Urography

Since the introduction of organic media for excretion urography by Swick and von Lichtenberg (Swick, 1929; Swick and von Lichtenberg, 1929) which followed the synthesis of Uro-Selectan by Binz and Rath,* the value of this method of outlining the urinary tract has been increasingly appreciated. The di-iodinated compounds Uro-Selectan-B (von Lichtenberg, 1931) and Diodone (Binz et al., 1932) rapidly followed Uro-Selectan and remained the preferred contrast media for over 20 years. Refinements in technique, such as preliminary dehydration (Berger, 1937), the use of compression (Lubash, 1930; Kornblum, 1932) and tomography (Jochims, 1939; Bourne and Hefke, 1941), led to improved visualisation. During this period Hellmer anticipated much of what is still current practice. He recommended early examination in renal colic with the use of delayed films (Hellmer, 1935); he advocated the prone position in the investigation of hydronephrosis (Hellmer, 1946) and he clearly described the value of the nephrographic phase (Hellmer, 1942) not only for demonstrating cysts, tumours and the non-functioning moiety of a duplex kidney but also for showing the presence of central fat or a hydronephrosis (inverse pyelogram). The elaboration of tri-iodinated contrast media—first sodium acetrizoate (Nesbit and Lapides, 1950; Richardson and Rose, 1950) and then the diatrizoates (Moore and Mayer, 1953; Lowman et al., 1955) and iothalamates (Dotter et al., 1962; Steinberg and Evans, 1962)—represented a further step forward, both because of their increased radiodensity and, for the diatrizoates and iothalamates, lowered toxicity (Hoppé et al., 1956; Hoppé; 1959; Sessions et al, 1962).