A retrograde pyelogram is a type of x-ray that allows visualization of the bladder, ureters, and renal pelvis. Generally, this test is performed during a procedure called cystoscopy - evaluation of the bladder with an endoscope (a long, flexible lighted tube). During a cystoscopy, contrast dye, which helps enhance the x-ray images, can be introduced into the ureters via a catheter.
As the techniques and technology of ultrasound (high-frequency sound waves) and contrast dye have improved, other procedures such as intravenous pyelogram (IVP) and renal ultrasound have become more commonly used than retrograde pyelography.
Reasons for the Procedure
A retrograde pyelogram may be used in persons suspected to have an obstruction, such as a tumor, stone, blood clot, or stricture (narrowing) in the kidneys or ureters. It evaluates the lower portion of the ureter to which urine flow is obstructed. A retrograde pyelogram is also used to evaluate placement of a catheter or a ureteral stent - a wire mesh designed to prop open the ureter.
An advantage of the retrograde pyelogram is that it can be performed even if the patient is allergic to contrast dye because a minimal amount of the contrast dye is absorbed by the body (unlike another more common test called an intravenous pyelogram). The procedure may also be performed on persons with impaired kidney function.
There may be other reasons for your physician to recommend a retrograde pyelogram.
Risks of the Procedure
The amount of radiation used during a retrograde 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 retrograde pyelogram include, but are not limited to, sepsis, urinary tract infection, bladder perforation, hemorrhage, nausea, and vomiting.
A retrograde pyelogram may be contraindicated for patients experiencing severe dehydration.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
Certain factors or conditions may interfere with a retrograde pyelogram. These factors include, but are not limited to, the following:
- feces or gas in the bowels
- barium in the intestines from a previous barium 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 prior to 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 prior to the procedure.
- A laxative may be prescribed the night before the test and a cleansing enema or suppository may be given a few hours before the procedure.
- You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
- Based upon your medical condition, your physician may request other specific preparation.
During the Procedure
A retrograde 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, the retrograde pyelogram follows this process:
- You will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
- If you are asked to remove clothing, you will be given a gown to wear.
- An intravenous (IV) line may be inserted in your arm or hand.
- You will be asked to lie face up on the x-ray table and place your legs in stirrups.
- You may receive a sedative in the IV prior to the insertion of the endoscope.
- An endoscope will be inserted through the urethral opening and advanced into the bladder. Once the endoscope is in place, the bladder can be examined and a catheter may be inserted into one or both ureters.
- The contrast dye will be injected through the catheters.
- A series of x-rays will be taken at timed intervals.
- The catheter will be removed.
- The physician will check for retention of the contrast dye.
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 urinary opening
- increased pain around the urinary opening
- 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.