From Big Medical Encyclopedia

UROGRAFYYa (Greek uron wetting + grapho to write, represent; synonym: intravenous urography, secretory urography, contrast urography, excretory urography) — the method of X-ray inspection of uric system based on selectivity of kidneys to emit the water-soluble iodinated radiopaque substances entered into blood. The modern radiopaque substances (see) applied at At., are removed generally by glomerular filtering and only partially by means of canalicular secretion.

At. it is for the first time offered in 1923 by Osborn (E. D. Osborne) et al.

In a crust, time At. is a widespread and high-informative method rentgenol. researches of kidneys and uric ways. It allows to obtain data on an anatomic structure and a functional condition of bodies of uric system and to estimate motor function of uric ways.

At. make at suspicion of a disease of kidneys (see) and uric ways (see the Bladder, the Urethra, the Ureter), as a rule, after a survey picture of bodies of uric system (survey At.) and, whenever possible, after ultrasonic or radionuclide scanning (see Scanning, Ultrasonic diagnosis). The urography is contraindicated at an oliguria and an anury, acute parenchymatous damages of a liver, kidneys, an acute stroke and a myocardial infarction. The compensated renal failure is not an absolute contraindication for carrying out a research.

In process At. carry out a X-ray television piyeloureterosko-piya in horizontal and vertical provisions of the patient with registration of process for series of uro-grams, large picture frame flyuorogramm, a film or in the form of a video. An important condition of obtaining the good image is adequate preparation for urography, edges consists in restriction one day before the research of meal, containing cellulose, and release of intestines. On the eve of the research do a cleansing enema, in 10 — 20 min. prior to At. the enema is done repeatedly. After assessment on a survey picture of readiness of intestines and the choice of technical specifications on shooting intravenously enter not less than 40 ml of radiopaque substance (60 — 76% r-ry ii iodine yes. of a triom-brast, Verografinum or Urografinum). The high dose of radiopaque substance (but no more than 1 ml of 76% of solution for 1 kg of weight) is an indispensable condition of obtaining the good image of kidneys and urinary tract, especially at decrease in functional capacity of kidneys. Under control of X-ray television raying (see Television in medicine) choose optimum time and projections for a X-ray analysis. The quantity of pictures and time of their performance vary depending on the nature of a disease and a research objective. At the kept function of kidneys and normal to urodynamic (see) the research comes to an end 20 — 30 min. later after administration of radiopaque substance. According to indications pictures carry out through

2, 3, 6 and even 24 hours. In fig. 1 it is shown Urogramum normal.

Significant improvement of quality of contrasting of kidneys and uric ways manages to achieve by means of infusional urography, at a cut radiopaque substance is entered intravenously within

5 — 7 min. It is parted at the rate of 1 ml 76% of solution for 1 kg of body weight of the patient with equal amount of isotonic solution of sodium chloride or 5% of solution of glucose.

To estimate reserve opportunities of kidneys and to establish character of dilatation of upper uric ways the special technique — headlights-makourografiya allows, at a cut in 20 min. after administration of radiopaque substance intravenously enter 40 mg of the furosemide dissolved in sterile isotonic solution of sodium chloride. By means of this technique it is possible to reveal the compensated and hidden disturbances of urodynamic of upper uric ways (a pyeloureterectasis or gidroure-teronefroz).

At At. lag of contrasting of the affected kidney and upper uric ways on Urogramums which are carried out the first 3 — 5 min. with a minute interval and also uniform reduction of its sizes more than on 10 — 15 mm in comparison with other kidney comes to light characteristic of renovascular hypertensia (see arterial hypertension). Has great diagnostic value At. at an urolithiasis (see the Urolithiasis). She allows to establish localization of an urinary stone, to estimate a functional condition of the affected and healthy kidney, to reveal changes in uric ways. At retentsion-ny processes At. gives the chance to establish morfol. features of defeat, degree of safety of a parenchyma of kidneys, functional capacity of the affected kidney to estimate a condition of urodynamic and to reveal a hydronephrosis (fig. 2). In case of the closed injury of kidneys and uric ways with the help At. define localization, volume and the nature of defeat, existence of an uric zatek and a pararenal hematoma. At nonspecific inflammatory diseases of kidneys and tuberculosis of uric system (see Tuberculosis extra pulmonary) on Urogramums clear changes of the image of kidneys and collective system are visible, and also extent of wrinkling of body comes to light. The tumor and a cyst of a kidney are followed by increase in a shadow of the struck body, deformation of cups and a pelvis of kidneys, not -

Fig. 1. Excretory it is normal of Urogramum:

shadows of kidneys are visible (the left kidney is located slightly above right); accurately to nt r nuclear heating plant and r about in ap y h and she chno-l about x and but chn and I am system and ureters.

tiic. 2. Infusional Urogramum at a bilateral hydronephrosis: on both sides accurately kontrastnroganny cavities on site of sharply expanded renal cups and a pelvis are visible.

1; is. 3. Excretory Urogramum at a malignant tumor of a bladder;

the defect of filling caused by a tumor of a bladder is visible (it is specified by shooters).

uniform density nefrogram-we. On the descending tsistogramma received in the course of excretory urography it is possible to judge changes in the lower uric ways at tumors, an urolithiasis, diverticulums of a bladder, to reveal adenoma prostatic 'glands (fig. 3).

At At. the complications connected with hypersensitivity to radiopaque substances are possible.

Bibliography: P y t e l A. Ya. and II y-

t e l Yu. A. Radiodiagnosis of urological diseases, M., 1966; Emmett’s clinical urography, An atlas and textbook of roentgenologic diagnosis, ed.

by D. M. Witten a. o., v. 1, Philadelphia a. o., 1977; To n e i s e O.

u. Sc ho-b e r K. L. Die Rontgenuntersuchung der Harnorgane, Lpz., 1963; OsborneE. D. a. o. Roentgenography of urinary tract during excretion of sodium iodid, J. Arner. med. Ass., v. 80, p. 368, 1923.

V. M. Perelman.