An imaging examination called a retrograde pyelogram employs X-rays to examine your bladder, ureters, and kidneys. The lengthy tubes that link your kidneys and bladder are called ureters. The cystoscopy procedure typically includes this test. It makes use of an endoscope, which is a lit, long tube. The doctor performing the cystoscopy has the option of directly injecting contrast dye into the ureters. On an X-ray, the contrast makes certain bodily components appear more distinct. Anesthesia is used during the examination.
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What distinguishes antegrade from retrograde pyelography?
Imaging of the urine collecting system is referred to as pyelography (or “pyelogram”).
The phrase is most frequently used in relation to “intravenous pyelography” (or “IVP”). According to others, the term “intravenous urography” is more appropriate for a test that visualizes intravenous contrast as it passes through the kidney parenchyma and into the urine collecting system. Both phrases are frequently used in the same context.
Pyelography can also be carried out antegrade following percutaneous access to the renal upper collecting system or retrograde through a catheter put into the distal ureter (e.g. through a percutaneous nephrostomy).
- backward pyelography
- Prior to pyelography
History and etymology
The name comes from the Greek terms puelos, which means “trough” or “basin” and refers to the urine collecting system, and graphia, which means “writing.”
How does a retrograde pyelogram work?
A retrograde pyelogram is an image made using X-rays and a dye injected into the ureters to provide detailed images of the urinary system’s components. The dye acts as a contrast enhancer to make the images more comprehensible. One or both ureters may be treated using the surgery.
The “When a liquid (urine) flow is retrograde, it signifies that it is moving in the opposite direction of how liquids typically move: outward. The “The term “pyelogram” describes images of a particular region of your kidney, the renal pelvis, which is close to where the ureter is attached. This process is also known as a retrograde pyeloureterogram.
What is the difference between a retrograde pyelogram and an intravenous pyelogram?
An intravenous pyelogram is a related procedure, except the dye is injected into your vein rather than your ureter. Both of them use contrast dyes to provide pictures of the upper urinary system. When you are allergic to contrast media and it cannot be injected into your vein, a retrograde pyelogram is performed.
The use of intravenous pyelograms has decreased over time. In order to detect bleeding, obstructions, or malignancies, providers now prefer to perform computed tomography (CT) urograms.
Why is a retrograde pyelogram done?
A retrograde pyelogram may be prescribed by your doctor if:
- Your ureter might have been harmed.
- Your ureter may be blocked or have a restricted area.
- Your kidneys, ureters, or bladder could all be affected by stones or tumors.
- To perform a ureteroscopy or implant a stent, your provider requires a clear image.
How common are retrograde pyelograms?
Retrograde pyelography was utilized more frequently in the past than it is today. Other imaging technologies have often taken its place. However, it is frequently combined with cystoscopy in situations like stenting to maintain pathways.
Does a retrograde pyelogram hurt?
A retrograde pyelogram is a short, comparatively painless treatment that aids in finding urinary tract problems. Additionally, it can aid your doctor in performing safe surgery or other urological operations.
There are dangers associated with any anesthesia-related surgery. Before having this surgery done, discuss your overall health and medical history with your doctor to prevent any long-term consequences.
A retrograde stent is what?
Each kidney has a tube called a ureter that leads to your urine bladder. It is the most typical location where a kidney stone becomes trapped and produces pain. A clogged ureter might happen for numerous causes. The ureter may contain scar tissue that is niching (termed a stricture). A tumor or inflammatory reaction in the pelvis or abdominal cavity may cause compression from outside the ureter. The ureter may have congenital abnormalities that are present at birth.
Sometimes a tube (stent) needs to be inserted into the ureter to clear the obstruction. To quickly diagnose or treat the issue, a specialized scope procedure (ureteroscopy) may occasionally be used. To unclog the kidney, a stent alone may be inserted sometimes. Once this is completed, a future surgery that is more conclusive might be performed. A stent may occasionally be removed at a later time without the need for additional therapies. Due to the placement of one end in the kidney and the other in the bladder, this stent is not visible from the outside of the body. A small thread may occasionally be tied to the bladder stent’s end and left dangling out of the urethra. Then, by pulling on the rope, the stent can be eliminated. If the string is missing, the stent can be removed in the office via a scope technique.
Hematuria may occasionally originate from the ureter or the kidney’s interior (blood in the urine). There are various methods for assessing a patient for hematuria. The inner kidney and ureters can occasionally be examined using specialized x-rays that involve injecting dye into a vein.
A retrograde pyelogram may be carried out sometimes. This occurs when the dye is administered during a cystoscopy operation directly into the ureter (as opposed to a vein). Your surgeon will go over the benefits of choosing this technique over an x-ray and intravenous injection. Prior to inserting a stent, a retrograde pyelogram may be performed to show the ureter’s anatomy or even to identify the source of an obstruction.
Preparation
Retrograde pyelograms and the implantation of stents don’t require any special preparation. You must fast for at least eight hours prior to the appointment, as with any surgery or operation needing anesthesia.
A retrograde pyelogram or stent implantation may occasionally be performed in the office with light sedation or without any medication at all. If so, we advise without eating for two to three hours prior to the surgery.
If your treatment is being done in a hospital, your anesthesiologist will have gone over the medications you should take the morning of your surgery during a prior consultation. Any medication will only be taken with a tiny sip of water. Please let us know if you were not told or if you forgot.
Procedure
To recap the main points of our office discussion: Depending on the specifics of the situation and the anatomy of the patient, the actual treatment could take anywhere from 15 minutes to an hour. You’ll be in the lithotomy posture (lying down on your back with your legs gently elevated in holsters called stirrups). The urethra and bladder are where the scope is inserted. Any abnormalities are checked for in the bladder.
Stent Installation: The ureteral orifice on the side of concern is located. This is the opening through which the ureter enters the bladder. The hole is filled with a wire, which is then threaded up the ureter and into the kidney. After that, a stent is inserted into the kidney over the wire. Once the position is satisfactory, the wire is removed, and the stent remains in the ureter. The stent has a curl on each side that aids in keeping it in place. To aid in the placement, we may employ ultrasound or x-ray guidance. Sometimes neither an ultrasound nor an x-ray are required.
The ureteral orifice (hole where the ureter enters the bladder) on the side of concern is located using a retrograde pyelogram. A tiny catheter is inserted into the opening. The catheter is then infused with X-ray dye, which is subsequently allowed to pass through the ureter and enter the kidney’s interior. We examine x-rays before, during, and after the injection to assess the inner kidney and ureter anatomy.
Post Procedure
You will stay in the recovery room following the procedure until you are ready to go. You might be watched for a short while before being allowed to depart if done in the office. Urination may cause you some discomfort. This is a cystoscopy result. Despite being made of soft plastic, the stent may cause some level of discomfort. On the other end of the spectrum, some people suffer really distressing symptoms. The signs can include any one or a combination of back or groin pain (like a stone is still there), frequent urination, urgency, or burning.
The symptoms could disappear after a single day or last for the entire time the stent is in place. But the majority of people only have bearable, very moderate symptoms.
Rarely does blood show up in the urine after the surgery. However, for a few days, a little amount of blood stains is possible. Blood in the urine is more common in men with big prostates or when there is a sharp stone in the ureter.
Expectations of Outcome
The wire or the stent cannot always be advanced into the kidney. It’s possible that the obstruction in the ureter (a stone or stricture) won’t pass. Sometimes it is impossible to catheterize the ureteral orifice, which is the opening to the ureter in the bladder. This would stop either action.
A man’s unusually big prostate may occasionally make it difficult to insert a wire or catheter into the ureter.
Possible Complications of the Procedure
No matter how complicated or lengthy a surgery is, unanticipated issues can arise. They could appear right away or perhaps fairly slowly. While we may have covered these and other topics during your appointment, we still want you to have a list in case you have any additional concerns. Every patient should be informed of all potential outcomes, which may include but are not limited to:
- Although we may give you antibiotics, it is still possible for you to get an infection in your urinary tract or bloodstream. The symptoms of burning urine, frequent urination, and a strong urge to urinate could be signs of a straightforward bladder infection. Taking antibiotics for a few days usually cures this. You can feel really ill if the virus spreads to your circulation. This sort of infection can show up as any combination of fevers, shaking chills, weakness or dizziness, nausea, and vomiting in addition to urine symptoms. You could need a brief hospital stay for observation, intravenous antibiotics, and hydration. Patients with diabetes, those taking long-term steroids, and those with immune system disorders are more likely to experience this issue. Additionally, individuals who already had a stent in place before this treatment tend to develop infections more frequently.
- Blood Clots in the Urine: As previously indicated, neither of these procedures typically result in severe bleeding. More serious bleeding may result in clots that restrict the flow of urine. It might be necessary to place a catheter to flush the clots out.
- Urinary Retention: In males, swelling of the prostate due to the scopes pressing against it or, less frequently, secondary to infection can occur even in the absence of bleeding. In this case, a catheter would be inserted, and your doctor would then go over the next course of action. Patients who already experience trouble peeing as a result of BPH before to the surgery are more vulnerable (benign prostatic hyperplasia).
- Ureteral Injury: Despite safety precautions, the catheter, stent, or wire may cause ureteral injury. In the event of ureteral injury, a stent can be inserted, and that is all that is required. Usually, the wound will heal on its own. The options include observation or the installation of another type of drainage if the stent cannot be inserted. Through a tiny incision in your back, a tube may need to be inserted into your kidney. Interventional radiologists are medical professionals who we occasionally ask to do this operation. The only way to treat a complete ureteral avulsion, which separates the ureter from the kidney or bladder, is with open surgery through an incision.
We make this literature available to patients’ families as well. It is meant to be a supplement to education that emphasizes some of the key ideas from earlier office discussions. Our in-person session covers alternative therapies, the reason for the procedure/surgery, and the topics in this handout (s).
Antegrade pyelography: What is it?
An imaging procedure called an antegrade pyelogram is used to detect obstructions in the upper urinary system. Your kidneys, ureters, and bladder are all parts of your urinary tract. The tiny tubes called ureters are responsible for transporting urine from the kidneys to the bladder.
What distinguishes a retrograde pyelogram from an intravenous pyelogram?
A pyelogram, sometimes known as a pyelogram or a urogram, is a procedure for visualizing the renal pelvis and ureter.
Types consist of:
- interstitial pyelogram In which the circulatory system receives a contrast solution through a vein.
- Backward pyelogram
- any pyelogram in which contrast material is administered and travels toward the kidney from the lower urinary tract (i.e. in a “retrograde” direction, against the normal flow of urine).
- pyelogram in antegrade (also antegrade pyelogram)
- a pyelogram where a contrast material mimics the normal flow of urine by moving from the kidneys to the bladder.
- A gaseous contrast medium is used in a gas pyelogram instead of a liquid one. It can also develop naturally when gas-producing microorganisms infect the uppermost regions of the urinary system.
What does the urology term “retrograde” mean?
An x-ray technique called retrograde pyelography is utilized to provide precise images of the kidneys and ureters. A particular dye (contrast agent) is injected into the ureters during retrograde pyelography. The dye improves x-ray visibility of the kidneys and ureters.
What is the purpose of a pyrography?
Your kidneys, ureters, and bladder are examined with an intravenous pyelogram (IV pyelogram). It enables your doctor to assess the size and shape of these structures as well as their functionality.
What does the surgical term “retrograde” mean?
Retrograde intrarenal surgery (RIRS): Using a fiberoptic endoscope as a viewing device, retrograde intrarenal surgery (RIRS) involves doing surgery inside the kidney.
In RIRS, the scope is inserted into the bladder through the urethra (the urinary opening), and then through the ureter into the kidney’s urine-collecting portion. As a result, the scope is advanced retrogradely (up the urinary system) to a location inside the kidney (intrarenal).
A stone may be removed using RIRS. Through the scope, the stone can be observed and handled, such as by using an ultrasound probe to crush it, a laser probe to evaporate it, a pair of tiny forceps to capture it, etc.
A urologist (endourologist) with specialized training in RIRS performs the procedure. Typically, either general or spinal anaesthetic is used during the surgery.
The benefits of RIRS over open surgery include a faster resolution of the issue, the elimination of protracted postoperative pain, and a significantly quicker recovery.
How long is a retrograde pyelogram with a cystoscopy?
Performing a retrograde pyelogram typically takes less than 30 minutes. Depending on the type of anaesthetic used during the test, recovery may take an hour or longer. Expect to spend roughly two hours overall, including paperwork. After the test, arrange to have a ride home. Do not count on receiving the retrograde pyelogram results before to departing.