From Big Medical Encyclopedia

PIYELOGRAFIYA (grech, pyelos a trough, a tub + grapho to write, represent) — X-ray inspection of a kidney after filling of pyelocaliceal system with a contrast agent.

Fig. 1. The retrograde right-hand piyelogramma is normal: 1 — cups, 2 — a pelvis, 3 — an ureter.

Depending on a way of administration of contrast medium distinguish retrograde (or ascending) and antegrade the Item. In case of contrasting only of an ureter speak about a retrograde ureterografiya. At retrograde P. a contrast agent is entered into a pelvis or an ureter, at antegrade P. — directly into pyelocaliceal system by a transdermal puncture or on a piyelonefrostoma. Retrograde P. is offered in 1906 by F. Voelcker and A. Likhtenberg. In some cases instead of a liquid contrast agent in chashechno - lokhanochny system enter gas, napr, oxygen or carbon dioxide gas (pnevmopiyelografiya), use also double contrast study based on simultaneous use of liquid contrast agents and gas. So, by the method offered in 1954 Mr. of Klami (R. of Klami), enter mix of a liquid contrast agent from 3% solution of hydrogen peroxide which, entering in uric ways to contact with purulent exudate, decays on water and oxygen. By means of a series of consistently made pictures (serial P.) it is possible to receive indicative data on motor function of uric ways if excretory is contraindicated urography (see). The item gives an idea about anatomo-morfol. features of collective system of kidneys, and at simultaneous contrasting of kidneys and an ureter (a retrograde piyeloureterografiya) — about upper uric ways in general. Define a form, size, the provision of a pelvis and cups, their quantity, interposition (fig. 1), existence or absence by P. patol, changes. At the same time even insignificant destructive processes in renal nipples and cups can be revealed.

Indications and Contraindications

Retrograde P. is shown at considerable depression of function of kidneys, a so-called mute kidney, and also at unsatisfactory results excretory Urografinum. Antegrade P. by a transdermal puncture is carried out when the excretory urography is not effective, and for retrograde P. there are no necessary conditions or it did not manage to be executed. To the item with a double contrast study it is shown for diagnosis of early stages of a nephrophthisis, tumors of a kidney and a pelvis, and also fornikalny bleedings.

Contraindications: a hamaturia, narrowings and impassability of an urethra, small capacity of a bladder, hypersensitivity to drugs of iodine.


Fig. 2. A right-hand pnevmopiyelogramma at a gidroureteronefroza: the cups filled with gas, a pelvis and an ureter are sharply expanded, in the lower cup against the background of gas the shadow of a stone is visible (it is specified by an arrow).
Fig. 3. A left-side retrograde piyelogramma at a nephrolithiasis: cups and a pelvis are expanded, in a lokhanochno-ureteric segment the defect of filling formed by a stone is visible (it is specified by an arrow).

After introduction to a bladder of the kateterizatsionny cystoscope (see. Tsistoskopiya ) under control of sight into the mouth of the corresponding ureter enter an ureteric catheter No. 4 — 6 on Sharryer's scale. Depending on a research problem the catheter is advanced on various height, but no more than on 20 cm not to cause a spasm of pyelocaliceal system. Usually apply to P. warmed up to the body temperature of 20%, 30%, 50% solutions of liquid contrast agents (Urografinum, Verografinum, a triombrin, etc.) in the quantity which is not exceeding 5 ml. It is reasonable to enter a contrast agent under roentgenoscopic control (piyeloureteroskopiya). At recognition of X-ray negative konkrekhment and tumors of a renal pelvis, and also for their differential diagnosis solutions of contrast mediums, gas or a double contrast study use 5 — 10%. Against the background of gas the stone becomes distinguishable (fig. 2), in a liquid contrast agent he creates defect of filling (fig. 3).

At antegrade P. by a transdermal puncture in position of the patient on a stomach under local anesthesia enter an aspirating needle under the XII edge on 10 — 12 cm lateralny the centerline, advancing it outside inside and up in the direction of a renal pelvis. Emergence of urine in the syringe attached to a needle demonstrates hit in pyelocaliceal system. Urine is aspirated and into cavities of a kidney entered a little smaller, than the volume of remote urine, amount of contrast medium. At antegrade P. through piyelo-or nefrosty a contrast agent is entered on the drainage inserted into a pelvis. It is reasonable to carry out antegrade P. under X-ray television: control.

The X-ray analysis depending on P.'s problems is made on a back, a stomach, in vertical and other provisions of the patient. In situation on spin also average are better contrasted upper, and in situation on a stomach — the lower cups and a lokhanochno-ureteric segment. At a pnevmopiye-loureterografiya for the purpose of moving of gas to overlying departments of pyelocaliceal system it is reasonable to conduct a research in situation with the raised upper body, and at a pnevmouretero-grafiya — in situation with the raised lower body of the patient. Items carry out with extra care at disturbance of outflow of urine from upper uric ways, at a nefrourete-rolitiaza, especially after an attack of renal colic, because of danger of piyelorenalny refluxes, aggravation of disturbances of urodynamic, and also at tumors of kidneys and upper uric ways.

Implementation of the Item. at children it is accompanied by the difficulties caused by age features of a structure of uric bodies. At introduction of the children's kateterizatsionny cystoscope it is necessary to consider big curvature of an urethra at boys, and also the fact that the triangle of a bladder is located at children under a big corner. Due to the small sizes of mouths of ureters thickness No. 4 should not apply ureteric catheters on Sharryera. The quantity of the entered contrast medium depends on age and makes from 0,5 — 1 ml at newborns to 3 — 4 ml at children at the age of 7 — 8 years.

Complications can be connected with a tsistoskopiya, catheterization of an ureter, retrograde administration of contrast medium. Injuries, bleedings, septic complications, a reflex anury concern to them.

Bibliography: Pytel A. Ya. and Pytel Yu. A. Radiodiagnosis of urological diseases, M., 1966, bibliogr.; D e u t i with k e P. Die Rontgen-untersuchung der Niere und. Harnleiters in der urologischen Diagnostik, Miinchen, 1974; Handbuch der medizinischen Radio-logie, hrsg. v. O. Olsson, Bd 13, T. 1, B. u. a., 1973; Lohr E. u. a. Atlas der urologischen Rontgendiagnostik, Stuttgart, 1972; Voelcker F. u. L i ch-tenberg A. Pyelographie (Rontgeno-graphie des Nierenbeckens nach Kollargol-fiillung), Miinch. med. Wschr., S. 105, 1906.

B. M. Perelman.