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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The definition of a retrograde stent
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).
What should you do to be ready for a retrograde pyelogram?
There are a few things you need do in advance of having an RPG created:
- Several hours before the surgery, go without food. On the night of the surgery, many doctors would advise you to refrain from eating and drinking after midnight. From four to twelve hours before the surgery, you might not be able to eat or drink.
- ingest a laxative To make sure your digestive tract is cleared out, you might be given an oral laxative or an enema.
- Take a break from your job. It only takes a few hours because it is an outpatient treatment. However, to keep you unconscious throughout the treatment, your doctor will probably administer general anesthetic. You’ll probably be unable to get to work and will require transportation home.
- Stop using specific drugs. Before the test, your doctor could advise you to cease taking blood thinners or specific herbal supplements.
Be sure to inform your doctor in advance if you’re:
- using any prescription or over-the-counter drugs
- pregnant or suspecting pregnancy
- any type of iodine or contrast dye allergy
- adverse reaction to a number of drugs, metals, or potential treatment materials, such as latex or anesthetic.
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 does an intravenous pyelogram do?
The size, shape, and structure of your kidneys, ureters, and bladder can be displayed to your healthcare physician via an IVP. If your healthcare professional suspects that you have:
This test may also be used by your doctor to identify the source of flank discomfort or pain spasms near the kidneys.
If there are kidney tumors or trauma-related renal issues, a CT scan of the kidneys will provide a more precise diagnosis.
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 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.
During a cystoscopy, a retrograde pyelogram is performed.
An X-ray is used during a retrograde pyelogram, a diagnostic procedure, to see inside your kidneys, bladder, and ureters. Your bladder and kidneys are connected by tubes called ureters.
A retrograde pyelogram is typically carried out in conjunction with another test called a cystoscopy.
Contrast dye is put into both ureters during this surgery. These dyes make certain body parts appear more distinct on X-rays.
The length of a cystoscopy.
Simple outpatient cystoscopies might take anything from five to fifteen minutes. The duration of a cystoscopy in a hospital under sedation or general anesthesia is between 15 and 30 minutes. Your cystoscopy procedure could proceed as follows: Your bladder will need to be empty.
What is an antegrade pyelogram?
An upper urinary tract obstruction is diagnosed with an antegrade pyelogram, a form of x-ray. During the procedure, a contrast dye is injected into the renal pelvis, which is the section of the ureter (the small tube that transports urine from the kidney to the bladder) closest to the kidneys. The movement of the contrast dye from the kidneys into the ureters and urine bladder can subsequently be seen on x-ray imaging.
The kidneys and ureters may be located during the process using fluoroscopy, a form of x-ray “movie, ” or ultrasonography, which uses high frequency sound waves.
What is an x-ray?
Invisible electromagnetic energy beams are used in X-rays to create images of inside organs, bones, and tissues on film. To create images of the body, its organs, and other internal structures for diagnostic purposes, X-rays use external radiation. A “negative” type picture is created when X-rays flow through body structures onto specially treated plates (similar to camera film) (the more solid a structure is, the whiter it appears on the film).
The kidney, ureters, and bladder (KUB) x-ray, computed tomography (CT scan) of the kidneys, renal ultrasound, renal angiography, intravenous pyelogram (IVP), retrograde pyelogram, and renal venogram are further related procedures that may be performed to diagnose issues with the upper urinary tract. For more details, please refer to following steps.