CT Urogram

Could someone please explain what a CT urogram is and how a CT urogram is different from a CT of the pelvis/abdomen? How do doctors decide which one to use for surveillance related to BC? I thought I was supposed to have a CT urogram; however, X-ray has me scheduled for a CT of the pelvis/abdomen and the nurse confirms that is what my doctor ordered. Thanks.

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A Ct Urogram is in essence a Ct Abd/pel, although the IV contrast is given in 3 increaments over 8 minutes. The resulting images will show the renal arteries and veins, the kidneys in the arterial and excreatory phases and the ureters and bladder with contrast in them. Sagittal, coronal sections and a 3D model are usually also included.
It is a through exam that focuses on the
urinary system.
Expect to get a warm flushed feeling from the iv.

Also ask the ct tech if you should or can empty your bladder right before the procedure. For some patients it may be difficult or uncomfortable to hold the contrast in during the ct if you already have a full bladder.

I hope this helps.

Stan

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Dear Stan,
If I understand what you are saying, the CT urogram is a more thorough test for focusing on the urinary system than an ordinary CT pelvis/abdomen since the dye is given in increments. Do I have this right? Last year as part of my original testing when the BC was discovered, I had a regular CT pelvis/abdomen, and I think all of the dye was injected at a single time. If so, I wonder why my doctor ordered the regular CT of the pelvis this time since he is checking the upper tracts and ureters now? (The tumor he removed was right by the ureter opening and both the ureter and tumor had to be resected). I get so confused and nervous about all of the subtleties of BC treatment and follow-up. This just seems like one more thing that varies from urologist to urologist. At the same time, I know others in this group are dealing with much worse stuff like RC and invasive disease so I feel bad asking too much.

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It's hard to guess about how the doc actually wrote the order. It may have said "CT Abd/pel with Urogram" which would cover all bases, including the upper tract.
I would check with the doc before testing if it is a concern...it's your body and future at stake.

Stan

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A pelvic and abdominal CT with contrast will highlight the entire urinary tract from kidneys to bladder. Since CT scans take "timed" scans there are small areas (about 1 mm) between "slices" (the location of each scan). This is true whether the dye is sequentially given or given as a single bolus I think.

jj

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I asked the urooncologist the best screening for upper urinary tract and was assured that abdo/pelvic CT was adequate. Does this sound right?

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With a routine or standard ct abd/pel, the IV contrast is given in a bolus over 60-70 sec. Serial slices are then taken at various thicknesses with no gap between slices. 70 sec is the optimal time for proper liver, spleen and kidney cortical enhancement to r/o masses. At 70 sec the kidneys have not yet begun to excreate contrast , so the renal pelvis and ureters are absent of contrast. They are seen but not enhanced with contrast. Some sites will wait 3 minutes before scanning through the pelvis, enabling the distal ureters and part of the bladder to have some contrast within them.

With a ct urogram, more time is given for the entire urinary tract to "fill out" or be enhanced with contrast, hence the 8 minute delay. A small bolus is given just before the 8 min. scan time to show the renal cortex. The renal pelvis, ureters and bladder have had time to fill during the delay, hence all parts are seen with contrast enhancement.

Keep in mind that not all ct scans must be done with iv contrast, some patients can't have it because of their medical condition(s). A lot of information is obtained either way, but contrast makes the images more sensitive, especially when looking at the bladder. Again some bladder tumors will be seen either way if large enough.

I hope this might clear some confusion.

Stan

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Stan so to be accurate we should ask that the request form state CT urogram right?

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Sorry Stan, I forgot to say that there is no contraindication to contrast.

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Well that's exactly what I get and I don't think it's called a CT / Pelvis Admn Urigram...My radiologist called it something the other day but I can't remember what she said ust had one last week. They are keeping an eye on a "node" on my remaining kidney...Which has remained unchanged...but Stan is right. You can void before going into the scan but not during the scan and it can ome painful for those of us who has had a Nephroureterectomy with a Bladder cuff resectioning. But they take the die free pictures....Then pictures of your kidney "enhancing"...and then I do a `10 minute wait that includes rotating from side to side and letting your bladder "enhance" and fill to capacity. They told me it takes better pictures if the bladder extends. It's pretty much a CT...but the focus is on the urinary tract also. It can catch something in the urinary tract and it can see the major organs liver. spleen, pancreas kidneys, et. But what I do want to stress stress stress...The Dr. will get a pelimenary report that day just in case there is anything major, but they will get a Radiology report that will tell you everything. GET A COPY!!!!! I went undiagnosed for several months because nobody read that report. I have a copy of every radiology report and CT Scan. And always remember... A human interprets the findings on that CT....I'm gonna give you an example on how and why you should be your own advocate....Right after my kidney was removed I had a follow up CT....Before I ever got kidney cancer a had a adenoma which was benign on my left adrenal gland. The gland had to be removed because it hemmorraged. So I do not have a left adrenal but my left kidney is my only kidney remaining. Well my radiology report came back my Urologist got he read it and told me nothing was out of the ordinary. I got a copy of the report and on my way home I read the report and the radiologist said..."Both" adrenals unremarkable. I called back very upset and sure enough it did come down to they were reading a "tumor"..."node" whatever it is as my Adrenal Gland. Get a copy of everything..Read Everything. Do not think your Dr. is not human...He can overlook and he can make mistakes. It is human nature.

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Sorry for all the misspelled words it was late when I wrote this.

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Thanks to all of you...I now understand a lot more than I did before I asked the question here so I feel confident discussing my concerns with my urologist. Before you all explained things, I didn't know if I should ask the uro about my concerns or not. Now I will. I think the order is for a CT pelvis/abdomen KUB (maybe that means kidney, ureter, bladder?). I have this barium stuff I am supposed to drink and they will also be using a dye. I just hate having this BC so very, very much and it makes me very upset and nervous. I have not slept well all weekend. You guys help me a lot...thanks again.

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Best wishes to you. Hoping for a good result and relief from anxiety and fear.

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