Retrograde Ureteropyelography

Definition

A retrograde ureteropyelogram provides x-ray visualization of the bladder, ureters, and the kidney (renal) pelvis by injection of sterile dye into the renal collecting system.

Purpose

A retrograde ureteropyelogram is performed to determine the exact location of a ureteral obstruction when it cannot be visualized on an intravenous pyelogram (a dye is injected and an x ray taken of the kidneys and the tubes that carry urine to the bladder). This may occur due to poor renal function and inadequate excretion of the contrast medium (dye).

Precautions

The doctor should be made aware of any previous history of reactions to shellfish, iodine, or any iodinecontaining foods or dyes. Allergic reactions during previous dye studies is not necessarily a contraindication, as dye is not infused into the bloodstream for this study. Other conditions to be considered by the physician prior to proceeding with the test include pregnancy and active urinary tract infection.

Description

After administration of anesthesia, the doctor will insert a thin, tubelike instrument (catheter) through the patient's urethra and into the bladder. A catheter is then placed into the affected ureter to instill the contrast medium. X-ray pictures are taken to visualize the ureter. If complete obstruction is found, a ureteral catheter may be left in place and secured to an indwelling urethral catheter to facilitate drainage of urine. The procedure takes approximately one hour.

Preparation

Laxatives or enemas may be necessary before the procedure, as the bowel must be relatively empty to provide visualization of the urinary tract. When general anesthesia is used for insertion of the ureteral catheter, there should be no eating and drinking after midnight prior to the procedure.

Aftercare

Even if no catheters are left in place after the procedure, the patient may have some burning on urination for a few hours after the procedure due to the irritation of the urethra. The discomfort can be reduced by liberal fluid intake, in order to dilute the urine. The appearance and amount of urine output should be noted for 24 hours after the procedure. If a stone was found, all urine should be strained to allow chemical analysis of any stones passed spontaneously. This will allow the doctor to provide advise on measures to prevent recurrent stone formation. Antibiotics are usually given after the procedure to prevent urinary tract infection.

Normal results

A normal result would reveal no anatomical or functional abnormalities.

Abnormal results

Abnormal results may indicate:

• congenital abnormalities
• fistulas or false passages
• renal stones
• strictures
• tumors

Resources

ORGANIZATIONS

American Kidney Fund (AKF). Suite 1010, 6110 Executive Boulevard, Rockville, MD 20852. (800) 638-8299. 〈http://216.248.130.102/Default.htm〉.

National Kidney Foundation. 30 East 33rd St., New York, NY 10016. (800) 622-9010. 〈http://www.kidney.org〉.