What Is It?
A retrograde pyelogram is a procedure allowing a physician to see the ureter and kidneys. Usually this test is used to diagnose kidney stones and tumors, or to see them more clearly to assess what treatments need to be offered to resolve tumors and stones.
During this procedure a doctor injects contrast die into the ureters which are tubes connecting the bladder to the kidneys. This die flows from the bladder to the kidney, which is the opposite of how urine typically flows. This is how the test gets its name, because this process is retrograde.
A retrograde pyelogram can help a doctor place a ureteral stent or perform a ureteroscopy as well, which is a procedure where the doctor examines the upper part of the urinary tract with an endoscope that passes through the bladder and urethra. A ureteroscopy is also often used to diagnose kidney stones.
Retrograde pyelography is usually done when an IVP also known as an “intravenous excretory study” or CT scan is not helpful because a patient has kidney or renal disease or is allergic to the contrast die they normally infuse into the patient for these tests. To complete this procedure a small tube must be inserted into the ureter so the doctor can inject the contrast material into the ureter and pelvis. A specific type of x-ray known as fluoroscopy is then used to help the doctor better visualize the internal organs. Usually general or regional anesthesia is used to complete this study.
Alternatives to Surgery
There are other imaging studies available including CT scans that also use contrast dies, however some patients seem to be more allergic to these than others. MRI or magnetic resonance imaging studies also take detailed studies of particular areas of the body although they may or may not provided as finite an image.
Before The Operation
Before the procedure you will consult with your physician and discuss any questions and concerns you have. You will also review your medical history and sign consent forms. You will need to abstain from food for 12 hours or a period defined by your doctor. You may need to discontinue certain medications for a certain period before the procedure as they may cause excessive bleeding or interfere with the accuracy of testing. Some patients may have to take a laxative or enema prior to the procedure.
After The Operation
The recovery process is usually simple. Patients are taken to a recovery room and have their vitals checked, including their blood pressure and puslse. Most patients are then discharged. It is important patients make note of their urine output. Some patients will notice a small amount of discharge or bleeding which is normal. Patients may also notice some pain. Any unusual symptoms including swelling, fever, excessive drainage or difficulty urinarting should be reported immediately. Other instructions may be offered at the time of discharge.
There are risks associated with this procedure including the risk of exposure to radiation associated with the x-rays used to visualize the kidneys and ureters after placeent of the device inside the ureters. There is also a risk of allergic reaction when contrast die is used. Some other complications may include a urinary tract infection, perforation or creation of a hole in the bladder, hemorrhage or uncontrollable bleeding, infection, vomiting or nausea. Some patients, especially those that are severely dehydrated, may not be suited to this procedure.
The kidneys serve many different functions, including removal of liquid wastes from the blood in the body and helping to balance out salts and other materials from the blood. The kidneys also are responsible for managing erythropoietin, which is a hormone that helps the body create red blood cells. The kidneys also help remove urea from the blood. All of these substances pass out of the kidneys through renal tubules.
Now, in addition to this there are two ureters that connect to the kidneys from which urine is passed to the bladder. There are muscles that typically work to prevent urine from backing up into the kidneys, but for one reason or another sometimes they do not work properly and urine does back up. This can result in an infection. Sometimes the ureters do not empty completely also which can also lead to infection.
The bladder itself is also part of the urinary tract. A retrograde pyelogram is helpful in diagnosing patients that are having problems with either the kidneys themselves or the ureters. Soemtims tumors or kidney stones or even blood clots can obstruct the flow of urine or block the ureters. The retrograde pyelogram can help diagnose this and also help with placement of a stent, which is often used to prop open the ureters to allow passage of urine.
Estimated Costs for Retrograde Pyelogram