Ureterography

URETEROGRAPHY (from Greek ureter—ureter and grapho—I write), a method of obtaining an X-ray image of the contours of the ureter after the preliminary introduction of a liquid or gaseous contrast medium into its lumen. Ureterography is usually performed simultaneously with pyelography, since the ureter and the renal pelvis represent only different sections of the same urinary system of the kidney. The technique of ureterography is generally the same as that for pyelography; it is only necessary to continue the introduction of the contrast medium while simultaneously gradually withdrawing the ureteral catheter. In this way, the lumen of the ureter is filled with the contrast medium along its entire length, the bends of the ureter artificially caused by the catheter are eliminated, and the catheter does not straighten out existing bends. With intravenous pyelography (see), it is usually possible to obtain an image of the ureter only in the presence of an obstruction to the outflow of urine of mechanical origin (stone, stricture) or dynamic nature (disturbance of peristalsis, atony of the ureter), etc. Ureterography is performed, like pyelography, in the horizontal position of the patient. If it is necessary to determine the condition of the ureter in nephroptosis (presence of a kink, relationship between the ureter and the renal pelvis), it is recommended to take images in the standing position. In some cases, to determine the position (direction) of the ureter or to clarify the relationships between a shadow in the region of the ureter and its lumen, one is limited to radiography of the ureteral region after the preliminary introduction of an opaque catheter into its lumen. Every ureterography with a liquid contrast medium must be preceded by a simple X-ray image of the ureteral region. Ureterography makes it possible to recognize duplication of the ureter not along its entire length (ureter fissus—split ureter), crossed dystopia, and some other anomalies. Ureterography is indicated in nephroptosis to clarify the presence and nature (fixed or non-fixed) of a kink in the ureter. Ureterography is of particular value in cases of ureteral stones, determining the condition of the ureter above the stone (degree of dilation, etc.). In the presence of ureteral strictures (tuberculous or of another nature), ureterography contributes to clarifying their existence, location, the condition of the ureter above the narrowing, etc. In cases of suspected empyema of the ureter, ureterography makes it possible to obtain an image of the ureteral stump. Ureterography or radiography with an inserted opaque catheter determines the position of the ureter in cases of suspected retroperitoneal tumor or metastatic lesions of the retroperitoneal lymph nodes in malignant neoplasms of the testicles. In cases of neoplasms located in the lumen of the ureter, ureterography often shows a filling defect at the site of the tumor's localization. An image of the ureter can sometimes be obtained on an X-ray image when the urinary bladder is filled with a contrast solution (see Reflux).