INTRAVENOUS

PYELOGRAM
WHAT IS AN INTRAVENOUS
PYELOGRAM?
An intravenous pyelogram
(commonly abbreviated as IVP) is a
technique in which x-rays are used
to take pictures of the urinary tract,
after a liquid substance called
contrast is injected into a vein (a
blood vessel that caries blood to
the heart). See below for a
description of the urinary tract, x-
rays, and contrast material.
WHAT IS THE URINARY TRACT?
The urinary tract is the part of the body that deals
with the formation and excretion of urine (pee). To
excrete means to release from the body as waste.
The urinary system is made up of four parts: the
bladder, urethra, kidneys, and ureters. The bladder
is a stretchable structure in the body that holds
urine. The urethra is a tube shaped structure in the
body that drains urine from the bladder. The
kidneys are two organs located on each side of the
spine, behind the stomach. The kidneys filter
(remove) wastes from the blood. The ureters are
two tube shaped structures that connect to the
kidneys and carry urine to the bladder. One ureter
is attached to each kidney. To help you visualize it
better, here is a picture of the urinary tract
WHAT ARE X-RAYS AND
CONTRAST?
X-rays are a type of radiation, which is a form of
energy. This means that x-rays are a form of energy.
Normally, x-rays pass through soft tissues of the
body, making them difficult to see. Different parts of
the body absorb x-rays at different rates. When x-rays
are shot at the body and a special film is placed
behind the body, the x-rays cast a shadow on the film,
which produces a picture of inside the body.
Although x-rays are very good at looking at bones,
any two organs in the body with similar thickness and
atomic number will be almost impossible to
distinguish with an x-ray. The atomic number is the
number of protons (positively charged particles) in
the nucleus (center) of an atom. An atom is the
smallest part of a substance that can exist and still
possess all of the properties that are characteristic of
the substance.
To better distinguish between organs, a liquid
substance called contrast is used that x-rays cannot
pass through. Contrast helps to form an artificial
distinction between organs in the body so that the
doctor can tell them apart. Contrast can provide this
distinction because it has a very high atomic number,
unlike the lower atomic number of the organs that it
helps distinguish between.
In the case of an intravenous pyelogram, after injecting
contrast into a vein in the arm, it circulates throughout
the blood and passes through the kidneys and the rest
of the urinary tract (see above). With the contrast
substance passing through these areas, the x-rays will
not be able to pass through them. This will allow these
areas to show up clearly on the x-ray because they will
show up in contrast to areas in the body where the x-
rays easily pass through. More specifically, when x-
rays hit organs that iodine has entered, these areas
will appear white on the x-ray, which serves to
highlight it.
WHAT IS THE CONTRAST MADE
OF?
The contrast used in an IVP is usually made of
iodine (a non-metallic element) or shellfish.
Yes, that's right, shellfish. The reason for this
is that seafood is the best source of iodine in
the diet. Iodine is a bluish black solid
substance. Although most solids turn into a
liquid and then into a gas after it is heated,
iodine does not. Rather, iodine turns directly
into a purple vapor after it is heated. Because
iodine does not turn into a liquid, it needs to
be combined with liquid substances so that t
can be injected into the body.
WHY IS AN INTRAVENOUS
PYELOGRAM PERFORMED?
An IVP is the most commonly performed test to assess if there
are any problems with the urinary tract (see above). Such
problems may include injuries to the urinary tract, reoccurring
urinary tract infections, reoccurring kidney infections, kidney
stones, and tumors (tissues that grow more rapidly than
normal). Cysts can also be seen, which are abnormal swellings
or lumps that are filled with fluid or some solid material. Young
people with high blood pressure may be asked to get an IVP to
determine if kidney disease is a cause of the problem.
Other problems that may lead for an IVP to be done includes
blood in the urine, frequent peeing, and pain in the side or
lower back. An IVP is also done if the doctor suspects that the
patient may have an enlarged prostate. The prostrate is a
structure about the size of a chestnut that is below the bladder
and in front of the rear end. The prostate produces a fluid that
is part of semen. Semen is a fluid that is discharged from a
male's penis in order to reproduce with a female.
HOW SHOULD I PREPARE FOR
AN INTRAVENOUS PYELOGRAM?
The day before the IVP, the doctor will ask the patient to
prepare for the procedure by eating less. Depending on
the patient's circumstances, the doctor will ask the
patient not to eat any food for several hours before the
exam. In most cases, the patient will be asked not to eat
anything after dinner or on the night before the IVP. The
patient will likely be allowed to drink clear liquids
(liquids that the patient can see through, such as water
or seltzer).
Some doctors do not want the patient to drink anything
for 8 to 12 hours before the IVP. Not eating or drinking
before the exam helps improve the quality of the x-ray
pictures. The patient should wear comfortable clothing
since he/she will be asked to lie down on an
examination table. The patient should remove jewelry,
eyeglasses, and other metal objects because they may
interfere with the quality of the x-ray pictures.
The doctor may also ask that the patient take a
medication known as a laxative, such as bisacodyl. This
medication will help the patient poop. The patient may
be asked to take this type of medication by mouth
and/or as a suppository. A suppository is a small,
medicated mass that is shaped to be readily inserted
into another bodily opening besides the mouth.
The suppository will help the patient poop in about 15
minutes to an hour, whereas taking the medication by
mouth usually takes many hours before the patient
poops. The patient may also be asked to give
him/herself an enema before the IVP. An enema is a
procedure in which fluid is passed through the rear end
through a tube that is inserted in it. The enema (and the
suppository) helps release poop and air from the body.
WHAT SHOULD I BE SURE TO TELL MY
DOCTOR BEFORE HAVING AN INTRAVENOUS
PYELOGRAM PERFORMED?

The patient should tell the doctor if

he/she is pregnant because the x-rays
can potentially harm the developing
baby. The patient should tell the doctor
if he/she is taking any medications or
has any illnesses. The patient should
also be sure to tell the doctor if he/she
has any allergies, especially to iodine
and seafood, which is present in many
types of contrast.
WHAT HAPPENS DURING AN
INTRAVENOUS PYELOGRAM?
After the patient checks in, he/she will be asked to take off the
his/her pants or shorts and to put a hospital gown on. The patient
should be allowed to keep his/her shirt and underwear on. Before
the procedure, the patient may be asked to go to the bathroom
and pee so that the strength of the contrast material is not
decreased after it mixes with the urine. Once the patient get to the
examination room, he/she will be asked to lie down on an
examination table. The table should have a thin mattress on it and
a pillow so that it is comfortable for the patient. An x-ray picture
will then be taken to make sure that the patient's belly is properly
prepared for the procedure. The x-ray machine is above the
patient and the x-ray film is beneath the patient.
Next, the radiologist will inject the contrast material (see above)
into a vein in the arm. This may cause a minor sting. All of the
medication may be injected at once or it will slowly flow into the
patient's vein through a special hook-up. An x-ray picture will be
taken immediately after the contrast is injected. In general, x-ray
pictures will also be taken 5, 10, 30, and 45 minutes after the
contrast is injected. The pictures are taken at different times to
track the flow of the contrast material from the kidney to the
bladder. If the kidneys are working properly, they will begin to
filter (remove) the contrast from the blood.
The contrast material may cause a warm and flushed feeling
throughout the patient's body. Some patients also notice a
slightly metallic, salty taste in their mouths. These are normal
reactions to the contrast and only last for a minute or two. The
patient should tell the person who is performing the IVP if
he/she feels itchy, has shortness of breath, or feels
uncomfortable in any other way, because this may mean that
the patient is allergic to the contrast material. The patient
should be observed by the person who is performing the IVP
to detect breathing difficulties. If breathing difficulty occurs,
medication and machinery should be readily available to help
the patient breathe better.
As the contrast travels through the patient's blood, he/she may
be asked to turn on his/her right and left side for pictures to be
taken while lying in these positions. When some of the x-ray
pictures are taken, the patient will be asked to hold his/her
breath, but only for a few seconds. Between the 5 and 10
minute x-rays, some pressure may be applied to the patient's
belly with a tight bandage to improve the quality of the
pictures of the central cavities (openings) of the kidneys.
Toward the end of the examination, when the bladder has been
filled with contrast, the patient will likely be asked to go to the
bathroom and pee. After the patient goes to the bathroom,
another x-ray picture will be taken to see whether all of the
urine has left the bladder. After the x-ray pictures are taken,
the patient will be asked to wait while the pictures are
reviewed to make sure they are ok. If more x-rays are needed,
they will be taken at this time.
HOW LONG DOES AN
INTRAVENOUS PYELOGRAM
TAKE?

An IVP usually takes about an

hour. The doctor will be able to tell
the patient how long his/her
particular exam will take.
WHAT HAPPENS AFTER AN
INTRAVENOUS PYELOGRAM?
After an IVP, the patient will be able to go home
and return to normal activities, unless told
otherwise by the doctor. The urine and feces
(poop) do not usually change colors because of
the contrast material (see above). The contrast
material will leave the body when the patient
pees. The patient is usually encouraged to drink
more fluids to allow the contrast material to
leave the body quicker and to make the contrast
material less poisonous to the kidneys. Peeing
should not be painful after being injected with
contrast. If peeing is painful, or pee and/or poop
have changed colors, the patient should tell the
doctor right away because it may indicate some
other type of problem.
IS AN INTRAVENOUS
PYELOGRAM SAFE?
Generally, an IVP is a very safe procedure. However, there are
some exceptions. The procedure should not be used with
people who are very sensitive or allergic to iodine or shellfish,
the main ingredient in contrast materials (see above for more
details about contrast material). People who are allergic to
these materials can have such a severe allergic reaction that it
causes death. A possible way to have an IVP done if a patient
has allergies is to take anti-allergy medications before the
procedure, such as diphenhydramine hydrochloride
(Benadryl). Brief hypersensitivity reactions, such as itching
and nausea are not serious and should not prevent the use of
future IVPs.
Another risk of an IVP is that infections of the urinary tract can
be made worse by the procedure. Patients with serious kidney
problems should not get an IVP because the kidneys will not
be able to remove the contrast material properly. Also,
contrast material can be poisonous to the kidneys and cause
kidney function to worsen. Pregnant patients should avoid an
IVP, especially during the first three months of pregnancy
because the x-rays may harm the developing baby. The only
exception is when there is a major risk in missing the correct
diagnosis by not doing the procedure.
WHO INTERPRETS THE
INTRAVENOUS PYELOGRAM?
A type of doctor known as a radiologist,
that has experience in interpreting IVPs,
will analyze the results and interpret
them. He or she will then write a report
about the results, sign it, and send it to
the patient's doctor. The radiologist may
also discuss the results with the
patient's doctor. This process can be
speeded up if the place that you get the
IVP done can send the results and
images to your doctor over the Internet.
WHAT CAN A RADIOLOGIST SEE
ON AN INTRAVENOUS
PYELOGRAM?
The pictures obtained by an IVP allow the radiologist to see
the shape, size, and position of the kidneys, the ureters, and
the bladder, as well as whether there are any obvious
blockages of the ureters. The radiologist can also see the renal
pelvis, which is a funnel-shaped opening that drains urine
from the kidney to the ureters. The renal calyces can also be
seen, which are narrow tubes that carry urine from the kidneys
to the renal pelvis. Any blockages in these areas will cause the
appearance of one or more of the urinary tract structures to
appear abnormal on the x-ray pictures.
The radiologist can also tell how well the kidneys are
functioning by looking at the x-ray pictures taken throughout
the exam. If the kidneys are working properly, they will remove
contrast material from the blood and pass it into the urine,
which goes to the bladder. As was mentioned earlier, the x-ray
picture taken after the patient goes to the bathroom, allows the
radiologist to see whether all of the urine has left the bladder.
The radiologist can also see if the bladder is not as tense as it
should be. See the beginning of this entry for a description of
the terms mentioned in this paragraph.
HOW WILL I GET THE RESULTS
OF THE INTRAVENOUS
PYELOGRAM?

The results of the intravenous

pyelogram will be provided to the
patient by the doctor that referred
the patient to get the test.
WHAT ARE THE ADVANTAGES OF
AN INTRAVENOUS PYELOGRAM?
An IVP is cheaper than other imaging procedures,
such as such as magnetic resonance imaging and
computerized axial tomography. .
An IVP is a fast procedure, generally taking about an
hour.
An IVP is generally a safe procedure and
complications are rare.
An IVP requires one injection, and other than that,
there is no pain or invasion of the body in another
way.
The IVP provides your doctor with detailed
information about the functioning of the urinary tract.
This information can help the doctor diagnose and
treat problems in the urinary tract.
The information obtained with an IVP can help the
patient avoid surgery.
WHAT ARE SOME PROBLEMS WITH
AN INTRAVENOUS PYELOGRAM?
Some people are very sensitive or allergic to the
contrast material used in an IVP, which can prevent it
from being used. However, adverse reactions to modern
forms of contrast are very rare.
In most cases, pregnant women should not have an IVP.
Although the pictures from an IVP are clear, more clear
and detailed pictures can be obtained to detect early
diseases with advanced imaging techniques such as
magnetic resonance imaging and computerized axial
tomography.
The radiation that you are exposed to during an IVP is
equal to the amount of radiation that you are exposed to
in you normal environment over a period of two years.
This risk can be decreased by having high-speed films
taken. These films reduce the amount of radiation that is
needed for a good image to result. Also, modern x-ray
machines can decrease the amount of radiation that is
spread to body parts not being examined.
CAN I GET AN INTRAVENOUS
PYELOGRAM IF I AM A
BREASTFEEDING MOM?
Yes. However, the doctor or nurse will ask the mom
to pump the breast milk out. The reason for this is
that iodine readily gains access to breast milk. If an
infant gets too much iodine, it can lead to
hypothyroidism. Hypothyroidism is a condition in
which the thyroid gland is underactive. The thyroid
gland is a butterfly-shaped organ located in front of
the neck that produces hormones. Hormones are
natural chemicals that affect virtually every cell in the
body and many functions such as disease fighting,
heart rate, energy level, and skin condition.
Although the breast milk should be pumped out for
an IVP, the mother is not required to stop
breastfeeding. It is generally recommended by
doctors that you do not breast feed for 24 hours after
the procedure. However, always speak to your doctor
to check what is right timetable for your particular
case.
WHAT ELSE IS AN INTRAVENOUS
PYELOGRAM CALLED?
An intravenous pyelogram is also
known as intravenous urography,
intravenous urogram, descending
urography, and excretory
urography. Intravenous pyelogram
is also known as an intravenous
pyelography, which is an older
term for the procedure.
WHAT IS THE ORIGIN OF THE
TERM, INTRAVENOUS
PYELOGRAM?
Intravenous (inside a vein) comes from the
Latin word "intra" meaning "within" and the
Latin word "vena" meaning "vein." Pyelogram
comes from the Greek word "pyelo" meaning
"pelvis," and the Latin word "gramma"
meaning "mark." Put the words together and
you get "within (a) vein, mark (the) pelvis." The
pelvis is a massive bone made of hip bones on
each side and the front, while the back part is
made of the sacrum and the coccyx. The
sacrum (pronounced say-crum) is a large
triangle shaped bone in the lower part of the
spine. The coccyx is below the sacrum.