Intravenous pyelogram (IVP) at Shrewsbury Hospital

An intravenous pyelogram (IVP), also called an intravenous urogram, is an X-ray test that uses a dye injected into a vein to take pictures of your kidneys, ureters and bladder. As the dye travels through your urinary system it shows up bright white on the X-rays, letting your doctor see the shape, size and workings of these organs.

What can it help diagnose?

Your doctor might suggest an IVP if you have symptoms such as:

• Blood in your urine
• Pain in your side or lower back
• Cloudy or bad-smelling urine, or pain when you urinate
• Needing to urinate frequently, or difficulty urinating at all
• Repeated urinary tract infections
• Nausea and vomiting alongside urinary symptoms

The images can help find:

• Kidney stones, or stones in the bladder or ureters
• Kidney cysts
• An enlarged prostate
• Tumours in the kidneys, ureters or bladder, cancerous or not
• Birth defects affecting the structure of the urinary tract
• Scarring from a past urinary tract infection

What are the benefits of having an IVP?

• It's a minimally invasive way to get detailed information about the structure and function of your kidneys, ureters and bladder
• It can sometimes give your doctor enough information to treat a problem, such as a kidney stone, with medication instead of surgery
• No radiation stays in your body once the test is finished
• It can also be useful before surgery, to help your surgeon understand the anatomy of your urinary tract

Is it the same as other urinary tract scans?

IVP goes by several names, and it isn't always the first test doctors reach for these days.

• It's also called intravenous urography (IVU), intravenous pyelography, excretory urography, or IV urography; these all describe the same test
• IVP has largely been replaced in many hospitals by CT urography, which can give more detailed information, particularly about small tumours or stones
• Ultrasound or MRI may also be used instead, especially in pregnancy or in children, where IVP is used rarely

What happens before the test?

Your care team will ask about your health before booking you in, and will want to know if you:

• Are pregnant, or think you might be
• Have allergies, particularly to iodine or contrast dye, or have reacted to a contrast injection before
• Take blood-thinning medication, or have diabetes, are on a medication called Metformin, kidney problems, or congestive heart failure
• Have had recent illness or other medical conditions

Some sources advise not eating or drinking anything from midnight the night before your test; others instead recommend a shorter fast of around 4 to 6 hours beforehand. Check your own appointment letter, as it can vary. You may also be given a mild laxative to take the evening before, to help clear your bowel. On the day, wear loose, comfortable clothing, and leave jewellery, dental appliances, glasses and other metal items at home, since these can interfere with the images.

What happens during the test?

1. You'll lie on your back on an X-ray table, and an initial picture is taken before any dye is given.
2. A thin tube is placed into a vein, usually in your arm or hand.
3. The iodine-based dye is injected through the tube. You may feel a brief sting, a flush of warmth, mild itching or a metallic taste, which usually settles within a minute or two.
4. A series of X-rays is taken as the dye passes through your kidneys, ureters and bladder. You might be asked to change position, hold your breath briefly, or have a belt placed around your middle to help show your kidneys more clearly.
5. Near the end, you'll be asked to empty your bladder, and a final X-ray checks how completely it has drained.
6. Most exams are finished within 30 minutes to an hour, though it can take up to 4 hours if your kidneys are working more slowly.

What does recovery look like?

An IVP is usually done on an outpatient basis, so you'll be free to go home the same day.

• The tube in your arm is removed and covered with a small dressing
• You can return to your normal activities straight away
• Drinking plenty of fluids over the next day or so helps flush the dye out of your system
• Results are usually ready within a few days; the doctor who referred you will explain what was found and any next steps

Contact your care team if you notice blood in your urine, cloudy urine, or pain in your back or side after the test. Seek urgent care straight away if you have any sign of a severe allergic reaction, such as difficulty breathing or swelling of your mouth or throat.

What are the risks and complications?

• A brief sting, warmth, itching or metallic taste when the dye is injected, which usually passes within minutes
• Occasional nausea or vomiting
• A mild allergic reaction, such as persistent itching or hives, which can be treated with medication
• Rarely, a more serious allergic reaction, such as difficulty breathing or swelling of the throat, which needs prompt treatment
• A small amount of radiation exposure; the risk from a single test is low, and your team will weigh this against the benefit of an accurate diagnosis
• IVP may not be recommended if you have poor kidney function, as this raises the risk of kidney injury, or if you're pregnant, because of the radiation involved