What is an Intravenous Pyelogram (IVP)?
An intravenous pyelogram (IVP) is an x-ray examination of the kidneys, ureters and urinary bladder that uses iodinated contrast material injected into veins.
An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.
When a contrast material is injected into a vein in the patient’s arm, it travels through the blood stream and collects in the kidneys and urinary tract, turning these areas bright white. An IVP allows the radiologist to view and assess the anatomy and function of the kidneys, ureters and the bladder.
What are some common uses of the procedure?
An intravenous pyelogram examination helps the physician assess abnormalities in the urinary system, as well as how quickly and efficiently the patient’s system is able to handle waste.
The exam is used to help diagnose symptoms such as blood in the urine or pain in the side or lower back.
- The IVP exam can enable the radiologist to detect problems within the urinary tract resulting from:
- kidney stones
- enlarged prostate
- tumors in the kidney, ureters or urinary bladder
How should I prepare?
Clear liquids only 24 hours prior to the exam.
- List of appropriate clear liquids and some No-No’s are listed as well:
- Coffee and tea – sugar is fine and small amount of creamer
- Fruit and vegetable JUICES – strain to remove fibers/solids
DO NOT drink TOMATO Juice.
- Broths – must be Semi-clear – chicken, beef or veggie
NO tomato soup and no solids in the soup.
- Soft Drinks – Coke, Sprite, ginger ale, 7-up, etc.
- Gatorade, Crystal Light, Kool-aide, Propel, etc
DO NOT drink the red or purple version.
- Jello without any fruit added
DO NOT eat the red or purple version.
DO NOT eat the red or purple version.
- Hard candies
DO NOT – CREAMY SOUPS, DRINK MILK, PROTEIN SHAKES, SLIM-FAST, BOOST, etc.
Bowel prep – Over the counter laxative of your choice taken the early evening prior to the exam. Take per package instructions.
Nothing to eat or drink after midnight
You should inform your physician of any medications you are taking and if you have any allergies, especially to barium or iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.
You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry and any metal objects or clothing that might interfere with the x-ray images.
Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.
For some patients a lab test to evaluate your renal (kidney) function may be required prior to the injection of the radiology contrast material.
Patients with a history of any of the following will require a lab test within 30 days prior to the exam.
1. Age 70 or older
2. History of kidney/renal disease, single kidney, kidney/renal surgery (kidney removed, tumor or transplant)
3. History of or taking medication for hypertension (high blood pressure)
4. History of or taking medication for hyperureicemia (gout, or high levels of uric acid in blood stream)
5. Taking medication containing Metformin (for diabetes)
6. History of liver disease, liver transplant, or impending liver transplant.
What does the equipment look like?
The equipment used for this examination consists of a radiographic table and an x-ray tube that is located in the examining room.
How does the procedure work?
X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate.
In the IVP exam, an iodine-containing contrast material is injected through a vein in the arm collects in the kidneys, ureters and bladder, giving these areas a bright white and sharply defined appearance on the x-ray images.
X-ray images are maintained as a digital image that is stored electronically. These stored images are easily accessible and are sometimes compared to current x-ray images for diagnosis and disease management.
How is the procedure performed?
This examination is usually done on an outpatient basis.
The patient is positioned on the table and still x-ray images are taken. The contrast material is then injected, usually in a vein in the patient’s arm, followed by additional still images.
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. The technologist will walk behind a wall to activate the x-ray machine.
As the contrast material is processed by the kidneys a series of images is taken to determine the actual size of the kidneys and to capture the urinary tract in action as it begins to empty. A few of the x-rays taken are called tomograms. For a tomogram, the x-ray tube will move over you as it takes the picture. This helps to focus on specific levels in the kidney by blurring out surrounding anatomy. You will again be asked to hold your breath until the tube stops moving.
When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained.
An IVP study is usually completed within an hour. However, because some kidneys empty at a slower rate the exam may last up to four hours.
What will I experience during and after the procedure?
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 flush of warmth, a mild itching sensation and a metallic taste in their mouth as it 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 that should be treated promptly. Tell the radiologist immediately if you experience these symptoms.
During the imaging process, you may be asked to turn from side to side and to hold several different positions to enable the radiologist to capture views from several angles. 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.
The contrast material used for IVP studies will not discolor your urine or cause any discomfort when you urinate. If you experience such symptoms after your IVP exam, you should let your doctor know immediately.
Who interprets the results and how do I get them?
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.
What are the benefits vs. risks?
- 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 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 diagnostic range.
- There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
- The effective radiation dose from this procedure is about 3 mSv, which is about the same as the average person receives from background radiation in one year.
- Contrast materials used in IVP studies can cause adverse allergic reactions in some people, sometimes requiring medical treatment.
- Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.
What are the limitations of IVP studies?
An IVP shows details of the inside of the urinary tract including the kidneys, ureters and bladder. Computed tomography (CT) or magnetic resonance imaging (MRI) may add valuable information about the functioning tissue of the kidneys and surrounding structures nearby the kidneys, ureters and bladder.
IVP studies are not usually indicated for pregnant women. However if the doctor believes it is necessary, a limited study will be performed.