An IVP (short for Intravenous Pyelogram) is a functional study of the Urinary system. In other words, an IVP demonstrates how well your Kidneys, Ureters, and Bladder are working in addition to finding any physical defects or blockages. In terms of what to expect when you go to have your IVP, the study is fairly simple.

The first thing to take care of is getting yourself prepared for the examination. Since the urinary system is directly behind the intestines that make up the largest part of the digestive tract, it is important that your intestines be reasonably empty. To this end, some facilities will tell you to eat "low residue" foods the day before. If the facility at which you are going to have your study is one of these, your doctor should give you a sheet with suggestions of foods on it, or you can see the Barium Enema page on this web site. Most of the organizations I have worked for however do not require a special diet, instead they will tell you to drink one bottle of Citrate of Magnesia (obtainable at most pharmacies and many grocery stores) at 8:00 the night before your exam, and then not to eat or drink anything except 2 large glasses of water about three hours before the exam until after you are through.

When you report to the x-ray department for your exam, the technologist will ask you about your problem (including where you hurt and if you are in pain now), your medical history (i.e.-have you ever had a kidney stone, do you have any known kidney problems, etc.), and whether you are allergic to anything. If you are an outpatient, they will also have you change into a hospital gown to insure that there is nothing that might show up in the x-rays. You will then be taken to the x-ray room where one to three "scout" films are taken. Just as army scouts precede the army into battle to find out things the generals will need to know, so too do scout films precede most contrast studies such as IVP's so that the technologist and radiologist who will be doing your exam will not be taken by surprise by unusual problems and your exam delayed. After the scout films have been taken, the radiologist, a nurse, or a specially trained technologist will start an IV on you if you do not already have one. This is to enable the technologist or radiologist to administer a contrast media that, when concentrated in the kidneys, will show up on x-rays. You may also be fitted with a compression band just below the kidneys which, when inflated, will delay the emptying of the kidneys, thus allowing the technologist more time to take a special set of x-rays of the kidneys called tomographs. Tomographs use movement of the x-ray tube and the film holder (called a bucky) to blur out objects in the body above, and below, the part we are most interested in. IVP's are not the only exams this technique is used in, but they are the most common exam to use it today.

Following three to five tomographs of the kidneys, regular x-rays are taken at various intervals to watch the contrast containing urine as it moves down the ureters from the kidneys to the bladder. Once a certain point is reached, usually 7 to 10 minutes after the contrast has been administered, two obliques, will be taken. These x-rays are taken after rolling you, the patient, about 30 to 40 degrees to your right side, and the same to your left. These are taken because the ureters enter the bladder low and towards the rear, so to see the junction of the ureters and the bladder it is necessary to take an angled shot. The reason you are the object angled, and not the x-ray tube, is that x-ray tables are designed so that x-rays coming in to the table at an angle from the side are blocked. This is to reduce a problem called scatter that occurs when x-rays are deflected inside the body in odd directions. If enough scatter can reach the x-ray film, one ends up with a gray, unreadable mess, so steps are taken to limit scatter when ever possible. One way to think of this is to compare it to polarized sunglasses. While the polarization does not reduce the amount of direct sunlight that gets through by very much, it greatly diminishes the glare caused by sunlight bouncing off the pavement and on coming cars.

Once enough contrast, or dye reaches the bladder from both kidneys, you will be asked to go to the bathroom and empty your bladder through a special funnel designed to trap kidney stones for later analysis in the lab. Finally one last x-ray is taken to see if there is an unusual amount of urine left in the bladder after you relieve yourself. Some facilities will do this "post void" film with you standing up in order to make sure that the kidneys or bladder do not sag or drop, which would indicate a possible problem with the tissue responsible for holding your kidneys and/or bladder in the correct position.

Of all the questions I have been asked about this exam, two are the most common. The first is how long will this exam take. Unfortunately, this question cannot be answered with any surety, as it depends entirely upon what is wrong with you. The average healthy patient with no problems with his urinary system can probably complete this exam in 15 to 20 minutes. However if something, such as a kidney stone, is causing a blockage that delays one of the kidneys from emptying into the bladder, the time required to complete the IVP can be greatly extended. I once saw a patient who took so long for the one kidney to empty that the exam was stopped before we had finished. Yet after treatment in lithotripsy the next day, this patient was able to be released the same day. So don't panic if your IVP seems to be taking an extremely long time. Wait until the doctor explains your problem to you. It may be that, while bad, it is still nothing to get too concerned about.

The second question I often am asked is how safe is the "x-ray medicine" or contrast we use. While it is true that the ionic compounds commonly used 20 years ago did have some problems, the newer non-ionic dyes commonly used today are extremely safe. In a study of 2,098 patients who received Optiray, a contrast media produced by Mallinckrodt Medical, Inc., less than 1% experienced any reactions that could be considered serious. In addition, all registered and/or licensed technologists are trained to recognize the signs and symptoms of any such reaction immediately, and drugs designed to counteract these reactions are kept in each room where IVP's may be performed. The most you are likely to experience from the contrast is a slight flushing sensation, and maybe a coppery/metallic taste in your mouth. And even these are by no means sure. Many patients go through this exam without ever experiencing any sensations at all.

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