Master or Visa Cards will be charged medical aid rates.

The account remains your responsibility.

In the event of non – payment by your medical aid, you will be held liable for the account and it should be paid within 30 days.