Norm of Retrograde Pyelography
Bilateral, symmetric, and uniform opacification of ureters, renal calyces, and renal pelvis. Normal size and architecture of these structures. Superimposed films on inspiration and expiration normally show two outlines of the renal pelvis 2 cm apart.
Usage of Retrograde Pyelography
Assessment of displacement, drainage, enlargement, or fixation of the structures of the renal collecting system; detection of complete or partial obstruction as a result of blood clot, calculus, perinephric abscess, inflammation, stricture, or tumor formation; assessment for integrity of the renal pelvis and ureters after blunt trauma to the ureteropelvic junction. Also used in clients with bladder tumor, severe renal insufficiency, or hypersensitivity to iodine-based contrast material, and when visualization of the renal collecting system with excretory urography is inadequate.
Description of Retrograde Pyelography
Retrograde pyelography is an invasive radiographic (fluoroscopic) examination of the kidneys from a distal direction via the ureters. During cystoscopy, catheters are passed into the ureters, and radiopaque contrast material is injected. The mucous membrane absorbs minimal amounts of the iodine radiopaque contrast material. Thus the complications of hypersensitivity reactions or delayed excretion of the dye in renal impairment that are associated with intravenous dye injections are avoided.
Professional Considerations of Retrograde Pyelography
Consent form IS required.
Bladder perforation, hemorrhage, nausea, vomiting, urinary tract infection, vasovagal response.
Pregnancy (because of the radioactive iodine crossing the blood-placental barrier); severe dehydration. Sedatives are contraindicated in clients with central nervous system depression.
- See Client and Family Teaching.
- The client should disrobe below the waist.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- If deep sedation or anesthesia is used, monitor respiratory status and ECG continuously throughout the procedure.
- The client is placed in a dorsal lithotomy position, and a cystoscopic examination is performed (see Cystoscopy).
- A catheter is then advanced through the ureter(s) into the renal pelvis. After drainage of the renal pelvis, iodine radiopaque contrast material is injected through the catheter(s) into the kidney(s), and anterior, posterior, lateral, and oblique radiographic films are obtained. A small amount of contrast material may be injected into the ureters as the catheter is removed, and radiographs of the ureters may then be taken.
- The procedure may also be performed without cystoscopy by injection of the radiopaque contrast material into the lower ureter after wedging a bulb catheter at the distal end of the ureter.
- A ureteral or Foley catheter may be left in place after the examination.
- Continue assessment of respiratory status. If deep sedation or anesthesia was used, follow institutional protocol for post-sedation monitoring. Typical monitoring includes continuous ECG monitoring and pulse oximetry, with continual assessments (every 5–15 minutes) of airway, vital signs, and neurologic status until the client is lying quietly awake, is breathing independently, and responds to commands spoken in a normal tone.
- Monitor vital signs at the end of the procedure and then every 4 hours for 24 hours.
- Observe for signs of allergic reaction to the dye for 24 hours.
- Encourage the oral intake of fluids when not contraindicated. Monitor urinary output for quantity and hematuria for 24 hours. Notify physician for bladder distention, anuria, oliguria, or hematuria. Gross hematuria or persistent hematuria after the third voiding is abnormal.
- Notify the physician if there are symptoms of infection (fever, tachycardia, hypotension, chills, dysuria, flank pain).
- Resume previous diet.
- Administer analgesics as prescribed.
Client and Family Teaching
- This test helps to evaluate kidney structure.
- Fast for 8 hours before the procedure if general anesthesia is to be administered.
- A laxative may be prescribed the evening before the procedure. A cleansing enema may be prescribed to be given the morning of the procedure.
- A sedative may be prescribed to be given just before the procedure.
- After the procedure is over, save all the urine voided and report chills or pain with urination. Notify the physician if there are symptoms of infection (see item 6 under Postprocedure Care).
Factors That Affect Results
- Views are obscured by the presence of feces, gas, or barium in the bowel.
- Impaired renal function does not affect test results.
- If the renal pelves are not visualized by this exam, ureteral obstruction may be present and may be localized by antegrade pyelography (see separate test listing).