Intravenous pyelogram

Intravenous pyelogram or IVP is a diagnostic test that refers to an X ray exam of kidneys, bladder and ureters. This test is also known as excretory urogram and is essentially performed to assess disorders related to the urinary tract.

IVP test is performed by injecting iodinated contrast dye into the patient's veins. It enters the blood stream and pools in the kidneys and the urinary tract thus producing brighter images of the organs. As the dye travels through the urinary system, the IVP test provides useful information regarding the functioning of the kidneys, bladder and ureters. Any delay in the fluid flow indicates blockage in the urinary system. Intravenous pyelogram is performed to diagnose the following disorders:

• Blockage or obstruction in the normal flow of urine.
  
• Kidney stone or bladder stone
  
• Enlarged prostate gland
  
• Injuries and congenital disorders of the urinary tract
  
• Kidney tumor
  

As the dye travels through the urinary system, a series of x-ray images are taken at frequent intervals. The visualization of the fluid flow will help understand the efficiency of the kidney functioning and as well as to diagnose the obstruction, if any.

Before the procedure

1.Patient should not consume any food 5 to 6 hours prior to the procedure. The day before the procedure, patient may be given a laxative to clear the bowels.

2. Pregnant women must not take this test.

3. Diabetic patients should inform the doctor about their medical condition and adjust their insulin dosage as per the instructions given by the doctor.

4. If the patient is allergic to coloring agents, the same should be informed to the doctor so that an anti-allergic medication is prescribed to be taken before the procedure.

Risks of Intravenous pyelogram

IVP is a safe procedure and there are rarely any complications associated with the intravenous pyelogram. Yet on few occasions, a patient may experience hot flushes, itching, nausea and vomiting. Very rarely patient develops allergic reaction to the dye and may experience breathing difficulty, choking sensation and swelling of the lips and tongue. Blood pressure may drop to alarming levels and patient may also lose consciousness.

Pyuria

The medical term for cloudy, frothy and foul smelling pus in the urine is pyuria. It means the presence of significantly elevated level of white blood cells (leukocytes) in urine. White blood cells work with the immune system to defend against infectious diseases. A small number of white blood cells are normally present in the urine. But elevated levels indicate urinary tract problems signaling possible damage to the kidneys, ureters, urethra or bladder, inflammation or a contaminant.

Pyuria symptoms

Pyuria can be symptomatic or asymptomatic. Pyuria due to bacterial infection is symptomatic unless partially treated. Pyuria is asymptomatic when related to chronic infection from tuberculosis or mycoplasma, long-time indwelling catheters, inflammatory conditions like hemorrhagic cystitis, tubulointerstital nephritis or chronic prostatitis in men, or a contaminant such as vaginal secretions, vaginitis, cystocele etc. Asymptomatic pyuria goes away on its own, even without treatment.

• Cloudy or milky urine
  
• Foul-smelling urine
  
• Frequent urgent need to urinate
  
• Discomfort when urinating
  
• Fever

Time to test

The test is done when individuals notice symptoms and seek medical attention. A physical examination is followed by laboratory urine test for pyuria urinalysis. If the test indicates pyuria, a culture of urine is suggested to detect the strain of bacteria that causes pyuria. To detect kidney abnormalities or infection, an intravenous pyelogram or ultrasound imaging of kidney is done. The presence of more than 3-5 white blood cells per high power field in the spun urine confirms pyuria.

Pyuria Causes

Urinary tract infection: The chance of urinary tract infection is high in men and women who are diabetic. As the urethra in women is comparatively shorter than men, it is easier for microorganisms to enter the female urinary tract and cause infection which increases the chance of women contracting urinary tract infection.

Sexually transmitted diseases: Men and women with sexually transmitted diseases are prone to pyuria.

Other causes: Other causes can be infectious or non-infectious.

• Viral infection
  
• Fungal infection
  
• Anaerobic infection
  
• Fastidious bacteria
  
• Infection in prostate glands in men
  
• Chemical poisoning
  
• Kidney Stones
  
• Tuberculosis of the urinary tract
  
• Cancer of the urinary organs or genital organs

Non infectious: Medications, advanced age, pregnancy, tumors either benign or malignant can cause pus in the urine. Any other underlying problem in the kidney can also result in excessive levels of white cells in the urine.

Pyuria Treatment

The cause for pyuria determines treatment. For urinary tract infections, doctors prescribe antibiotic medicines. If the cause is due to sexually transmitted diseases, hygiene and other precautionary measures is recommended. Drinking plenty of water, juices sans sugar, avoiding fried foods, practicing good hygiene, not delaying for too long the urgency to urinate are proven precautionary measures of pyuria.

Lithotripsy

Lithotripsy is a medical procedure wherein shock waves are used to break up kidney stones, ureter or bladder. Extra corporeal shock wave lithotripsy is the most commonly used type. The shock wave is termed extra corporeal as the shock wave is generated outside the body. It is a non-invasive technique. This procedure is used when the stone is too large to pass out on its own or if the stone is stuck in the ureter.

Lithotripsy Procedure

Prior to the treatment the following is followed:

• Complete physical examination
  
• Urine analysis
  
• Blood test
  
• IVP: intravenous pyelogram is used to locate the stone and understand the extent of blockage
  
• ECG for people with history of heart problems
  

Patient is made to lie down on a comfortable cushion/bed (usually water-filled). A mild sedative, pain killer and antibiotics are administered before the procedure so as to prevent any kind of discomfort, pain or infection. High energy sound waves pass through the body until they hit upon the kidney stone. The machine through which the waves is passed is called as the lithotripter. The kidney stone is broken into several pieces by the wave. The broken stone debris is called gravel. This gravel passes out while urinating. Usually there is no damage to skin or other internal organs as the shock waves are not focused on them. Generally after lithotripsy, people tend to bleed while urinating. This is common and will stop on its own. People who have undergone the procedure should drink plenty of water so as to flush the gravel out. A few patients may report abdominal pain which subsides on its own after a few days. If the symptoms persist, it is suggested that the patient visit the physician.

Lithotripsy should not be performed on people with skeletal deformities, persons with uncontrolled bleeding and pregnant women. Some of the possible side-effects include:

• Kidney infection
  
• Ulcers in the stomach or small intestine.
  
• Pieces of the stone may block free urine passage.
  
• Pieces of stone might be left behind in the body.
  
• Bleeding (internal)
  
• Very rarely stones do not get completely fragmented during the first time and so the procedure might have to be repeated again.