Retrograde pyelography

Published by Bupa's Health Information Team, January 2011.

This factsheet is for people who are having retrograde pyelography, or who would like information about it.

Retrograde pyelography is an X-ray test used to examine the upper urinary system (kidneys and ureters).

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About retrograde pyelography

In retrograde pyelography, a contrast fluid (special contrast dye that shows up in X-rays) is injected into the tubes that carry urine from your kidneys to your bladder (ureters). The fluid travels up the tubes into your kidneys. X-ray pictures are taken during the procedure.

Retrograde pyelography can help identify obstructions such as kidney stones, tumours, blood clots or narrowing in the kidneys or ureters.

The position of the kidneys and surrounding structures

What are the alternatives?

Your doctor may suggest alternative imaging tests, such as an intravenous urogram, plain X-rays of the urinary system, a CT (computed tomography) scan or kidney (renal) ultrasound.

Retrograde pyelography is only done if other tests haven’t given useful results or if you have poor kidney function which makes it difficult to do other tests.

Preparing for a retrograde pyelography

Retrograde pyelography may be done as a day case, which means you have the test and go home the same day. If you need to have a catheter afterwards, you may stay in hospital for up to two days.

The procedure is usually done under general anaesthesia. This means you will be asleep during the test. Sometimes, it's done under spinal or regional anaesthesia. This completely blocks feeling from the waist down and you stay awake. You may also have a sedative with regional anaesthesia to relieve anxiety and help you relax. Your surgeon will talk to you about which type of anaesthesia is most suitable for you.

If you’re having general anaesthesia, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your anaesthetist’s advice.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

Usually, a radiographer (a health professional trained to perform imaging procedures) operates the X-ray machine and produces images on film or in digital format.

Your surgeon or radiographer will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You must tell your surgeon or radiographer about any medicines you are taking and if you have any allergies, glaucoma or heart disease. If you’re a woman of childbearing age, you must tell your surgeon or radiographer if you could be pregnant. X-rays are safe for adults, but may harm your developing baby. If you're pregnant, your surgeon will discuss alternatives to the procedure.

What happens during a retrograde pyelography

Retrograde pyelography usually takes 10 to 20 minutes.

Your surgeon will carefully pass a rigid telescope (called a cystoscope) through the urethra (the tube that carries urine from your bladder and out of your body) into your bladder. A camera attached to the end of the tube allows your surgeon to examine the inside of your bladder.

Next, your surgeon will insert a thin tube (catheter) through the cystoscope into the opening of the ureters and inject the contrast fluid. An X-ray machine positioned above your pelvis will take pictures as the contrast fluid flows through the ureters into the kidneys. Afterwards, the contrast fluid is drained away and your surgeon will remove the catheter.

You will be given intravenous antibiotics to reduce your risk of urinary infection.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may have some blood in your urine after the procedure but this is normal.

You will be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Your surgeon may talk to you about your results immediately after the test or at a later date. Alternatively, a report may be sent to the surgeon who recommended your test.

Recovering from retrograde pyelography

Drink plenty of clear fluids over 48 hours to help flush your bladder and reduce your risk of infection.

Contact your GP if you develop any of the following symptoms, as you may have developed an infection:

• severe pain or pain that lasts for more than 48 hours
• high temperature
• a burning sensation on passing urine, or urine that smells
• heavily blood-stained urine

What are the risks?

As with every procedure, there are some risks associated with retrograde pyelography. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor/surgeon to explain how these risks apply to you.

You will be exposed to some X-ray radiation. The level of exposure is about the same as the background radiation that you would receive naturally from the environment over a few years. Pregnant women are advised not to have retrograde pyelography as there is a risk the radiation may affect the development of the unborn child. If you are, or think you may be, pregnant, tell your surgeon before your appointment. He or she will discuss alternatives to the procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure.

Side-effects of retrograde pyelography include:

• feeling some discomfort when passing urine
• feeling mild stinging when passing urine
• some blood in the urine for a short time

Complications

This is when problems occur during or after the procedure. Most people are not affected. Complications of retrograde pyelography are uncommon but can include:

• urinary tract or bladder infection (cystitis) — you may need antibiotics to treat this
• damage to your urethra or bladder — this may require treatment with medicines or surgery
• urinary retention — you may need a temporary catheter to help drain urine from your bladder
• allergic reaction to contrast fluid — medicines are available to treat this

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.