IVP: Common Concerns and Questions About Urinary Imaging

Urinary tract imaging issues?

Hello, Doctor: This afternoon, I went to the hospital for an X-ray intravenous pyelogram (IVP).
Following the doctor's instructions, I took a laxative before the examination, but since I finished lunch at 4 PM yesterday, I skipped dinner to avoid affecting the IVP.
I took the laxative (250 ml of magnesium citrate) at 8 PM and drank about 1500 ml of water afterward.
However, my body did not respond well to the laxative; I only went to the bathroom twice throughout the night, and the stool volume was not significant.
This morning, I had one episode of diarrhea upon waking (not sure if it was due to the laxative from the night before), and after using a suppository, I went to the bathroom again about 1.5 hours later.
After that, I was instructed to fast and refrain from drinking water until the afternoon examination.
I have a few questions:
1.
During the imaging, it was noted that there was still stool in the intestines.
Will inadequate bowel cleansing significantly affect the interpretation of the IVP results? Is it similar to a colonoscopy in this regard?
2.
During the examination, the radiologic technologist asked me to drink water continuously.
Although I sipped slowly, my abdomen felt very bloated, and I eventually couldn't help but vomit (which was just water).
Why, after fasting for so long, did the water not pass smoothly through my gastrointestinal tract to the urinary system? Instead, I felt nauseous (it felt like the water was accumulating in my stomach, causing bloating).

3.
The IVP is an X-ray imaging technique primarily used to examine the urinary system, but since the abdominal area was also imaged, can other abnormalities (such as tumors) in the abdomen be detected?
4.
The radiologic technologist later asked me to hold my urine for the imaging, but at the time of the imaging, I did not feel a strong urge to urinate.
Will this affect the results?
5.
If I have a poor reaction to laxatives, what methods can I use next time to ensure the bowel is adequately cleansed for this type of examination? (I am concerned that inadequate cleansing might compromise the results.)
6.
This IVP was performed because I felt a mass in the right side of my abdomen (to the right of the navel) and have had continuous hematuria for two years (with urine tests every 3-6 months showing blood each time).
If the kidney is confirmed not to be drooping, what could this mass likely be? Which specialist should I consult? Thank you, Doctor.

Kunhuo de ren, 30~39 year old female. Ask Date: 2020/10/07

Dr. Du Shixi reply Urology

1.
During the imaging procedure, it was noted that there was still stool in the intestines.
Will inadequate bowel preparation significantly affect the interpretation of the IVP results? (Is it similar to a colonoscopy?) --> Based on personal experience, as long as there isn't an excessive amount of retained stool, a very high percentage of the results can still be interpreted.
2.
During the examination, the radiologic technologist asked me to drink water continuously.
Although I was sipping slowly, my stomach became very bloated, and I eventually couldn't help but vomit (it was all water).
Why, after fasting for a long time, does the water not pass smoothly through the gastrointestinal tract to the urinary system? Instead, I felt nauseous? (It felt like the water was accumulating in my stomach, causing abdominal distension.) --> It varies by individual; some people are not accustomed to drinking too much at once, which can lead to abdominal bloating.
3.
IVP is a type of X-ray imaging primarily used to examine the urinary system, but since I noticed that the abdominal area was also imaged, can other abnormalities (such as tumors) in the abdomen be detected? --> Tumors are not easily visible.
4.
The radiologic technologist later asked me to hold my urine for a shot, but at the time of the imaging, I did not feel a strong urge to urinate.
Will this affect the results? --> No, it will not.
5.
If I have a poor reaction to laxatives, what methods can I use to ensure proper bowel preparation for future examinations? (I am concerned that inadequate preparation will compromise the results.) --> Increase the dosage of laxatives.
6.
This IVP was performed because I felt a mass in the right side of my abdomen (to the right of the navel) and I have had continuous hematuria for two years (urine tests every 3-6 months, each showing blood).
I want to confirm if the kidney is free-floating; if the results show that the kidney is not drooping, what could this mass likely be? Which specialty should I consult? --> The urology department should be able to handle this.

Wishing you good health.

Reply Date: 2020/10/07

More Info

Intravenous Pyelography (IVP) is a specialized imaging technique used to visualize the urinary system, including the kidneys, ureters, and bladder. It involves the injection of a contrast dye that highlights these structures on X-ray images. While IVP is a valuable diagnostic tool, patients often have concerns and questions regarding the procedure, especially regarding preparation, potential complications, and interpretation of results. Here’s a comprehensive overview addressing common concerns related to IVP.

1. Impact of Incomplete Bowel Preparation
Inadequate bowel preparation can affect the clarity of the IVP images. While it is not as critical as in a colonoscopy, residual stool in the intestines can obscure the view of the kidneys and ureters. However, if the bowel is not excessively filled with stool, radiologists can still interpret the images effectively. It is essential to follow the preparation instructions carefully, but minor deviations may not significantly impact the results.

2. Drinking Water During the Procedure
Patients may experience discomfort when asked to drink water during the IVP procedure. This discomfort can arise from several factors, including anxiety, the volume of water consumed, and individual tolerance levels. Even when fasting, the stomach may not process large amounts of liquid quickly, leading to feelings of fullness or nausea. If a patient feels nauseous, it’s important to communicate this to the radiology staff, as they can adjust the procedure accordingly.

3. Detection of Abdominal Abnormalities
IVP primarily focuses on the urinary system, but it can incidentally reveal abnormalities in adjacent structures, including the abdomen. However, it is not a comprehensive diagnostic tool for abdominal conditions like tumors. If there are concerns about abdominal masses or other abnormalities, additional imaging studies, such as a CT scan or ultrasound, may be recommended for a more thorough evaluation.

4. Bladder Filling During the Procedure
The requirement to have a full bladder during IVP is crucial for optimal imaging of the bladder and ureters. If a patient does not feel the urge to urinate, it may not significantly affect the results, but a full bladder can provide better visualization. If you feel uncomfortable or unable to hold your urine, inform the technician, as they may allow you to void before taking the images.

5. Managing Bowel Preparation for Future IVPs
If a patient experiences adverse reactions to bowel preparation, such as ineffective cleansing, it’s important to discuss this with the healthcare provider. Alternatives to magnesium citrate or different bowel prep regimens may be available. Additionally, dietary adjustments leading up to the procedure, such as consuming a low-fiber diet, can help facilitate better bowel clearance.

6. Understanding the Findings and Next Steps
In your case, the presence of a mass in the right abdominal area, coupled with persistent hematuria (blood in urine), warrants further investigation. If the IVP results show no kidney displacement, the mass could represent various conditions, including a benign cyst, a lymph node, or other soft tissue abnormalities. Referral to a urologist or a specialist in abdominal imaging may be necessary for further evaluation, including possible CT scans or MRI, to clarify the nature of the mass.

Conclusion
IVP is a valuable imaging technique for assessing the urinary tract, but it is essential to understand its limitations and the importance of proper preparation. Patients should communicate openly with their healthcare providers about any concerns or discomfort during the procedure. If there are ongoing symptoms or abnormalities, further diagnostic evaluations may be necessary to ensure comprehensive care. Always follow your physician's recommendations and do not hesitate to seek clarification on any aspect of your care.

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