What is Pyelogram Antegrade?

A pyelogram antegrade is a kind of x-ray that is utilized in order to diagnose an obstruction found in the upper urinary tract. During the procedure, fluoroscopy, which is a type of x-ray “movie” or an ultrasound, which are high-frequency waves are used. This procedure is used to visualize the ureters when other procedures such as intravenous pyelogram and retrograde pyelogram have not provided enough definitive information.

Effects of Pyelogram Antegrade

Through this procedure, the visualization of the ureters and the diagnosis of an obstructed upper urinary tract is made possible.

Candidates for Pyelogram Antegrade

This procedure is used for patients with suspected obstruction of the urinary tract because of a stricture or a narrowing, the presence of a kidney stone, a blood clot, or a tumor. In the event of an obstruction, the injected contrast dye is unable to move properly through the kidney which is detected on x-ray images.

Those undergoing surgical treatment, as well as those who have undergone a surgical treatment are candidates for a pyelogram antegrade. This is to assess their kidneys or ureters preoperatively and postoperatively. If a blockage is present, a nephrostomy tube may be inserted at the time of the procedure so that the flow of urine may be diverted past the obstruction.

Antegrade pyelogram may be recommended by your physician for a lot of other reasons besides those mentioned above.

Your Consultation

Before undergoing the procedure, the physician will give you a background and clarify the procedure to you. You will also be given the chance to ask any questions that you might have about pyelogram antegrade. A consent form will be given to you for signature giving permission to proceed with the treatment. It is important that you read the form carefully and if you see that something is not clear, feel free to ask questions. Prior to the procedure, you will need to fast for a certain amount of time as indicated by your physician. This could be for a few hours or overnight.

You should notify your physician if you are pregnant or if you suspect that you are pregnant. Any reaction to contrast dye experienced previously should be informed to your physician. Notify your physician if there are any allergies to iodine or seafood. Let your physician know any sensitivities or allergies to any medications, latex, tape, and anesthetic agents both local and general. Make a list of all medications that you are taking both prescribed and over-the-counter, as well as herbal supplements and give this to your physician.

History of bleeding disorders or if you are taking blood thinners or anticoagulant medications, aspirin, or medications that affect blood clotting should be reported to your physician prior to undergoing this procedure. It is possible that you have to stop these medications temporarily prior to pyelogram antegrade.

Preoperatively, a sedative is given for you to be able to relax. Since the sedative can make you drowsy, arrangements should be made for someone to drive you home after the procedure. Antibiotics may be given before and after the procedure. Other specific preparations may be requested by your doctor depending on your medical condition.

The Pyelogram Antegrade Procedure

This procedure may be done on an outpatient basis or as a part of one’s hospital stay. The procedure may differ depending on the condition and the practices of the physician.

This is the usual process followed for an antegrade pyelogram:

1. Clothing, jewelry, or objects that could cause interference with the procedure should be removed.

2. A gown will be given if you are asked to remove your clothes.

3. It may be possible to have an intravenous (IV) line inserted into your arm or hand.

4. You will be requested to lie prone or face down on the x-ray table. Iodine solution will be wiped on an area of the skin on your lower back in order to sterilize the area. Sterile drapes will be placed around it.

5. Injection of a local anesthetic is done. A needle will be advanced into the renal pelvis and the contrast dye will be injected with the aid of ultrasound or fluoroscopic guidance. A little discomfort may be felt during the injection of the local anesthetic and a brief feeling of warmth from the contrast dye.

6. As the dye travels through the ureters, a series of x-rays will be taken at timed intervals.

7. As soon as the needle has been inserted, a thin wire may be threaded through the needle allowing the positioning of catheters, the nephrostomy tube, or other devices.

8. In the case that a nephrostomy is not warranted, the physician may remove the needle.

9. Application of a sterile bandage/dressing is done.

Recovery

Depending on the type of procedure performed and the physician’s practices will one’s recovery process vary. The patient will be taken to the recovery room after the procedure for observation. Once the patient is alert and his or her blood pressure, pulse, and breathing stabilize, he or she will be taken to a hospital room or may be discharged to go home.

The urine output will be closely monitored for volume and any signs of blood; however, urine may be red from even a small amount of blood and is considered normal and does not necessarily point out a problem. Monitoring the urine output should be continued even if at home for a day or so.

One may experience a painful urination. A pain reliever for soreness may be taken as prescribed by the physician. Make sure that only recommended medications are taken as aspirin or certain kinds of pain medications may increase the chance of bleeding.

Risks

There is a risk for radiation exposure; however, this is very low as the amount of radiation used during antegrade pyelogram is considered minimal. If one is pregnant or suspects that she is pregnant, it is important to notify the physician, as radiation exposure at the time of pregnancy may lead to birth defects. A risk of allergic reaction is possible if a contrast dye is used. It is important to inform the physician for any allergies or sensitivities to medications, contrast dye, iodine, or shellfish.

Kidney failure or other kidney problems should be mentioned to the physician as there are cases wherein the contrast dye can cause kidney failure especially if the patient is taking Glucophage, a diabetic medication.

Likely complications in antegrade pyelogram include but are not limited to bleeding, blood clots in the nephrostomy tube if placed, or clots in the bladder, rapid heart rate, low blood pressure, and electrolyte imbalance because of a rapid urine loss after the placement of the nephrostomy tube.

One contraindication for antegrade pyelogram is patients with blood clotting disorders. Depending on the patient’s medical condition, other risks are possible. It is imperative that concerns are discussed with the doctor before undergoing the procedure.

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FAQs

What is a pyelogram antegrade for?

This procedure is used in order to visualize ureters and identify any obstruction of the urinary tract due to a stricture or narrowing, a kidney stone, a blood clot, or a tumor. It is also used for the purpose of assessing kidneys or ureters before and/or after a surgical procedure.

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What happens during this procedure?

A contrast dye is injected into a segment of the ureter, a slender tube that transports urine from the kidney to the bladder, that is closest to the kidneys called the renal pelvis. Through x-ray images, the flow of the contrast dye can then be monitored as it travels from the kidneys into the ureters and urinary bladder.

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What is an x-ray?

X-rays utilize electromagnetic energy beams that are invisible in order to create images of internal tissues, bones, and organs on film. By means of external radiation, x-rays are made to create images of the body, its organs, and other internal structures for diagnostic purposes. The x-ray passes through body structures onto plates that are specially treated and a “negative” type picture is formed. The structure appears whiter on film if the structure is more solid.

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What indicates that the procedure turned out successful or not?

The presence of fever and/or chills, redness, swelling, bleeding, or other drainage from the urinary opening should be reported immediately to the doctor, as well as increased pain in the area of the urinary opening, increased amount of blood in the urine, and difficulty in urinating.

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