DRIP INFUSION PYELOGRAPHY. INDICATIONS AND APPLICATIONS IN UROLOGIC ROENTGEN DIAGNOSIS.

Abstract

Iintravenous infusion of a large volume of dilute contrast material, as devised by Winchell and Arata (13), has proved a useful and versatile technic in urologic roentgen diagnosis. Excellent, anatomically complete pyelograms are consistently obtained (Fig. 1). The nephrogram is dense; the calyces, pelves, and ureters are completely filled. The resulting cystogram rivals the average retrograde bladder study in quality and allows for good voiding urethrograms. Early “minute sequence” and late “wash-out” films are easily obtained in the study of hypertensive patients. In addition, the technic has been diagnostic in chronic renal failure, where ordinary intravenous methods commonly fail. Drip infusion also provides a simple method for modified nephrotomography. The technic of drip infusion, its indications and adaptations, and our experience in more than 200 cases are the subject of this paper. Technic Understanding the principle of drip infusion is basic to proper technic. The drip infusion pyelogram achieves its excellence by virtue of hydration, diuresis, and complete filling of the urinary tract. A large volume of fluid must be given to insure this. Along with this fluid, a proportionately large amount of contrast material must also be administered to secure satisfactory contrast visualization of the collecting system. The recommended dosage is 1 c.c. per pound of body weight of 50 per cent Hypaque2 mixed with 1 c.c. per pound of 5 per cent dextrose in water. The minimal adult dose is 150 c.c. of each; or a total volume of 300 c.c. Diuresis is better if the patient is not dehydrated; fluids are not withheld prior to the examination. Ordinarily the intravenous infusion is allowed to drip rapidly (unrestricted) through an 18-gauge needle. While this usually takes six to ten minutes, the time for infusion is not critical. In older patients and in those with cardiac disease, a slower infusion rate is prudent. The optimal nephrogram occurs at the end of the infusion. Therefore, a film at ten minutes from the beginning of the study is best for evaluating the renal outlines. Filling and distention of the collecting system increase to a maximum at twenty to thirty minutes from the start of the infusion, and therefore films are obtained at both times. If there is delayed excretion, as in cases of ureteral obstruction or renal failure, later films are obtained as necessary. Indications 1. A Second Procedure. While the drip infusion pyelogram is of excellent quality, it is prohibited as a routine primary procedure by the increased monetary cost. The bulk of drip infusion pyelograms are obtained following inadequate standard excretory urography. Whenever a repeat double dose or retrograde study is considered, drip infusion is preferentially employed to good advantage (Fig. 2). The infusion is often started immediately after the initial unsatisfactory study.