Urography is an X-ray examination that visualizes the general structure and location of the organs of the urinary system. The method is often used in the initial treatment of patients with nephrological symptoms, allows to diagnose volumetric processes, hydronephrosis, concretions of the kidneys, bladder and ureters, anomalies of the structure of organs. The results of urography determine the need for targeted radiography.
In urology, performing urography precedes any radiopaque examination of the urinary system, allowing you to get an idea of the size, position and shape of the urinary organs. Overview urography allows you to assess the general condition of the urinary tract before other diagnostic procedures, as well as to identify the presence of tumors, hydronephrosis, foreign bodies, X-ray positive stones (phosphates, oxalates) in the bladder, ureters or kidneys. Urography is indicated for trauma, abdominal and lumbar pain to exclude or confirm urological pathology.
Urography, like other methods of X-ray diagnostics, is not performed during pregnancy. In the case of a recent X-ray examination of the abdominal cavity using barium contrast, the examination should be postponed for several days until the bowel cleansing. Overview urography gives only general ideas about the urinary system, not allowing to assess kidney tissue, functional disorders, the exact localization of concretions, etc.
2-3 days before the planned study, gas-forming food (black bread, vegetable fiber, legumes, milk, carbonated drinks, etc.) is excluded from the diet, and polyphepane or carbolene is prescribed. The patient makes the last meal at lunch on the eve of urography; the intestines are cleaned with laxatives or enemas. In the X-ray room, the condition of the intestine is checked using X-ray. With flatulence, planned urography is postponed to another day with recommendations for preparing the intestines. The procedure is performed in an X-ray room. The patient is placed on his back, the picture is taken with the ventrodorsal passage of X-rays. While taking pictures, you should stay still and hold your breath.
Interpretation of results
When interpreting the results of urography, the revealed changes correlate with the state of the skeleton: developmental anomalies and pathological changes in the spine (lumbarization, sacralization, scoliosis, spondylitis, deforming spondylosis, tuberculosis, tumor metastases), ribs, pelvis, femurs.
Normally, the topography of the right kidney corresponds to the level of the XII thoracic – III lumbar vertebrae; on the left – the projection of the XI thoracic – II lumbar vertebrae; on the right, the XII rib is at the level of the upper segment of the kidney, on the left crosses its middle. When the bladder is filled, its elliptical shadow is determined. The contours of the kidneys are smooth, the shadows are homogeneous. In the absence of changes, the ureters are not visible on the urogram. The shadows of the lumbar muscles have the shape of truncated pyramids with a peak in the area of the thoracic 12th vertebra.
With tumors, giant kidney cysts, amniotic hematomas, paranephritis, the contours of the lumbar muscle may be erased or completely absent. In acute pyelonephritis or paranephritis, there is an increase in the density of renal shadows and the clarity of contours. The main diagnostic value of urography is the detection of additional shadows: foreign bodies, concretions, calcifications, tumors, etc. To differentiate and clarify the localization of suspicious formations, in addition to urography, radiopaque research techniques are used.