Retrograde pyelogram

Overview 

A retrograde pyelogram is a medical imaging procedure that combines X-rays with a contrast dye to capture detailed images of the urinary system. The dye is injected directly into the ureters, the tubes that carry urine from the kidneys to the bladder, making the urinary tract more visible on X-rays. This procedure can be performed on one or both ureters to help identify blockages, stones, or other abnormalities.

Reasons for undergoing the procedure  

Retrograde pyelography was once a common procedure but has been largely replaced by more advanced imaging technologies. Despite this, it is still frequently used in conjunction with cystoscopy, particularly for procedures like stent placement to maintain open passageways. 

A healthcare provider might recommend a retrograde pyelogram if:  

• There is a possibility of ureteral injury.  
• A blockage or narrowing in the ureter is suspected.  
• Kidney, ureter, or bladder stones or tumors may be present.  
• A clear image is required for precise stent placement or ureteroscopy.  

Risk 

While no procedure is entirely without risk, retrograde pyelograms are considered very safe. Potential risks include:  

• Complications related to anesthesia.  
• Urinary tract infections.  
• Possible damage to areas of the urinary tract accessed by the cystoscope, such as the bladder and ureters. 

Before the procedure  

• Consultation: You’ll meet with your doctor to discuss your symptoms, medical condition, and any medications or over-the-counter products you’re taking. Be sure to mention if you’re pregnant, taking blood-thinner medications, or have any allergies. 
• Setting: This is typically an outpatient procedure performed in a hospital or a walk-in surgery center. 
• Anesthesia: Most likely, you’ll receive general anesthesia, so you will need someone to drive you home afterward. 
• Pre-procedure instructions: Your healthcare provider will let you know when to stop eating and drinking the night before the procedure and whether you can take your usual medications. 

On the day of the procedure: 

• Personal Items: Leave your jewelry and valuables at home. 
• Appearance: Avoid using lotions or makeup. 
• Attire: Wear loose, comfortable clothing for your comfort post-procedure. 

During the procedure  

You will be given a hospital gown to wear for the procedure. A member of the healthcare team will insert an intravenous (IV) line into your arm, and you will receive a sedative to help you relax. Most people undergoing retrograde pyelograms receive general anesthesia, although your provider may choose to use regional anesthesia instead. 

Procedure steps: 

• Preparation: 
  • You’ll be taken to an operating room and transferred to the operating table. 
  • Depending on the setup, you may need to place your feet in stirrups, or the table might be adjusted for the procedure. 

• Anesthesia: 
  • Once the anesthesia takes effect, your healthcare provider will begin the procedure. 

• Cystoscopy: 
  • A cystoscope is used to allow the provider to place a tube for injecting dye into the upper part of your urinary tract. 
  • The cystoscope and instruments will pass through your urethra into your bladder, and then be positioned in one of your ureters. 

• Dye injection and imaging: 
  • The provider will carefully inject dye into your ureter, ensuring no air bubbles are present. 
  • A series of X-rays will be taken once the dye is fully in place. 

• Completion: 
  • If the retrograde pyelogram is part of another procedure (like placing a stent or removing a stone), it will continue. 
  • If not, the scope will be withdrawn, and the anesthesia will be lessened as the procedure concludes.  

This process ensures detailed imaging of your urinary tract, aiding in diagnosis or treatment. 

After the procedure  

The healthcare provider will do the following after the procedure:  

• You’ll be transferred to a recovery unit where you’ll be monitored until the anesthesia wears off, and your blood pressure and breathing are stable.  
• In the recovery area, healthcare providers will examine your urine for any signs of blood and monitor your urine output. You may also be asked to track your urine output and its appearance once you’re home.  
• Your healthcare provider will give you detailed instructions regarding any medications to take or avoid, dietary guidelines, and when to contact their office if necessary.  
• Once cleared, you’ll be discharged and your driver may take you home.  

Outcome  

Undergoing a retrograde pyelogram offers several benefits:  

1. Safety for allergy sufferers: Since the dye used in the procedure remains localized and does not circulate throughout your body, it is generally safe for individuals with dye allergies.  
2. Immediate intervention: The use of a cystoscope and other instruments enables your healthcare provider to address specific urinary issues identified during the test. For instance, they may be able to remove stones or resolve a blood clot right away.  
3. Minimal radiation exposure: The procedure involves limited radiation exposure. It’s advisable to maintain a record of your medical procedures to keep track of your cumulative radiation exposure.  
4. Quick recovery: Recovery time can vary based on whether any additional procedures are performed. However, most patients can return to work or school within a few days. You can resume your normal diet and should ensure you stay well-hydrated. 

Contact your healthcare provider after a retrograde pyelogram if you:  

• Develop a fever.  
• Experience chills or shaking.  
• Have difficulty urinating.  
• Feel severe pain during urination.  
• Notice increased bleeding.