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Excretory Urogram 1101

Excretory Urogram
VetBooks.ir

• Nonionic contrast medium (iohexol,
Difficulty level: ♦♦
collapse, bronchospasm)
iopamidol) if clinically warranted • Anaphylaxis (p. 54) (airway edema, vascular
Synonyms • Syringe • Perivascular injection may result in sloughing
Intravenous pyelogram (IVP), intravenous (IV) • Heparin/saline for flush of surrounding tissue.
urogram • Enema set • Contrast medium–induced kidney injury
• Antianaphylactic agents (e.g., diphenhy- • Administration of iodinated contrast media
Overview and Goal dramine, 2-4 mg/kg for IM injection) may affect urine specific gravity, urine sedi-
When the kidneys are difficult to assess by plain- • Oxygen and drug cart to address any possible ment, and urine culture results for 24 hours
film radiography or qualitative renal functional procedural complication after administration.
information is needed, an excretory urogram • Blood values (blood urea nitrogen [BUN],
could be performed. On survey abdominal Anticipated Time creatinine, prothrombin time [PT], activated Procedures and Techniques
radiographs, the kidneys may not be visualized Approximately 1 hour partial thromboplastin time [aPTT], throm-
in animals that have decreased abdominal detail boplastin time [TT], and hematocrit) might
(young, thin, peritoneal fluid). Preparation: Important also be affected for up to 24 hours after
Checkpoints contrast administration.
Indications • Advise owner that hair will be clipped from
• Identify kidneys (if poor abdominal the site of IV catheter placement. Procedure
detail) • Animal should be fasted for 24 hours before • Preliminary abdominal radiographs are made
• Mass lesions of kidneys (or mass in region the procedure; water is given ad libitum. to determine adequate animal preparation
of kidney) • Enema (p. 1099) given at least 2 hours before and to set radiographic technique.
• Qualitative assessment of renal function study to remove a maximum of the fecal • The kilovoltage peak (kVp) should be set
(subjective) material from the colon, allowing visualiza- between 65 and 75 to maximize contrast.
• Patency, continuity of urinary tract tion of kidneys and ureters • Flush the catheter to again ensure patency.
• Before nephrectomy • Assess hydration: proceed only if normal. • Inject contrast material rapidly as a bolus.
• Abnormal renal size, shape • Standard aseptic placement of IV catheter • Flush catheter of residual contrast material
• Persistent hematuria (p. 428) in a cephalic vein; it is imperative that the using heparin/saline syringe.
• Suspected renal or ureteral calculi catheter be properly placed. • A ventrodorsal view is obtained at 20 seconds.
• Suspected hydronephrosis (p. 483) or • Secure the catheter in place with tape/ • Ventrodorsal and right lateral views are
pyelonephritis (p. 849) releasing elastic (Vetrap-type) bandage. obtained at 5, 20, and 40 minutes.
• Suspected ureteral ectopia (p. 282), uretero- • Draw 900 mg iodine per kg body weight of • Oblique views are obtained at 5 minutes to
cele, ureteral rupture contrast material into syringe. visualize ureteral termination at the urinary
• To evaluate the urinary bladder when it • Add an appropriate amount of heparin/saline bladder.
cannot be catheterized flush into a syringe.
• Postoperative assessment of urinary tract Postprocedure
(patency, strictures, leakage) Possible Complications and • If general anesthesia is used: routine anes-
Common Errors to Avoid thetic recovery
Contraindications • Vomiting: this often occurs immediately • Maintain adequate hydration.
• Dehydration after injection of the contrast medium. If • The IV catheter should remain in place at
• Previous reaction to iodinated contrast the animal is muzzled, the muzzle should least 15-20 minutes after the procedure.
medium (a nonionic medium should be used) be removed immediately to avoid aspiration. This allows venous access should an adverse
• Caution should be used in animals with the • Systemic hypotension, bradycardia reaction to the contrast medium occur.
following conditions:
○ Diabetes mellitus (p. 251)
○ Multiple myeloma (p. 663)
○ Congestive heart failure (pp. 408 and 409)
○ Hypertension
○ Concurrent drug administration (cardiac
glycosides)
○ Severe debilitation
Equipment, Anesthesia
• Many recommend the use of general
anesthesia or heavy sedation; however, an
excretory urogram can be performed in an
unanesthetized animal.
• IV catheter
• Hair clippers
• Surgical scrub solution, rubbing alcohol, and
gauze/sponges to prepare skin for catheter
placement
• Tape/releasing elastic (Vetrap-type) bandage EXCRETORY UROGRAM Excretory urogram, lateral view. Both kidneys and ureters are clearly seen. The
• Iodinated contrast medium (sodium iothala- diagnosis was ectopic ureter, supported by the presence of contrast on the haircoat of the dog’s hindquarters
mate, sodium diatrizoate) (the dog did not void voluntarily during the procedure).

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