Adiss Ababa university

Collage of health
science School of
medicine
Department of medical radiology technology
Procedure group assignment
Submission to:

Submission date
Group members ID number
Feven Moges UGR/1934/14

Selamawit Admas UGR/3565/14

Genet Alemgena UGR/0359/14

Mubarek Umer UGR/8823/14

Nardos Amanuel UGR/8722/14

Ruhama Birhanu UGR/1244/14

Yemenzwerk nguse UGR/8113/14

Table of contents
Introduction....................................................1
Pre procedure................................................1
Intra procedure...............................................3
Post procedure................................................7
Summary..........................................................8
Reference…......................................................9
 Retrograde pyelography

Introduction
Retrograde pyelography also called retrograde pyeloureterography is a non-functional radiologic
procedure, which use a contrast media that is introduced by a means of catheterization in a retrograde
way through the ureter via the bladder into the ureter to take radiographs and diagnostic abnormality of
the ureter and kidney. It is often used to check for urinary tract blockages, such as tumor or stone.
Blockages are more likely to show up in kidneys or ureters, Urinary tract blockages can cause urine to
collect in your urinary tract, which can lead to complications.

This test is usually done during a test called cystoscopy. It uses an endoscope, which is a long, flexible,
lighted tube. During a cystoscopy, the healthcare provider can inject contrast dye directly into the
ureters.

Pre procedure
Patient preparation

 Explain the whole procedure to the patient before the start of the procedure and ask the
patient to sign a consent form that gives permission to do the procedure.
 Advise the patient to take laxatives at night before the examination after considering the
patient's medical history.
 Stop blood thinner and diabetic medicine 1-2 days before the examination.
 Ask the patient about pregnancy status and contrast hypersensitivity also bleeding history.
 The patient should micturate before the procedure.

Informed consent
The consent form for retrograde pyelography would typically include:

1. Explanation of the procedure: The form should explain what retrograde pyelography is, why it is being
done, how it will be performed, and what risks are involved.

2. Risks and benefits: The form should list the potential risks and benefits of the procedure. Risks may
include infection, bleeding, allergic reactions, or damage to surrounding organs. Benefits may include
improved diagnosis and treatment of kidney or bladder problems.

3. Alternative options: The form should describe alternative options to retrograde pyelography,
including other imaging tests or procedures.

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4. Anesthesia: If anesthesia will be used during the procedure, the form should explain the type
of anesthesia, how it will be administered, and any associated risks.

5. Consent: The form should include a section for the patient to sign, indicating that they understand
the risks and benefits of the procedure and consent to it being performed.

6. Contact information: The form should include contact information for the healthcare
provider performing the procedure in case the patient has any questions or concerns before or
after the procedure.

Contrast media
 Water-soluble iodinated contrast media is commonly used in retrograde pyelography. It is
preferred over oil-based contrast media as it has a lower risk of complications and is easier to
eliminate from the body.
 Both LOCM and HOCM can be used in retrograde pyelography, depending on the specific
needs of the patient and the imaging goals of the procedure.
 LOCM is often preferred in patients with a history of allergic reactions to iodinated contrast
media or those with pre-existing kidney disease.
 Examples of LOCM used in retrograde pyelography include iohexol (Omnipaque) and
iopamidol (Isovue).
 HOCM, on the other hand, has a higher osmolality and is more concentrated than LOCM. This
makes it more effective in providing high-contrast images, However, HOCM is associated with a
higher risk of adverse reactions, particularly in patients with a history of allergies or kidney
problems
 Examples of HOCM used in retrograde pyelography include diatrizoate (Hypaque) and
iothalamate (Conray).

 Dose 10-20 mL for each collecting system

Equipment preparation
 Fluoroscopy ● Syringe
 Cytoscope ● Catheter
 Radiographic cassette. ● Gloves
 Endoscopy. ● Contrast media

To prepare the equipment for retrograde pyelography, the following steps should be taken:

1. Gather all necessary equipment: This includes a catheter, contrast dye, syringes, X-ray machine, and
any other necessary instruments.

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2. Clean and disinfect all equipment: All equipment must be thoroughly cleaned and disinfected
to prevent infection. This can be done using an autoclave or other sterilization methods.

3. Prepare the contrast dye: The contrast dye should be prepared according to the health care
provider instruction.

4. Set up the X-ray machine: The X-ray machine should be set up and tested to ensure it is
functioning properly.

Intra procedure
Pathology identification (Indication)

1. When IVP failed or is inconclusive

2. In patients who cannot receive intravenous radiographic contrast due to
renal insufficiency or adverse reaction to it and also in patient in whom a
previous intravenous urogram (IVU) are incompletely evaluated.
3. Hematuria: a condition in which a blood is seen in the urine it could be gross that is seen
by a naked eye or microscopic when the use of microscope is needed
4. Hydronephrosis: is a condition where one or both kidneys become stretched
and swollen as the result of a build-up of urine inside them.

Figure 1,The arrow in the figure indicates the

dilated lower collecting system of the left kidney

5,Puj obstruction: also known as pelviureteric

junction obstruction, is a condition in which
there is a blockage or narrowing at the point

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where the renal pelvis meet the ureter. This can result in urine backing up into the kidney, causing
swelling and damage.

Figure 1.2, Intraoperative retrograde studies

demonstrating a dilated right renal pelvis with calyceal dilation and a tortuous narrowing ureteropelvic
junction

6, Renal calculi :are kidney stones ,development of the stones is related to decreased urine
volume or increased excretion of stone-forming components such as calcium, oxalate, uric acid,
cysteine, xanthine, and phosphate. Calculi may also be caused by low urinary citrate levels or
excessive urinary acidity.

Figure 1.3, Retrograde pyelogram showing distal ureteral filling defect with dilated upper pole
ureter proximal to stone, lower pole stone exiting medially without dilation.

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7,Renal cancer: Renal cancer, also known as kidney cancer, is a type of cancer that develops in the cells
of the kidneys. Symptoms of renal cancer may include blood in the urine, abdominal pain, weight loss,
and fatigue

Figure 1.4 Right retrograde pyelogram demonstrates large filling defect in

midureter due to transitional cell carcinoma (large arrow)

Contraindication
 Acute urinary tract infection
 Pregnancy
 Complete ureteral obstruction
 Recent instrumentation
 Barium in the intestines from a past barium test.
 Stool or gas in the intestine
 Contraindications to anaesthesia

Positioning of the patient

Lithotomy

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The lithotomy position has the patient lying on the dorsum with the knees, as well as the hips flexed at
90 degrees. The hips are also abducted to about 30 degrees, while the calves are supported on
appropriately padded leg supports.

Radiographic technique

 Tell the patient to remove any clothing, jewelry, or other objects that may get in the way of
the test.
 Give a hospital gown to wear for the procedure.
 Tell to lie face up on the X-ray table and place your legs in stirrups (lithotomy position)
 Full length preliminary AP film
 A sedative or general anesthesia should be given in the IV before putting the endoscope in, an
endoscope through the opening in your urethra is inserted and moved into the bladder. Once
the endoscope is in place, the bladder can be imaged.
 Radio-opaque ureteric catheter is inserted by cystoscope into one or two ureters.
 Contrast injection made under fluoroscopic control.
 Stop injection if there is pain or flank fullness.
 Injection should be slow with fluoroscopic table head down.
 Films where taken in AP 35 oblique position with elevation of contralateral side after injection.
 Then catheter withdrawn 5 cm and injection continued.
 Spot radiographs are taken during injection.
 Radiograph taken after catheter withdrawal of the catheter to show the presence of hold up.

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 Post procedure
Image evaluation

 Both kidneys, ureters and bladder (the entire urinary system) should be clearly visible.
 Renal calyces and renal pelvis should be clearly visible.
 Unless sclerosis is present, the spine should be straight and centered to the film.

A. Minor calyces. E. Right or left proximal ureter

B. Major calyces. F. Distal ureter
C. Renal pelvis. G. Bladder
D. Ureteropelvic junction

Patient monitoring and consultation

 After the procedure, the patient will be taken to the recovery room to be watched until
the anesthesia wears off and the patient become fully awake and stable.
 Check for vital signs such as blood pressure, heart rate and oxygen saturation regularly.
 Once the blood pressure, pulse, and breathing are stable and they are alert, they will be
taken to their hospital room or sent home.
 Urine output will be watched closely for volume and signs of blood. It may be red from even
a small amount of blood. This is normal and doesn't necessarily mean a problem.
 The patient should be told to keep watching their urine output for a day or so once even at
home for few days. This usually means urinating into a graduated container and recording
the

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 amount. There could be pain and feeling of soreness and a burning sensation when urinating yet
the discomfort must be minimal.
 A pain reliever for soreness as recommended by the healthcare provider can be taken but apirin
or certain other pain medicines may increase the chance of bleeding. Only recommended
medications should be taken.
 The patient should increase fluid intake because drinking plenty of fluids helps flush out contrast
medium and help prevent urinary tract irritation/infection.
 Give the patient a follow-up appointment to evaluate results of the procedure and for
further treatment plans.

If there are any feelings of

 Fever or chills
 Redness, swelling, or bleeding or other drainage from the urinary opening
 Increased pain around the urinary opening
 bright red bleeding from the urethra ( A little blood or pink-tinged urine after a retrograde
pyelogram or cystoscopy is common)
 Trouble urinating,
The healthcare provider must be contacted and may give other directions, depending on the situation.

summary
Retrograde pyelography is a diagnostic procedure used to assess the condition of the urinary tract. It
involves injecting a contrast dye into the ureter and capturing X-ray images as it travels through the
bladder and into the kidneys. This procedure helps identify abnormalities or blockages in the urinary
system, such as kidney stones or tumors. The findings from retrograde pyelography aid healthcare
professionals in determining appropriate treatment plans for patients. Overall, this procedure provides
clear and detailed images that assist in accurate diagnoses and effective treatment strategies.

In conclusion, retrograde pyelography is a valuable diagnostic procedure that plays a crucial role in
assessing the condition of the urinary tract. By injecting a contrast dye and capturing X-ray images,
healthcare professionals can identify abnormalities and blockages in the urinary system, leading to
accurate diagnoses and effective treatment plans. With its ability to provide clear and detailed images,
retrograde pyelography aids in improving patient outcomes and ensuring appropriate care.

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 References
 Rod Brouhard, EMT-P Updated on November 07, 2022, Medically reviewed by Matthew
Wosnitzer, MD https://www.verywellhealth.com

 https://images.app.goo.gl/PtzzG7gyCxmE1kTF8

 A Guide to radiological procedure Fourth Edition

 https://quizlet.com/479183131/retrograde-pyelogram-diagram/

 https://images.app.goo.gl/PtzzG7gyCxmE1kTF8

 https://my.clevelandclinic.org/health/treatments/22684-retrograde-pyelogram

 https://radiopaedia.org/images/39080732?case_id=60501

 https://s3.amazonaws.com/static.wd7.us/c/ca/Rim-Sigh.jpg