VCUG Intravenous Pyelogram Kidneys, Ureters, Bladder Loopogram Nephrostogram Urethrogram
VCUG (Voiding Cystourethrogram)
Overview
A cystogram is an x-ray examination of the urinary bladder, which is located in the lower pelvic area. A cystogram can show the bladder’s position and shape, and the exam often is used to diagnose a condition called reflux. Reflux occurs when urine in the bladder moves back up the ureters, the tubes that transport urine from the kidneys to the bladder. This condition can cause repeated urinary tract infections. A cystogram may be performed after a patient has experienced a pelvic injury to ensure that the bladder has not torn. Cystograms also are used to detect polyps or tumors in the bladder. The x-ray below shows a sample of a cystogram with the black arrow pointing out the bladder, and the white arrow shows the catheter in the bladder.
During the Examination
You will be positioned on your back on the x-ray table, with your knees flexed. Your pubic area will be washed, and then the radiographer or a radiology nurse will gently insert a small, flexible catheter into your urethra, the duct from which you urinate. Skin tape may be used to hold the catheter to your inner thigh.
Next, a radiologist (a physician who specializes in the diagnostic interpretation of medical images) or a urologist (a physician who specializes in conditions of the urinary system) will slowly fill your bladder with a contrast agent. The contrast agent is a substance that helps make organs easier to see on radiographs and is administered through the catheter. You will feel pressure and fullness in your bladder and will have an urge to urinate.
After your bladder is full, the physician will take radiographs using fluoroscopy. A fluoroscope is an x-ray unit attached to a television screen. You will be asked to lie on your side or to turn slightly from side to side while the physician watches your bladder on the TV screen. The radiographer also may take a few additional x-ray images.
Following this portion of the exam, the catheter will be removed, and you will be allowed to use the restroom. In addition to being sticky, the contrast agent that you expel is clear and odorless, so it will not be visible to you. After you return to the x-ray room, an additional x-ray image will be taken. This final radiograph will show whether any contrast agent stays in your bladder following urination. Any remaining contrast will be expelled the next time you urinate.
Voiding Cystourethrogram
Voiding cystourethrograms follow the same routine as cystograms with one difference. Toward the end of the examination, when the urinary catheter is removed, you will be asked to urinate into a special urinal. Radiographs will be taken while you urinate. These images will show the size and shape of the bladder when it is under stress caused by urination.
Patient Preparation
Before your examination, a radiographer will explain the procedure to you and answer any questions you might have. A radiographer, also known as a radiologic technologist, is a skilled medical professional who has specialized education in the areas of radiation protection, patient care and radiographic positioning and procedures.
If you are a woman of childbearing age, the radiographer will ask the date of your last menstrual period and if there is any possibility you are pregnant. Next, the radiographer will ask if you have any allergies. It is important to list all allergies to food and medicine, as well as to let the radiographer know if you have a history of hay fever or asthma. Some allergies may indicate a possible reaction to the contrast agent that will be used during the examination.
You will be asked to put on a hospital gown and then the radiographer will direct you to the restroom and ask you to completely empty your bladder.
Intravenous Pyelogram (IVP)
What is an Intravenous Pyelogram (IVP)?
An IVP is an x-ray examination of the kidney, ureter, and urinary bladder. It can be performed for the following patient complaints:
- Flank pain (pain in the side of the trunk between the right or left upper abdomen and the back)
- Hematuria (presence of blood in the urine)
- Frequent urination
- Dysuria (painful urination)
- Suspected renal calculus (kidney stones)
- Urinary system tumors
- Urinary Tract Infection (UTI)
The test involves taking a series of radiographs after injecting non-ionic contrast material (dye) into a vein, usually in the arm. The contrast agent flows through the veins, is excreted by the kidneys, and enhances the x-ray images of the kidneys, ureter and bladder.
If a kidney stone is blocking the ureter, the contrast agent builds up in the affected kidney and is excreted more slowly. An IVP can take a very long time if the blockage to the kidney is severe. Most kidney stones (e.g., calcium stones) can be precisely located using this procedure.
What Should I Expect During the IVP?
You will be asked by the radiologist to lie on your back. A radiograph of your kidneys, ureter, and bladder may first be taken without non-ionic contrast material. You may be asked to turn from side to side and hold several different positions to enable the radiologist to capture views from several angles.
A needle will be put into a vein in your arm or hand, and the contrast material will be injected. The first radiograph will be taken about one minute after the dye is injected. More radiographs will be taken after 5, 10, 15, 20 and 30 minutes. Sometimes “moving” pictures called tomographs (TOME-o-graphs) are also taken.
At the end of the test, you may be asked to urinate. Another radiograph will be taken to see if urine has stayed in your bladder. The test usually takes about 45 minutes to one hour.
What Kind of Side Effects Might I Experience?
- Besides the minor sting from the injection of contrast material, an IVP causes no pain. When the contrast material is injected, some people report feeling a flush of heat, and at times a metallic taste in the mouth. Do not worry about these common side effects, as they disappear within a couple of minutes.
- Some people experience a mild itching sensation caused by an allergic reaction to the contrast material. If it persists or is accompanied by hives, the itch can be treated easily with medication.
- In rare cases a patient may have shortness of breath or experience swelling in the throat or other parts of the body. Your x-ray technologist will closely monitor the patient throughout the study.
IF YOU ARE A DIABETIC…
Diabetic patients who are taking glucophage type medications (i.e., Glucophage,Glucovance, Adandament, Metformin), should discontinue their use for 48 hours prior to your IVP exam. Please remain off these medications for a period of 3 to 5 days after the study, as per your doctor’s instructions. These medications may reduce the body’s ability to flush out the contrast
IVP Preparation Instructions
Please complete all steps:
- Please purchase a bottle of Magnesium Citrate from a local pharmacy, and take it at approximately 12:00 noon the day prior to your study. Please note: Use this product only as directed on the bottle, or per your physician’s instruction. This is a laxitive so stay close to a restroom.
- Take all three Dulcolax (Bisacodyl) laxatives (at the same time) the day before your examination at about 4:00 p.m. Dulcolax is available in our office, or from any pharmacy. Please note: Individual response to laxatives varies. The Dulcolax should work within 30 minutes, but may take as long as 3 hours. Remain close to a restroom as multiple bowel movements may occur.
- The following refers to the day before your exam; please do not consume carbonated drinks. You must be on a clear liquid diet. You may drink fruit juices without pulp (apple, white grape, orange, lemonade, etc), Gatorade type sport drinks, Kool-Aid, water, tea, or coffee (no milk, or non-dairy creamer), bouillon/broth, popsicles (no sherbets, or fruit bars).
- Do not eat or drink anything after midnight the night before your exam.
- If you are on prescribed medications (e.g., blood pressure medicine, etc.) you may take them with just a sip of water, enough to swallow them safely. Do not take vitamins 24 hours prior to the x-ray.
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, please notify your physician as soon as possible. This symptom likely indicates a different kind of problem.
IF THERE IS A POSSIBILITY OF PREGNANCY…
Please notify your physician or the radiology department prior to your scheduled exam.
If you are unable to keep your appointment, please call our office 48 hours prior, so that we may reschedule your appointment.
KUB (Kidneys, Ureters, Bladder)
Overview
A KUB (kidneys, ureter, and bladder) produces a radiographic image of the kidneys, urinary bladder, gas patterns of the bowel and the lower outline of the liver. This examination may be ordered when a patient has received an injury to the abdominal area or is experiencing unexplained pain. An abdomen x-ray may help to diagnose the source of nausea, vomiting, pain, or other abdominal symptoms. It can help to detect kidney stones, locate a foreign object that has been swallowed, and assess whether there is air or fluid in the spaces surrounding the abdominal organs.
Abdomen x-rays are performed by a radiologic technologist, a skilled medical professional who has received specialized education in the areas of anatomy, radiation protection, patient care, radiation exposure, radiographic positioning and radiographic procedures.
What happens during the x-ray?
You probably will be asked to lie down on the x-ray table, although in some cases the radiograph will be taken while you are standing. To ensure that you are properly positioned on the table, the radiographer will look for anatomical landmarks. He or she will touch the sides of your abdomen and your pelvic bones to position you correctly. You will be asked to hold your breath while the exposure is made. It is important not to move during the exposure, because any movement will blur the image.
A lead-equivalent rubberized shield might be used to cover your reproductive organs, unless its use would interfere with the examination. Sometimes the area that needs to be examined would be hidden if a shield were used.
Once the examination is complete, the radiographer will process your x-ray films, determine whether they are technically acceptable and assess whether additional films are needed. The films then will be given to a radiologist, a physician who specializes in the diagnostic interpretation of medical images.
How do I get my Results?
In most cases, your urologist will interpret the results himself immediately after the x-ray is taken. Your urologist will look at the x-rays and talk with you during your office visit about what was seen. In my instances your urologist will show you the x-rays to give you a better understanding of the findings.
Loopogram
Overview
A loopogram is an x-ray of your ileal conduit. This x-ray shows your kidneys, your ureters, your ileum (the loop of bowel that the ureters are now attached to), and your stoma (the opening on the outside of your abdomen). Contrast material (x-ray dye) is used to make these parts of the body show up on x-ray pictures. The dye is injected into your stoma through a thin catheter.
Loopogram FAQ
Why am I having a Loopogram?
Your doctor has scheduled you for this x-ray to check your anastomosis site (the place at which your ureters are connected to your ileum). Your exam may be just a follow-up exam or you may be having symptoms that indicate a problem with your normal urine flow. These symptoms may include abdominal pain, bloody or foul-smelling urine or decreased urine output in your drainage bag. Ask your doctor to explain more about why you are having this exam.
How do I prepare for this x-ray?
There is no preparation required for this exam
What happens during the x-ray?
You will be asked to put on a hospital gown.
You will be assisted onto a special x-ray table. The technologist or doctor will either remove your ostomy bag or cut a small opening in the front. An x-ray doctor will place a thin lubricated catheter into your stoma. The doctor will use a syringe of air or water to inflate a small balloon at the end of the catheter. This balloon will help seal off the opening of your stoma during the exam.
Next, the catheter will be connected to a bottle of clear x-ray dye. As the dye flows inside your body, pictures will be taken. You may be asked to move in different positions. As each x-ray is taken you will be asked to hold your breath and remain as still as possible.
How do I get my Results?
In most cases, your urologist will interpret the results himself immediately after the x-ray is taken. Your urologist will look at the x-rays and talk with you during your office visit about what was seen. In my instances your urologist will show you the x-rays to give you a better understanding of the findings.
Nephrostogram
Overview
A nephrostogram (neh FROST o gram) is an x-ray of the kidney collecting system and ureter. Doctors inject x-ray contrast (dye) through the nephrostomy tube so the collecting system and ureter show up on x-ray pictures. This exam also shows how your kidney drains urine through your ureter to your bladder.
Nephrostogram FAQ
Why am I having a nephrostogram?
Your doctor has scheduled you for this x-ray to check the placement of your nephrostomy tube and to see how well your kidney is draining. This may be done because you are having problems with your kidney or your nephrostomy tube. Symptoms may include pain, leaking at the tube site, or decreased urine output in your drainage bag. This exam may be done as a follow-up to see if your kidney is draining properly so the nephrostomy tube can be removed.
How do I prepare for this x-ray?
There is no preparation required for this exam.
What happens during the x-ray?
We will ask you to put on a hospital gown and help you onto the x-ray table. The x-ray staff and doctor will explain more about your exam and answer your questions. We will ask you to sign a consent form and ask about allergies you have to medicines or x-ray
The x-ray technologist will help you get into the most comfortable position that will show your back and your nephrostomy tube. We may remove the bandage covering your nephrostomy tube. The x-ray technologist will clean your back and tube with iodine and place sterile towels around the tube on your back. It is important that you do not touch these towels.
How do I get my Results?
In most cases, your urologist will interpret the results himself immediately after the x-ray is taken. Your urologist will look at the x-rays and talk with you during your office visit about what was seen. In my instances your urologist will show you the x-rays to give you a better understanding of the findings.
Retrograde Urethrogram
Overview
Retrograde Urethrogram is an x-ray examination of the urethra, the small tube that connects your bladder to the outside of your body. Contrast material is injected into the urethra through the opening to the outside of your body. This contrast material allows the urethra to be seen on the finished x-ray film.
How do I prepare for a Retrograde Urethrogram?
There is no preparation required for this exam.
What happens during the x-ray?
An x-ray technologist will help you onto the table, where you will lie on your back. One x-ray will be taken of your urethra and bladder before the contrast material is injected. The urethral opening to the outside of your body will be cleaned with an antiseptic solution. Your urologist will put a small tube (catheter) or the tip of a syringe about ½ inch into the urethral opening. A small amount of contrast material will be injected while x-rays are taken. This may be repeated a few times until all of the x-rays are taken. You will then be allowed to go to the bathroom and urinate the remaining contrast material from your bladder.
How do I get my Results?
In most cases, your urologist will interpret the results himself immediately after the x-ray is taken. Your urologist will look at the x-rays and talk with you during your office visit about what was seen. In my instances your urologist will show you the x-rays to give you a better understanding of the findings.