A method that evaluates urinary tract anatomy and function by following the elimination of intravenous contrast through the urinary system with serial X-ray images; it has now largely been replaced by CT urography.
Indication
- Investigation of recurrent urinary tract infections
- Evaluation of the etiology of hematuria (blood in the urine)
- Findings suggesting ureteral stone and obstruction
- Diagnosis of congenital urinary tract anomalies
- Anatomical assessment after urinary tract surgery
- Alternative imaging in cases where CT or MR urography cannot be performed
Preparation
- Fasting for 6-8 hours before the procedure
- Use of a laxative for bowel preparation in some cases on physician's advice
- Allergy history, asthma, kidney failure, and metformin use must be reported in advance
- The current creatinine value is checked
- Adequate fluid intake before the procedure; the examination is not performed during pregnancy
How it's performed
- The patient is placed supine on the X-ray table; an initial non-contrast plain film (scout) is obtained
- An IV line is established in the arm and iodinated contrast material is injected
- The contrast material is filtered through the kidneys and passes into the ureters and bladder
- Serial X-ray images are taken at specific intervals (such as 1, 5, 10, 15 minutes)
- Additional films are obtained after the bladder fills and after voiding (post-micturition)
- The procedure usually takes 30-60 minutes
Post-procedure
- Drinking plenty of fluids is recommended to accelerate excretion of the contrast
- There are no restrictions after the procedure; daily activities can be resumed
- Late allergic reactions to contrast are rare but possible; in case of rash, itching, or shortness of breath, a physician must be consulted
- In patients using metformin, the timing of restarting the medication is determined by the physician
- Findings can usually be confirmed with CT urography
Risks
- Allergic reaction to iodinated contrast (ranging from mild itching to serious reactions)
- Risk of contrast-induced kidney injury in patients with kidney failure
- Exposure to ionizing radiation (generally lower than CT urography)
- Reduced image quality if adequate fasting was not maintained before the test
- Fetal radiation exposure during pregnancy (not performed during pregnancy)
FAQ
What method is preferred today instead of IVP?
Due to its diagnostic sensitivity and rapid results, CT urography has replaced IVP in many centers. However, IVP remains a valuable method when CT is not suitable.
Is the procedure painful?
When the contrast material is administered, a temporary feeling of warmth, change in taste, or nausea may occur; the procedure itself is not painful.
How long does the test take?
The total time depends on the contrast excretion rate; it is usually completed within 30-60 minutes.
Can it be performed if I have a contrast allergy?
In patients with a previous history of allergy to iodinated contrast, the procedure is carefully evaluated; if necessary, alternative methods or premedication are used.
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