Intravenous Pyelography

THE demonstration of contrast material in the urinary organs is made possible by two methods: First, through the filling up of these organs by the introduction of instruments into the interior of the body—instrumental pyelography or urography; second, by utilizing renal function as the dispenser of contrast media—e-excretion pyelography or urography. This can be effected through the introduction of contrast media by mouth, rectum, or vascular system, especially by vein. This latter method, intravenous pyelography, and the disclosures made by it, form the subject of this report. Intravenous pyelography is entering upon a momentous period of development. Although the idea is not new, experimental knowledge is universally limited, for it is but recently that reliable means have become available; therefore, it is not possible at the present time to form any conclusive opinion, and a report can afford only a glimpse into a newly discovered land. On the basis of over six hundred clinical investigations, and intensive labor in the field of urography, I shall endeavor to convey this glimpse to you. I should like particularly, wherever possible, to state the indications and limitations of intravenous pyelography, and I thank the German Rontgen Society for entrusting to me the presentation of this report. A few brief remarks relative to the history of intravenous pyelography may be permitted. The first experiments were undertaken by Völcker and myself in 1905, immediately following the announcement of instrumental pyelography. These experiments were not successful, due to the toxicity of the colloidal heavy metals used at that time. In 1923, Rowntree and his collaborators made public the first promising experiments with excretion pyelography. For this purpose sodium iodid was used. The result of their experiments must be accepted as the first proof that this method, in its essential points, was feasible. In connection with this publication, I, too, together with Rosenstein, took up the work, using sodium iodid with the aid of pneumoradiography, but found it of no clinical value. The experiments of Volkmann, in this direction, were also without result. Lenarduzzi and Pecco were the first to ligate the ureter, in animal experimentation, utilizing the blockage for the purpose of increasing the concentration of the contrast substance. This method also had at first only theoretical value. It was Roseno who, through the intravenous administration of an iodin-urea compound, achieved clinical results, and fostered the theory essentially. His method was then supplemented by the researches of Ziegler and Köhler, who added materially to the previously tested compression of the ureter.