Antegrade Pyelogram

An antegrade pyelogram is a type of x-ray used to diagnose an obstruction of the upper urinary tract. During the procedure, a contrast dye is injected into a portion of the ureter (narrow tube that carries urine from the kidney to the bladder) closest to the kidneys called the renal pelvis. The flow of the contrast dye can then be observed with x-ray images as it moves from the kidneys into the ureters and urinary bladder.

Fluoroscopy (a type of x-ray "movie") or ultrasound (high frequency sound waves) may be used during the procedure to locate the kidneys and ureters.

Reasons for the Procedure

An antegrade pyelogram may be used to visualize the ureters when other procedures, such as intravenous pyelogram and retrograde pyelogram, have not provided enough definitive information.

The antegrade pyelogram may be used to detect an obstruction of the urinary tract due to a stricture (narrowing), a kidney stone, a blood clot, or a tumor. In the presence of an obstruction, the injected contrast dye is unable to move properly through the kidney and this is detected on x-ray images.

An antegrade pyelogram may also be used to assess the kidneys or ureters before or after surgical treatment. If a blockage is found, a nephrostomy tube may be inserted during the procedure to divert the flow of urine past the obstruction.

There may be other reasons for your physician to recommend an antegrade pyelogram.

Risks of the Procedure

The amount of radiation used during an antegrade pyelogram is considered minimal; therefore, the risk for radiation exposure is very low.

If you are pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure during pregnancy may lead to birth defects.

If contrast dye is used, there is a risk for allergic reaction to the dye. Patients who are allergic to or sensitive to medications, contrast dye, iodine, or shellfish should notify their physician.

Patients with kidney failure or other kidney problems should notify their physician. In some cases, the contrast dye can cause kidney failure, especially if the person is taking Glucophage® (a diabetic medication).

Possible complications of antegrade pyelogram include, but are not limited to, the following:

• Bleeding
• Blood clots in the nephrostomy tube, if placed, or clots in the bladder
• Fast heart rate, low blood pressure, and electrolyte imbalance due to rapid urine loss after nephrostomy tube placement

An antegrade pyelogram may be contraindicated for patients with blood clotting disorders.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your physician before the procedure.

Before the Procedure

Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

• You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• You will need to fast for a certain period of time before the procedure. Your physician will notify you how long to fast, whether for a few hours or overnight.
• If you are pregnant or suspect that you may be pregnant, you should notify your physician.
• Notify your physician if you have ever had a reaction to any contrast dye, or if you are allergic to iodine or seafood.
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications before the procedure.
• You may receive a sedative before the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
• You may be given antibiotics before and after the procedure.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

An antegrade pyelogram may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

Generally, an antegrade pyelogram follows this process:

1. You will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
2. If you are asked to remove clothing, you will be given a gown to wear.
3. An intravenous (IV) line may be inserted into your arm or hand.
4. You will be asked to lie face down on the x-ray table. An area of skin on your lower back will be wiped with an iodine solution to sterilize the area, and sterile drapes will be placed around it.
5. Local anesthetic will be injected. With the help of ultrasound or fluoroscopic guidance, a needle will be advanced into the renal pelvis and the contrast dye will be injected. You may feel mild discomfort during the injection of the local anesthetic, as well as a brief feeling of warmth from the contrast dye.
6. A series of x-rays will be taken at timed intervals as the dye travels through the ureters.
7. Once the needle has been inserted, a thin wire may be threaded through the needle to allow placement of catheters, a nephrostomy tube, or other devices.
8. If a nephrostomy tube is not needed, the physician will remove the needle.
9. A sterile bandage or dressing will be applied.

After the Procedure

Your recovery process will vary depending upon the type of procedure performed and your physician’s practices. After the procedure, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.

Your urine output will be monitored closely for volume and signs of blood. It may be red from even a small amount of blood. This is considered normal and does not necessarily indicate a problem. You may be instructed to continue monitoring your urine output for a day or so once you are at home.

You may experience pain when you urinate. Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Notify your physician to report any of the following:

• Fever and/or chills
• Redness, swelling, or bleeding or other drainage from the insertion site
• Increased pain around the insertion site
• Increase in the amount of blood in your urine
• Difficulty urinating

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation