Excretory Urography (EU)

WHAT IS EXCRETORY UROGRAPHY (EU)?

Excretory urography (EU) is an x-ray evaluation of your urinary system, viewing your kidneys, bladders, and ureters. The technique is used in diagnosing disorders affecting the urinary tract. 

These disorders may likely include: 

• Kidney stones, 
• Bladder stones, 
• Kidney cysts, 
• Enlarged prostate,
• Urinary tract tumors. 

With the help of an x-ray dye (iodine contrast solution) injected into a vein in our arm and flowing into your kidneys, uterus, and bladder, x-ray pictures are taken at specific times during the exam, so your urinary tract can be assessed to know how well it is functioning. Alternative terms of excretory urography are:

• Intravenous pyelogram (IVP).
• Excretory urogram (EU).
• Intravenous urography (IVU).

USES OF EXCRETORY UROGRAPHY

Excretory geography is used to diagnose conditions affecting the urinary tract, such as:

• Tumors.
• Surgery.
• Kidney cysts.
• Kidney stones.
• Bladder stones.
• Enlarged prostate.
• Blood in the urine (hematuria).
• Pain in the sides and lower back.
• Reoccurring urinary tract infections.
• Medullary sponge kidney (a congenital disorder of the kidneys, in which there is cystic dilation of the connecting tubules in one or both kidneys).

Before now, excretory urography was the most frequently used imaging test for examining possible urinary tract disorders. 

With recent advances in imaging techniques, modalities have been progressively refined, such that computer tomography (CT) and/or magnetic resonance imaging (MRI) have largely replaced EU as the optimal way to evaluate the genitourinary system. 

The benefits of less time consumption and non-requirement of x-ray dye are the major reasons behind the importance of CT and MRI over excretory urography. 

Despite these, excretory urography (EU) proves to be of help, being used in:

• Identifying kidney stones.
• Detecting some structural urinary tract disorders.
• Evaluating and giving information about urinary tract obstruction.

EXCRETORY UROGRAPHY RISKS

Excretory urography is generally safe, but no medical procedure can pass a “no-risk” test. 

Excretory urography also shares in its risks of complications, which include:

• Cardiac arrest (which is quite rare).
• Very low blood pressure (which is also quite rare).
• Exposure of the fetus to radiation; at times, causing birth defects.
• Exposure to low radiation levels (with few damages to the body cells).
• Allergic reaction to contrast solution (x-ray dye); sometimes needing treatment.
• Breathing difficulties and some life-threatening symptoms like anaphylactic shock (quite rare).

The following effects of contrast material will disappear within a minute or two. They are risks associated with the EU procedure, but are not harmful, since they fade quickly:

• Itching.
• Nausea.
• Unusual warmth (flushing).
• A metallic taste in the mouth.
• The swollen reddish area on the skin (hives).

EXCRETORY UROGRAPHY PREPARATION

• Ahead of an excretory urography, disclose to your doctor if you:
• Are allergic to substances, especially iodine.
• Are pregnant or think you might be.
• Have had a severe reaction to x-ray dye in the past.
• Don’t eat or drink after midnight, on the night before the exam.
• You may be asked to take a mild laxative on the evening before the procedure.
• Tell your doctor if you have any allergies, especially to iodine.
• Tell your doctor about any medication you’re taking.
• Discuss your medical history with your doctor, before the test.
• You may be asked to take off your jewelry, eyeglasses, removable dentures, and any metal object likely to interfere with the x-ray images.
• You will change into a hospital gown.

THE EXCRETORY UROGRAPHY PROCEDURE

Duration:	1─4 hours.
Specialist:	Urologist.
Performed by:	Radiologist or technologist.
Venue:	Radiology test room.

 

• You will lie on the radiographic while still x-ray images are taken.
• Hold your breath when the images are being taken.
• The x-ray dye is injected into a vein in your arm.
• An additional still x-ray image is taken.
• You must hold very still and may be asked to hold your breath for a few seconds while the x-ray picture is taken to reduce the chance of blurring.
• The number of images depends on the reason for the test and your anatomy. 
• You may be asked to turn from side to side, to enable the radiologist to capture views from several angles.
• A series of captures are taken (while the contrast material is processed by the kidneys), to determine the actual size of the kidneys and to capture the urinary tract in action, as it begins to empty.
• The compression bond may be applied around your body to better visualize the urinary structures.
• You may be asked to empty your bladder, near the end of the exam, so that an additional x-ray of your urinary bladder can be taken after it empties.

After the Procedure,

• You may be asked to kindly wait until the radiologist confirms that all necessary images have been obtained.
• Your urine will be normal.
• The contrast dye will not discolor your urine or cause any discomfort when you urinate.

EXCRETORY UROGRAPHY RESULTS

A radiologist will verify and analyze the images and send a signed report to your doctor or the referring urologist, who will discuss the result with you. He may likely fix a follow-up exam with you, for further evaluation of your condition. Follow-up is a monitoring yardstick to see if treatment is working or if an abnormality is stable or has changed.

EXCRETORY UROGRAPHY LIMITATIONS

EU concentrates on details of the inside of the urinary tract, including the kidneys, ureters, and bladder, without information on the functioning tissues of the kidneys and surrounding structures near the kidneys, ureters, and bladder.

Excretory urography is not usually performed on pregnant women. It is rarely done in pediatric patients. Excretory urography in infants and children is limited, as an alternative imaging method is always needed.

FAQs

• How do you prepare for the EU test?

Don’t eat or drink after midnight on the night before your test. You may take a mild laxative on the evening before the test. 

Tell your doctor if you are allergic to iodine or have had a previous reaction to an x-ray contrast solution. Tell your doctor if you are pregnant. 

Also reveal any medications you are taking, as well as your medical history. You may have to take off your jewelry, eyeglass, dentures, and any metal object.

• Which contrast material is used in the EU?

With the help of the iodine contrast material injected into a vein in your arm, flowing into your kidney, ureters, and bladder, x-ray images are taken at specific times during the exam.

• Can you see contrast dye in your urine?

The excretory urography contrast dye you receive on the day of the procedure will be filtered by your liver and/or kidneys and will pass out of your body via urine. This will happen in the next 24 hours. The dye will not discolor your urine.

• How long does the EU test take?

Normally, excretory urography usually takes one hour. But some people’s kidneys function at a lower rate, in this case, it may take up to 4 hours.

• Which doctor handles genitourinary system disorders?

A urologist is a medical specialist that treats disorders of the urinary tract and the genitourinary system.