Radiology

Procedures

Bone Density Scan (DEXA)

Overview

Urology Associates offers a comprehensive Bone Density Study Department, complete with a full-size imaging table and a specifically trained professional to perform the exams.

Bone density measurement is used to determine the amount of mineral and calcium in your bones. The most commonly used test is Dual Energy X-ray Absorptiometry (DEXA). This involves lying on a table for 10-20 minutes while a low-dose x-ray beam scans your spine, hip, or both. There is no discomfort and no known risk from this diagnostic procedure, other than minimal radiation exposure.

What is a Bone Density Scan (DEXA)?

Bone density scanning, also called dual-energy x-ray absorptiometry (DXA or DEXA) or bone densitometry, is an enhanced form of x-ray technology that is used to measure bone loss. DEXA is today’s established standard for measuring bone mineral density (BMD).

DEXA is most often performed on the lower spine and hips. Portable DEXA devices, including some that use ultrasound waves rather than x-rays, measure the wrist, fingers or heel and are sometimes used for screening purposes.

Why is a Bone Density Scan Done in Urology?

Major treatment options for prostate cancer include surgery, radiation, hormonal therapy, chemotherapy, and watchful waiting.  Bone densities are done for patients that decide to go with hormone therapy to treat their prostate cancer and the effect it can have on your bones.

Testosterone is a male hormone produced primarily by the testicles. Testosterone can stimulate the growth of hormone dependent prostate cancer. As long as the body produces testosterone, prostate cancer will continue to spread. There are various types of hormonal therapies. The most common are:

1.  Drugs that reduce testosterone production by the testicles (i.e., LH-RH agonists).
2.  Surgical removal of the testicles (orchiectomy), which produce male hormones.
3.  Antiandrogen therapy to block the effects of testosterone.

Lupron, Zoladex, Eligard and Trelstar are types of hormonal therapy injections that many of our patients decide to use as their treatment option for prostate cancer. These LH-RH agonist drugs are used to shut down testosterone produced by the testicles. This decrease in testosterone can lead to other potential symptoms such as loss of Bone Mineral Density (BMD), which can eventually lead to osteoporosis.

A decrease or loss of testosterone affects bone regeneration, leading to bone weakness. Throughout our lives, our bones change, constantly renewing itself through a process called remodeling. In doing so, cells called osteoclasts break apart old areas of bone, and other cells called osteoblasts create new bone to fill in old areas. When this process is balanced, bone strength and bone health are maintained. When this process is not balanced, we start to see bone weakness.  Many of our urologists will monitor your bone mineral density on an annual basis if you decide to have hormonal therapy for prostate cancer to make sure it does not start to give you bone weakness.

How is the procedure performed?

The DEXA machine sends a thin, invisible beam of low-dose x-rays with two distinct energy peaks through the bones being examined. One peak is absorbed mainly by soft tissue and the other by bone. The soft tissue amount can be subtracted from the total and what remains is a patient’s bone mineral density.

DEXA machines feature special software that compute and display the bone density measurements on a computer monitor.

The DEXA examination measures bone density in the hip and spine, and  the patient lies on a padded table. An x-ray generator is located below the patient and an imaging device, or detector, is positioned above.

To assess the spine, the patient’s legs are supported on a padded box to flatten the pelvis and lower (lumbar) spine (as seen below).  To assess the hip, the patient’s foot is placed in a brace that rotates the hip inward. In both cases, the detector is slowly passed over the area, generating images on a computer monitor.

The patient must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. The technologist will walk behind a wall or into the next room to activate the x-ray machine.

How do I get my results?

A test report is produced from the computer that is attached to the bone density machine.  Often, you will be scanned and seen by your urologist immediately after your scan. Some of our urologists will bring you back on another day to discuss the results.  

Your test results will be in the form of two scores:

T score

This number shows the amount of bone you have compared with a young adult of the same gender with peak bone mass.  A score above -1 is considered normal. A score between -1 and -2.5 is classified as osteopenia, the first stage of bone loss.  A score below -2.5 is defined as osteoporosis. The T score is used to estimate your risk of developing a fracture.

Z score

This number reflects the amount of bone you have compared with other people in your age group and of the same size and gender.  If this score is unusually high or low, it may indicate a need for further medical tests.

CAT Scan or CT Scan

CT Scan FAQ

What is Computerized Tomography (CT) or CAT Scan?

CT (Computerized Tomography) or CAT (Computerized Axial Tomography) is a highly advanced computerized x-ray machine used to obtain images—or slices—of the body in the axial plane, much like slices of bread. The CT scanner obtains image data from different angles of the body, and then uses computer processing of the information to show a cross-section of body tissues and organs with great clarity. Below is an example of a CT image of the abdomen:

Image 1:  Normal right kidney size and function

Image 2:  Normal left kidney size and function

In August 2005 we installed our own CT scanner to assist in the determination of urologic conditions for our patients.  CT imaging gives our urologists the ability to provide treatment plans for kidney stones, hematuria (blood in the urine), kidney masses, and other diagnoses. For the most part, our urologists will order studies revolving around the pelvis and abdomen.

How does the procedure work?

Inside the CT scanner is a doughnut shaped rotating gantry that has an x-ray tube mounted on one side, and an arc-shaped detector mounted on the opposite side. An x-ray beam is emitted in a fan shape as the rotating frame spins the x-ray tube and detector around the patient. Each time the x-ray tube and detector make a 360-degree rotation and the x-ray passes through the patient’s body, the images are reconstructed by a dedicated computer into a two-dimensional image of the section that was scanned.

CT1.jpeg

How is the CT scan performed?

The technologist begins by positioning the patient on the CT table.  As the study proceeds, the table will move slowly into the CT scanner. Depending on the area of the body being examined, the increments of movement may be so small that they are almost undetectable, or large enough that the patient feels the sensation of motion.

CT2.jpeg

Your physician may have ordered your study to be done with contrast in order to enhance the visibility of certain tissues or blood vessels.

How Should I Prepare for the Procedure?

You should wear comfortable, loose fitting clothing for your CT exam. Metal objects can affect the image quality, so please avoid clothing with zippers and snaps. You may also be asked to remove hairpins, jewelry, eyeglasses, hearing aids, and removable dental work.

Is CT Imaging Safe?

Yes, CT imaging is considered a safe examination.  In general, the diagnostic benefit of a CT scan outweighs the risk of x-ray radiation exposure or injection of imaging contrast (if applicable). If your procedure involves contrast, we pre-screen all patients for prior contrast reactions, history of renal insufficiency, and diabetes to avoid any contrast reactions.  Pregnant women should not have a CT exam or any x-ray examination, especially if the woman is in her first trimester (first of three 3-month periods of pregnancy).

Please inform your physician’s staff or the CT technologist if there is any chance you may be pregnant.

Patient CT Results

All of our CT studies are read in a digital manner by the radiologists at Sierra Imaging Associates.  This type of joint venture makes it possible for a radiologist to read the CT study within 30 minutes, and in emergent cases we get results within the hour.  The radiologist is responsible for everything that is scanned, so often incidental findings come up that are not related to urology but we will refer to the proper doctor to resolve your problem.  The result service we receive makes it possible for us to treat our patients in a very fast and efficient manner. We have a dedicated CT scheduler who sets up your appointment and also requests any prior CT of the abdomen and pelvis you may have had in the past.  These prior studies are requested and used by the radiologist to track time progression of a given condition you may have, and is very important in the reading of your study. Unless we are waiting on prior studies to be delivered for comparison results are usually ready on the same day of examination.

Depending on your urologist’s protocol, you may be brought back to the office for a follow-up appointment, or you may receive a phone call with your results.    

CT Billing

Sierra Imaging Associates located here in Fresno is a radiology center that reads all of our CT and ultrasound studies done in our office.  Sierra Imaging bills for the professional component (CT reading)of the study, and they will bill your insurance. Please be advised you may receive a bill from Sierra Imaging.  Urology Associates of Central California (UACC) will be billing your insurance for the technical component of the study, which is the actual scan. You may receive a bill from us as well if you have an out-of-pocket expense from your insurance.

CT Preparation

Studies Without Contrast

Please do not eat or drink anything 4 hours prior to the exam.

Studies With Contrast

You should have received one bottle of oral contrast from our office.  Please shake the bottle of contrast before drinking. You may refrigerate the contrast to make it taste a little better.  Do not eat or drink anything at least 4 hours prior to your appointment.

1. You may take all non-diabetic medications as you normally do with  water, even if it is during the four-hour time frame.

1. Diabetic patients taking Glucophage     type medications (i.e., Glucovance, Advandamet, Metformin HCL) must discontinue their use 2 days before the CT study.  You must not take this medication for a period of 2-5 days after the study. These medications can reduce the body’s ability to flush the IV contrast from your kidneys.    

1. Drink the first bottle of oral contrast 1 hour prior to your appointment.

1. You will be given a second bottle of oral contrast to drink 15 minutes prior to your CT study in our office.  

1. You will be asked to drink about 16 oz. of water immediately before the exam.

Ultrasound

Ultrasound FAQ

What is Ultrasound Imaging?

Ultrasound imaging (also called ultrasound scanning or sonography) is a method of obtaining images from inside the human body through the use of high frequency sound waves. The reflected sound wave echoes are recorded and displayed as a real-time visual image. No ionizing radiation (x-ray) is involved in ultrasound imaging.

Ultrasound is a useful way of examining many of the body’s internal organs, including but not limited to the heart, liver, gallbladder, spleen, pancreas, kidneys, and bladder. For urological purposes, your physician has probably ordered a renal (kidneys), pelvic, abdominal, scrotal, or penile ultrasound. Combinations of these procedures may be ordered as well (for example, renal and pelvic ultrasound).

How Does the Procedure Work?

Ultrasound scanners consist of a console containing a computer and electronics, a video display screen, and a transducer that is used to scan the body.

The transducer is a small hand-held device about the size of a bar of soap, attached to the scanner by a cord. The transducer functions as both a generator of sound (similar to a speaker) and a detector (like a microphone).

• Our technologist spreads lubricating gel on the area being examined and then presses the transducer firmly against the skin to obtain images.

• When the transducer is pressed against the skin it directs inaudible, high-frequency sound waves into the body.

• As the sound echoes from the body’s fluids and tissues the transducer records the strength and character of the reflected waves.

These echoes are instantly measured and displayed by the scanner computer, which creates a real time picture on the monitor.  These images are digitally sent over to a radiologist who will read and report the ultrasound to your urologist. Below is an example of a sonographic image of a left kidney.

Renal US Image.jpeg

How Should I Prepare for the Procedure?

You should wear comfortable, loose fitting clothing for your ultrasound study. Other preparation depends on the type of examination you will have.

Please refer to the inside flap of this brochure for exam-specific preparation.

For example, an abdominal ultrasound requires you to fast for 8-12 hours, with no food or drink after midnight.

Where Do I go for my Ultrasound?

Your ultrasound study will be done in our main office, but not in the same area of the office you go to see your urologist. Please enter the building through our main entrance and make a right. Ultrasound is located in the second doorway to the right in the same area as our laboratory.

• Have a seat in the small waiting area and one of our sonographers will call your name at the time of your procedure.

• Also, feel free to ask our greeter Donna where you are supposed to go for an ultrasound, and she will direct you to this location.

Ultrasound Preparation

Abdominal Ultrasound

• Fast for 8-12 hours. No food or drink after midnight.
• Bring prescribed medication to take after the exam is finished.
• Bring a snack to eat (if needed) after the exam is finished.
• Dress in loose fitting clothing, if possible.
• This exam should take 30 minutes.

Renal Ultrasound

• Drink 24 ounces of water one hour before the exam. do not empty your bladder!
• Dress in loose fitting clothing, if possible.
• This exam should take 30 minutes

Pelvic Ultrasound

• Have a full urinary bladder.
• 32 to 40 ounces of clear fluid should be ingested one hour prior to your exam, and finished within a 15-20 minute time period.
• Do not empty your bladder!  If for any reason the patient cannot retain a full bladder, a Foley catheter will be used.
• This exam should take 30 minutes.

Prostate Ultrasound and Biopsy

Your Prostate

Just below your bladder and in front of your rectum is a small, muscular gland called the prostate.  It wraps around the urethra, the tube that carries urine from your bladder. Your prostate produces most of your semen.

prostate_urinary.jpeg

At risk for cancer

If cells in the prostate change abnormally, cancer may form.  Cancer often appears in the outer area of the prostate (near the rectum) before spreading to the inner areas of the gland. Usually, there are no symptoms unless the growth begins to press on the urethra, which will cause you some pain.  Below are some examples from left to right of a normal prostate and open urethra, then you have a small tumor that still allows an open urethra. The last image on the right shows large prostate tumor growth causing a narrowed urethra that will cause pain and effect the flow of urine.

      (Prostate_tumor3)               (Prostate_tumor2)              (Prostate_tumor1)

Why you need a prostate ultrasound biopsy

If a potential prostate problem is identified through a digital rectal exam or a PSA (Prostate-Specific Antigen) blood test, your doctor may suggest that you have a prostate ultrasound and biopsy.  This imaging technique, along with a biopsy, helps your physician discover cancer early, when it is more likely to be treatable.

What ultrasound reveals

Ultrasound uses high-frequency sound waves to create an image of the prostate gland. This can help your doctor identify abnormalities in the gland.

How ultrasound is performed

The ultrasound test is simple and will be performed at Urology Associates of Central California (UACC). The test takes about 15 minutes. To clear your rectum, you will be asked to use a Fleets Enema.  If a biopsy is performed, you will be given antibiotics both before and after the test to prevent infection. One of our ultrasound sonographers will conduct the ultrasound portion of the exam, and your urologist will do the prostate biopsy.  In some instances your urologist may conduct the ultrasound portion of the test as well.

Creating the image

You will lie on your side or with your feet in stirrups. A tube-like probe barely bigger than a thumb is covered with a condom. Your doctor gently inserts the probe into your rectum.

The probe emits sound waves, creating an image of your prostate on a video screen. Your doctor views the image, looking at the size, shape, and structure of your prostate.

If a biopsy is needed

If your doctor finds suspicious areas in your prostate or if your PSA blood test is abnormal, a biopsy may be recommended. To do the biopsy, your doctor takes tissue samples from the suspicious areas of your prostate for examination. A biopsy is often performed during the ultrasound test.

Taking the prostate biopsy sample

• The small tip of the biopsy needle is inserted through your rectum into your prostate.

• One or more tissue samples are taken from the prostate (this is only slightly uncomfortable). Your tissue samples are then sent to a lab for pathology analysis.

After your biopsy

When the results of your biopsy are ready, your doctor will talk with you about the results, and any further exams or treatment that may be needed.

• You may notice some rectal bleeding or blood in your urine for a few days.

• You may see blood in your semen for 2-3 weeks.

• Ask your doctor if you should temporarily limit exercise or sexual intercourse after your biopsy.

• Call your doctor if you have a fever, excessive urinary or rectal bleeding, muscle aches, fatigue, or difficulty urinating.

Preventing future problems

Ultrasound alone is not a complete prostate exam; it is used to check abnormalities found by other tests. Even if your ultrasound shows no problems, continue to have regular prostate exams. The American Cancer Society recommends yearly digital rectal exams for men over age 40 and yearly PSA blood tests for men over age 50. If you are African American or have a family history of prostate cancer, you are at high risk.

Ultrasound Prostate Biopsy Preparation Instructions

You are scheduled for an ultrasound with possible biopsy of the prostate gland. Please follow these instructions:

1. Two hours before the exam give yourself or have someone give you a Fleets Enema (Regular). You may purchase this at any pharmacy.
2. The morning of the exam, take one of the antibiotic pills that you were given.
3. The morning after the exam, take the second antibiotic pill that you were given.
4. Your physician will give you instructions regarding your postoperative care.
5. If you take aspirin products regularly, discontinue use 5-7 days prior to your procedure. If you take any blood thinners please remind your physician so that he may instruct you.

If you have any questions, please feel free to call our office at 559-321-2800.  If you are unable to keep this appointment, call us and we will reschedule your appointment for you.

Your biopsy specimen will be sent to a local hospital for analysis by a pathologist, and additional charges will be incurred for this service. The pathology facility will bill for these charges independent from Urology Associates of Central California.

When entering the front entrance of our facility make a right, and you will enter the 2nd doorway on the right in our laboratory and ultrasound departments.  

X-Ray

VCUG (Voiding Cystourethrogram)

Overview

A cystogram is an x-ray examination of the urinary bladder, which is located in the lower pelvic area.  A cystogram can show the bladder’s position and shape, and the exam often is used to diagnose a condition called reflux.  Reflux occurs when urine in the bladder moves back up the ureters, the tubes that transport urine from the kidneys to the bladder. This condition can cause repeated urinary tract infections.  A cystogram may be performed after a patient has experienced a pelvic injury to ensure that the bladder has not torn. Cystograms also are used to detect polyps or tumors in the bladder. The x-ray below shows a sample of a cystogram with the black arrow pointing out the bladder, and the white arrow shows the catheter in the bladder.

Cystogram.jpeg

During the Examination
You will be positioned on your back on the x-ray table, with your knees flexed. Your pubic area will be washed, and then the radiographer or a radiology nurse will gently insert a small, flexible catheter into your urethra, the duct from which you urinate. Skin tape may be used to hold the catheter to your inner thigh.

Next, a radiologist (a physician who specializes in the diagnostic interpretation of medical images) or a urologist (a physician who specializes in conditions of the urinary system) will slowly fill your bladder with a contrast agent. The contrast agent is a substance that helps make organs easier to see on radiographs and is administered through the catheter. You will feel pressure and fullness in your bladder and will have an urge to urinate.

After your bladder is full, the physician will take radiographs using fluoroscopy. A fluoroscope is an x-ray unit attached to a television screen. You will be asked to lie on your side or to turn slightly from side to side while the physician watches your bladder on the TV screen. The radiographer also may take a few additional x-ray images.

Following this portion of the exam, the catheter will be removed, and you will be allowed to use the restroom. In addition to being sticky, the contrast agent that you expel is clear and odorless, so it will not be visible to you. After you return to the x-ray room, an additional x-ray image will be taken. This final radiograph will show whether any contrast agent stays in your bladder following urination. Any remaining contrast will be expelled the next time you urinate.

Voiding Cystourethrogram
Voiding cystourethrograms follow the same routine as cystograms with one difference.  Toward the end of the examination, when the urinary catheter is removed, you will be asked to urinate into a special urinal.  Radiographs will be taken while you urinate. These images will show the size and shape of the bladder when it is under stress caused by urination.

Patient Preparation
Before your examination, a radiographer will explain the procedure to you and answer any questions you might have. A radiographer, also known as a radiologic technologist, is a skilled medical professional who has specialized education in the areas of radiation protection, patient care and radiographic positioning and procedures.

If you are a woman of childbearing age, the radiographer will ask the date of your last menstrual period and if there is any possibility you are pregnant. Next, the radiographer will ask if you have any allergies. It is important to list all allergies to food and medicine, as well as to let the radiographer know if you have a history of hay fever or asthma. Some allergies may indicate a possible reaction to the contrast agent that will be used during the examination.

You will be asked to put on a hospital gown and then the radiographer will direct you to the restroom and ask you to completely empty your bladder.

IVP

What is an Intravenous Pyelogram (IVP)?

An IVP is an x-ray examination of the kidney, ureter, and urinary bladder. It can be performed for the following patient complaints:

• Flank pain (pain in the side of the trunk between the right or left upper abdomen and the back)
• Hematuria (presence of blood in the urine)
• Frequent urination
• Dysuria (painful urination)
• Suspected renal calculus (kidney stones)
• Urinary system tumors
• Urinary Tract Infection (UTI)

The test involves taking a series of radiographs after injecting non-ionic contrast material (dye) into a vein, usually in the arm. The contrast agent flows through the veins, is excreted by the kidneys, and enhances the x-ray images of the kidneys, ureter and bladder.

If a kidney stone is blocking the ureter, the contrast agent builds up in the affected kidney and is excreted more slowly. An IVP can take a very long time if the blockage to the kidney is severe. Most kidney stones (e.g., calcium stones) can be precisely located using this procedure.

What Should I Expect During the IVP?

You will be asked by the radiologist to lie on your back. A radiograph of your kidneys, ureter, and bladder may first be taken without non-ionic contrast material. You may be asked to turn from side to side and hold several different positions to enable the radiologist to capture views from several angles.

A needle will be put into a vein in your arm or hand, and the contrast material will be injected. The first radiograph will be taken about one minute after the dye is injected. More radiographs will be taken after 5, 10, 15, 20 and 30 minutes. Sometimes “moving” pictures called tomographs (TOME-o-graphs) are also taken.

At the end of the test, you may be asked to urinate. Another radiograph will be taken to see if urine has stayed in your bladder. The test usually takes about 45 minutes to one hour.

What Kind of Side Effects Might I Experience?

• Besides the minor sting from the injection of contrast material, an IVP causes no pain. When the contrast material is injected, some people report feeling a flush of heat, and at times a metallic taste in the mouth. Do not worry about these common side effects, as they disappear within a couple of minutes.

• Some people experience a mild itching sensation caused by an allergic reaction to the contrast material. If it persists or is accompanied by hives, the itch can be treated easily with medication.

• In rare cases a patient may have shortness of breath or experience swelling in the throat or other parts of the body.  Your x-ray technologist will closely monitor the patient throughout the study.

IF YOU ARE A DIABETIC…

Diabetic patients who are taking glucophage type medications (i.e., Glucophage,Glucovance, Adandament, Metformin), should discontinue their use for 48 hours prior to your IVP exam.  Please remain off these medications for a period of 3 to 5 days after the study, as per your doctor’s instructions. These medications may reduce the body’s ability to flush out the contrast

IVP Preparation Instructions

Please complete all steps

1. Please purchase a bottle of Magnesium Citrate from a local pharmacy, and take it at approximately 12:00 noon the day prior to your study.  Please note: Use this product only as directed on the bottle, or per your physician’s instruction. This is a laxitive so stay close to a restroom.  

1. Take all three Dulcolax (Bisacodyl) laxatives (at the same time) the day before your examination at about 4:00 p.m.  Dulcolax is available in our office, or from any pharmacy. Please note: Individual response to laxatives varies. The Dulcolax should work within 30 minutes, but may take as long as 3 hours. Remain close to a restroom as multiple bowel movements may occur.

1. The following refers to the day before your exam; please do not consume carbonated drinks.  You must be on a clear liquid diet. You may drink fruit juices without pulp (apple, white grape, orange, lemonade, etc), Gatorade type sport drinks, Kool-Aid, water, tea, or coffee (no milk, or non-dairy creamer), bouillon/broth, popsicles (no sherbets, or fruit bars).

1. Do not eat or drink anything after midnight the night before your exam.

1. If you are on prescribed medications (e.g., blood pressure medicine, etc.) you may take them with just a sip of water, enough to swallow them safely. Do not take vitamins 24 hours prior to the x-ray.

The contrast material used for IVP studies will not discolor your urine or cause any discomfort when you urinate.  If you experience such symptoms after your IVP exam, please notify your physician as soon as possible. This symptom likely indicates a different kind of problem.

IF THERE IS A POSSIBILITY OF PREGNANCY…

Please notify your physician or the radiology department prior to your scheduled exam.

If you are unable to keep your appointment, please call our office 48 hours prior, so that we may reschedule your appointment.

KUB (Kidneys, Ureters, Bladder)

Overview

A KUB  (kidneys, ureter, and bladder)  produces a radiographic image of the kidneys, urinary bladder, gas patterns of the bowel and the lower outline of the liver. This examination may be ordered when a patient has received an injury to the abdominal area or is experiencing unexplained pain.  An abdomen x-ray may help to diagnose the source of nausea, vomiting, pain, or other abdominal symptoms.  It can help to detect kidney stones, locate a foreign object that has been swallowed, and assess whether there is air or fluid in the spaces surrounding the abdominal organs. 

Abdomen x-rays are performed by a radiologic technologist, a skilled medical professional who has received specialized education in the areas of anatomy, radiation protection, patient care, radiation exposure, radiographic positioning and radiographic procedures. 

What happens during the x-ray?

You probably will be asked to lie down on the x-ray table, although in some cases the radiograph will be taken while you are standing. To ensure that you are properly positioned on the table, the radiographer will look for anatomical landmarks. He or she will touch the sides of your abdomen and your pelvic bones to position you correctly. You will be asked to hold your breath while the exposure is made. It is important not to move during the exposure, because any movement will blur the image.

A lead-equivalent rubberized shield might be used to cover your reproductive organs, unless its use would interfere with the examination. Sometimes the area that needs to be examined would be hidden if a shield were used.

Once the examination is complete, the radiographer will process your x-ray films, determine whether they are technically acceptable and assess whether additional films are needed. The films then will be given to a radiologist, a physician who specializes in the diagnostic interpretation of medical images.

How do I get my Results?

In most cases, your urologist will interpret the results himself immediately after the x-ray is taken.  Your urologist will look at the x-rays and talk with you during your office visit about what was seen. In my instances your urologist will show you the x-rays to give you a better understanding of the findings.

Loopogram

Overview

A loopogram is an x-ray of your ileal conduit.  This x-ray shows your kidneys, your ureters, your ileum (the loop of bowel that the ureters are now attached to), and your stoma (the opening on the outside of your abdomen).  Contrast material (x-ray dye) is used to make these parts of the body show up on x-ray pictures. The dye is injected into your stoma through a thin catheter.

Loopogram FAQ

Why am I having a Loopogram?

Your doctor has scheduled you for this x-ray to check your anastomosis site (the place at which your ureters are connected to your ileum).  Your exam may be just a follow-up exam or you may be having symptoms that indicate a problem with your normal urine flow. These symptoms may include abdominal pain, bloody or foul-smelling urine or decreased urine output in your drainage bag. Ask your doctor to explain more about why you are having this exam.

How do I prepare for this x-ray?

There is no preparation required for this exam

What happens during the x-ray?

You will be asked to put on a hospital gown.

You will be assisted onto a special x-ray table. The technologist or doctor will either remove your ostomy bag or cut a small opening in the front. An x-ray doctor will place a thin lubricated catheter into your stoma. The doctor will use a syringe of air or water to inflate a small balloon at the end of the catheter. This balloon will help seal off the opening of your stoma during the exam.

Next, the catheter will be connected to a bottle of clear x-ray dye. As the dye flows inside your body, pictures will be taken. You may be asked to move in different positions. As each x-ray is taken you will be asked to hold your breath and remain as still as possible.

How do I get my Results?

In most cases, your urologist will interpret the results himself immediately after the x-ray is taken.  Your urologist will look at the x-rays and talk with you during your office visit about what was seen. In my instances your urologist will show you the x-rays to give you a better understanding of the findings.

Nephrostogram

Overview

A nephrostogram (neh FROST o gram) is an x-ray of the kidney collecting system and ureter.  Doctors inject x-ray contrast (dye) through the nephrostomy tube so the collecting system and ureter show up on x-ray pictures.  This exam also shows how your kidney drains urine through your ureter to your bladder.

Nephrostogram FAQ

Why am I having a nephrostogram?

Your doctor has scheduled you for this x-ray to check the placement of your nephrostomy tube and to see how well your kidney is draining.  This may be done because you are having problems with your kidney or your nephrostomy tube. Symptoms may include pain, leaking at the tube site, or decreased urine output in your drainage bag.  This exam may be done as a follow-up to see if your kidney is draining properly so the nephrostomy tube can be removed.

How do I prepare for this x-ray?

There is no preparation required for this exam.

What happens during the x-ray?

We will ask you to put on a hospital gown and help you onto the x-ray table.  The x-ray staff and doctor will explain more about your exam and answer your questions.  We will ask you to sign a consent form and ask about allergies you have to medicines or x-ray

The x-ray technologist will help you get into the most comfortable position that will show your back and your nephrostomy tube.  We may remove the bandage covering your nephrostomy tube. The x-ray technologist will clean your back and tube with iodine and place sterile towels around the tube on your back.  It is important that you do not touch these towels.

How do I get my Results?

In most cases, your urologist will interpret the results himself immediately after the x-ray is taken.  Your urologist will look at the x-rays and talk with you during your office visit about what was seen. In my instances your urologist will show you the x-rays to give you a better understanding of the findings.

Retrograde Urethrogram

Overview

Retrograde Urethrogram is an x-ray examination of the urethra, the small tube that connects your bladder to the outside of your body.  Contrast material is injected into the urethra through the opening to the outside of your body. This contrast material allows the urethra to be seen on the finished x-ray film.

How do I prepare for a Retrograde Urethrogram?

There is no preparation required for this exam.

What happens during the x-ray?

An x-ray technologist will help you onto the table, where you will lie on your back.  One x-ray will be taken of your urethra and bladder before the contrast material is injected.  The urethral opening to the outside of your body will be cleaned with an antiseptic solution. Your urologist will put a small tube (catheter) or the tip of a syringe about ½ inch into the urethral opening.  A small amount of contrast material will be injected while x-rays are taken. This may be repeated a few times until all of the x-rays are taken. You will then be allowed to go to the bathroom and urinate the remaining contrast material from your bladder.

How do I get my Results?

In most cases, your urologist will interpret the results himself immediately after the x-ray is taken.  Your urologist will look at the x-rays and talk with you during your office visit about what was seen. In my instances your urologist will show you the x-rays to give you a better understanding of the findings.