Surgical Management Cystoscopy With Retrograde Pyelogram: Procedure

Surgical Management
Cystoscopy with Retrograde Pyelogram

PROCEDURE
A retrograde pyelogram is a type of x-ray that allows visualization of the bladder, ureters, and renal pelvis. Generally, this
test is performed during a procedure called cystoscopy - evaluation of the bladder with an endoscope (a long, flexible lighted
tube). During a cystoscopy, contrast dye, which helps enhance the x-ray images, can be introduced into the ureters via a catheter.
A tube is passed from the bladder into the kidney followed by contrast media injections into a vein to show up the ureter
(the tube that carries urine from the kidney to the bladder) and the kidney on x-ray. A sample of urine from the kidney is collected.
If a blockage in the ureter is found, a stent (plastic tube) will be put into the ureter to keep the tube open.
In our client’s case a double J-stent was used. A thin, hollow tube placed inside the ureter during
surgery to ensure drainage of urine from the kidney into the bladder. J shaped curls are present at both
ends to hold the tube in place and prevent migration, hence the description "Double J stent". Stents are
placed in the ureter which is the tube that runs from the kidney to the bladder. A stent is placed to
prevent or relieve a blockage in the ureter. After many stone surgeries the small pieces of stone can
drop down into the ureter and block it, causing severe pain and occasionally infection. A stent allows
the ureter to dilate, which makes it easier for stones or stone fragments to pass.
Reasons for the Procedure
A retrograde pyelogram may be used in persons suspected to have an obstruction, such as a tumor,
stone, blood clot, or stricture (narrowing) in the kidneys or ureters. It evaluates the lower portion of the
ureter to which urine flow is obstructed. A retrograde pyelogram is also used to evaluate placement of a
catheter or a ureteral stent - a wire mesh designed to prop open the ureter.
An advantage of the retrograde pyelogram is that it can be performed even if the patient is allergic to contrast dye because
a minimal amount of the contrast dye is absorbed by the body (unlike another more common test called an intravenous
pyelogram). The procedure may also be performed on persons with impaired kidney function.
RISKS OF THIS PROCEDURE
There are some risks/ complications, which include:
(a) Allergic reaction to the contrast media used as part of the x-ray, which may need emergency treatment.
(b) Rarely damage to the urethra - the passage that brings the urine out of the bladder. A false passage may be produced causing
leakage of urine or in the long term narrowing that may affect flow of urine. An open operation may be required to repair the
damage.
(c) Damage may occur to the bladder with puncturing of the bladder. This may need further surgery.
(d) Swelling at the exit of the bladder which may stop passage of urine. A tube (catheter) may need to be put in place to drain the
urine until the swelling goes down.
(e) Bacteria may get into the blood stream with the development of septicaemia. Further treatment with antibiotics may be
necessary.
(f) The tube may pass outside the ureter into the tissues. This may need further surgery to remove and replace the tube.
(g) Bleeding which may stain the urine colour and sometimes cause blockage of urine flow.
(h) Burning and scalding of urine for a few days after the procedure. This usually settles.
(i) The catheter may not be able to be passed through the ureteric opening and up to the kidney because of a blockage.
(j) The indwelling stent may cause bladder irritation and blood in the urine occasionally.The stent is usually removed after a few
weeks.
(k) Rarely, damage to ureter. A stricture may form (very rarely).
Before the Procedure

• The physician will explain the procedure and offer the opportunity to ask any questions that the client might have about
the procedure.
• Client will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask
questions if something is not clear.
• Client will need to fast for a certain period of time prior to the procedure. The physician will notify how long to fast, whether
for a few hours or overnight.
• Notify physician if client have ever had a reaction to any contrast dye, or if you are allergic to iodine.
• Notify physician if client is sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and
general).
• Notify physician of all medications (prescribed and over-the-counter) and herbal supplements that client is taking.
• Notify physician if client have a history of bleeding disorders or taking any anticoagulant (blood-thinning) medications,
aspirin, or other medications that affect blood clotting. It may be necessary to stop these medications prior to the
procedure.
• A laxative may be prescribed the night before the test and a cleansing enema or suppository may be given a few hours
before the procedure.
• Client may receive a sedative prior to the procedure to help client relax. Generally, the retrograde pyelogram follows this
process:
After the Procedure

• The recovery process will vary depending upon the type of procedure performed and your physician’s practices. After the
procedure, client will be taken to the recovery room for observation. Once the blood pressure, pulse, and breathing are
stable and client is alert, client will be taken to hospital room or discharged home.
• Urine output will be monitored closely for volume and signs of blood. It may be red from even a small amount of blood. This
is considered normal and does not necessarily indicate a problem. Client may be instructed to continue monitoring urine
output for a day or so once at home.
• May experience pain when urinating. Administer pain reliever for soreness as recommended by your physician. Aspirin or
certain other pain medications may increase the chance of bleeding. Be sure to administer only recommended medications.
Notify physician to report any of the following:
fever and/or chills

redness, swelling, or bleeding or other drainage from the urinary opening
increased pain around the urinary opening
increase in the amount of blood in your urine
difficulty urinating

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Surgical Management Cystoscopy With Retrograde Pyelogram: Procedure

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Surgical Management

Cystoscopy with Retrograde Pyelogram

Reasons for the Procedure

RISKS OF THIS PROCEDURE

There are some risks/ complications, which include:

Before the Procedure

After the Procedure

Notify physician to report any of the following:

fever and/or chills

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