Urinary System - Diagnostic Studies - Radiology Procedures

Description & Purpose
KUB study involves x-ray examination of abdomen and pelvis and delineates size, shape, and position of kidneys. Radiopaque stones and foreign bodies can also be seen.
Nursing Responsibility
Perform bowel preparation (if ordered).

Description & Purpose
In intravenous pyelogram, x-ray examination visualizes urinary tract after IV injection of contrast material. The presence, position, size, and shape of the kidneys, ureters, and bladder can be evaluated. Cysts, tumors, lesions, and obstructions cause a distortion in the normal appearance of these structures. Patient with significantly decreased renal function should not have IVP because contrast media can be nephrotoxic and worsen renal function.
Nursing Responsibility
Evening before procedure, give cathartic or enema to empty colon of feces and gas. Keep patient on NPO status for 8 hr before procedure. Before procedure, assess patient for iodine sensitivity to avoid anaphylactic reaction. Inform patient that procedure involves lying on table and having serial e-rays taken. Advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur. After procedure, force fluids (if permitted) to flush out contrast material.

Description & Purpose
Antegrade pyelogram is an x-ray to evaluate the upper urinary tract when there is allergy to contrast media or decreased renal function and when abnormalities prevent passage of a ureteral catheter. Contrast medium may be injected percutaneously into the renal pelvis or via a nephrostomy tube that is already in place when determining tube function or ureteral integrity after trauma or surgery.
Nursing Responsibility
Explain procedure and prepare patient as for IVP. Watch for signs of complications (e.g., hematuria, infection, hematoma).

Description & Purpose
Nephrotomogram is an x-ray taken with rotating tubes. Test delineates segments of the kidney at different levels. Multiple exposures are taken to visualize specific sections of the kidney after IV injection of contrast material.
Nursing Responsibility
Explain procedure and prepare patient as for IVP.

Description & Purpose
Retrograde pyelogram is an x-ray of urinary tract taken after injection of contrast material into kidneys. It may be done if an IVP does not visualize the urinary tract or if the patient is allergic to the contrast material or has decreased renal function. A cystoscope is inserted and ureteral catheters are inserted through it into renal pelvis. Contrast material is injected through catheters.
Nursing Responsibility
Prepare patient as for IVP. Inform patient that pain may be experienced from distention of pelvis discomfort from cystoscope. Inform patient that anesthesia may be given for procedure. Complications are similar tho those for cystoscopy.

Description & Purpose
Purpose of renal arteriogram is to visualize renal blood vessels. Findings can assist in diagnosing renal artery stenosis, additional or missing renal blood vessels, and renovascular hypertension. Can assist in differentiating between renal cyst and renal tumor. Renal arteriograms are also included in the workup of a potential renal transplant donor. A catheter is inserted into the femoral artery and passed up the aorta to the level of the renal arteries. Contrast medium is injected to outline the renal blood supply.
Nursing Responsibility
Prepare patient evening before procedure by giving cathartic or enema. Before injection of contrast material, test for iodine sensitivity. The patient may experience a transient warm feeling along the course of the blood vessel when the contrast material is injected. After procedure, place a pressure dressing over the femoral artery injection site. Observe the site for bleeding. Have patient maintain bed rest with the affected leg straight. Take peripheral pulses in the involved leg every 30-60 min to detect occlusion of blood flow caused by a thrombus. Observe for complications, including thrombus, embolus, local inflammation, and hematoma.

Description & Purpose
Renal ultrasound is used to detect renal or perirenal masses, in differential diagnosis of renal cysts and solid masses, and in identification of obstructions. Small external ultrasound probe is placed on patient's skin. Conductive gel is applied to the skin. Noninvasive procedure involves passing sound waves into body structures and recording images as they are reflected back. Computer interprets tissue density based on Sound waves and displays it in picture form. Can be used safely in patients with renal failure.
Nursing Responsibility
Explain procedure to patient. Because radiation exposure is avoided, a number of images can be obtained and repeat studies can be done over a brief period of time. Images can be obtained from both the prone and supine positions. A bowel preparation is not required.

Description & Purpose
CT scan probides excellent visualization of kidneys. Kidney size can be evaluated; tumors, abscesses, suprarenal masses (e.g., adrenal tumors, pheochromocytomas), and obstructions can be detected. Advantage of CT over ultrasound is its ability to distinguish subtle differences in density. Use of IV-administered contrast medium during CT accentuates density of renal tissue and helps differentiate masses.
Nursing Responsibility
Explain procedure to patient. Ask patient about iodine sensitivity. The patient is instructed to lie very still during the procedure while the machine takes precise transaxial images. Sedation may be required if the patient is unable to cooperate.

Description & Purpose
MRI is useful for visualization of kidneys. Not proven useful for detecting urinary calculi or calcified tumors. Computer-generated films rely on radiofrequency waves and alteration in magnetic field.
Contraindications: Presence of implanted ferromagnetic clips or prosthesis, pacemaker, and some cardiac valves.
Nursing Responsibility
Explain procedure to patient. Have patient remove all metal objects. Patients with a history of claustrophobia may need to be sedated.

Description & Purpose
Magnetic resonance angiography allows visualization of renal vasculature. Gadolinium-enhanced studies allow visualization of the renal artery.
Contraindications: Same as above
Nursing Responsibility
Same as above. Does not require femoral artery puncture.

Description & Purpose
Cystogram is used to visualize bladder and evaluate vesicoureteral reflux. Also used to evaluate patients with neurogenic bladder and recurrent urinary tract infections. Can also delineate abnormalities of the bladder, such as diverticula, calculi, and tumors. Contrast material is instilled into bladder via cystoscopy or catheter.
Nursing Responsibility
Explain procedure to patient. If done via cystoscopy, follow nursing care related to cystoscopy.

Description & Purpose
Urethrogram involves the retrograde injection of contrast material into the urethra to identify strictures, diverticular, or other urethral pathologic conditions. When urethral trauma is suspected, a urethrogram is done before catheterization.
Nursing Responsibility
Explain procedure to patient.

Description & Purpose
Voiding cystourethrogram is a voiding study of the bladder opening (bladder neck) and urethra. The bladder is filled with contrast material. Fluoroscopic films are taken to visualize the bladder and urethra. After urination, another film is taken to assess for residual urine. Can detect abnormalities of the lower urinary tract, urethral stenosis, bladder neck obstruction, and prostatic enlargement.
Nursing Responsibility
Explain procedure to patient.

Description & Purpose
Loopogram is used to detect obstructions, anastomotic leaks, stones, reflux, and other uropathologic features when patient has a urinary pouch or ileal conduit. Because urinary diversions are created with bowel, there is risk of absorption of contrast medium.
Nursing Responsibility
Explain procedure to patient. The patient should be closely monitored for reactions to the contrast medium.