Patient education: Retrograde pyelogram (The Basics)

What is a retrograde pyelogram? — This is a procedure that lets a doctor look at the inside of the kidneys, ureters, and bladder (figure 1).

This is most often done at the same time as a "cystoscopy." During cystoscopy, a doctor puts a thin tube with a tiny camera on the end into the urethra and moves it up into the bladder (figure 2). The tube is called a "cystoscope."

For a retrograde pyelogram, the doctor injects a special dye through the tube. The dye helps the kidneys, ureters, and bladder show up more clearly on X-ray.

A retrograde pyelogram might be done for many reasons. Examples include checking:

●For a blockage in the bladder or ureters – This can be caused by scar tissue, a kidney stone, or a tumor.

●For a narrowing or blockage of the ureter – These can be caused by surgery or kidney stones.

●If a stent or catheter is in the right place – A stent is a small mesh tube that helps keep the ureter open if it is blocked.

●If the ureters or bladder are injured

How do I prepare for a retrograde pyelogram? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. If you have a high risk of urinary tract infections ("UTIs"), your doctor might do a urine test to check for signs of infection. If you already have a UTI, your doctor will wait for it to go away before doing the procedure. In some cases, you might get an antibiotic medicine to help prevent infection.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●If you need to take a laxative or do an enema the night before the test – This will help clear your intestines of any stool that might keep the doctor from clearly seeing your kidneys, ureters, or bladder.

●Eating and drinking before your procedure – In some cases, you might need to "fast" before the procedure. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during a retrograde pyelogram? — When it is time for the procedure:

●You might get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●Right before the procedure, you will empty your bladder. The doctor might ask you to collect a small urine sample for testing.

●You will lie on your back on the exam table, with your legs bent and apart.

●The doctor will clean your urethra with a special soap to help prevent an infection.

●They will put numbing medicines inside of your urethra. You might also get medicine to make you feel sleepy and relaxed.

●They will insert the cystoscope into your urethra and move it up into your bladder. They will use a lubricant on the cystoscope to help it slide in easily. The tiny camera on the end will send pictures to a screen that the doctor can see.

●Once the cystoscope is in your bladder, the doctor will inject the dye. This helps them see your kidneys, ureters, and bladder more easily.

●If needed, they will use the cystoscope to:

•Take small tissue samples for testing (called a "biopsy")

•Put a stent in your ureter to help hold it open

●The procedure takes 20 to 30 minutes.

What happens after a retrograde pyelogram? — You might be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Most people can go home the same day.

Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

After a retrograde pyelogram, you might:

●Have some pain or discomfort when urinating, or feel like you need to urinate suddenly. These should only last for a short time.

●See a small amount of blood in your urine the first few times you urinate

●Be asked to pay attention to how much you are urinating

What are the risks of a retrograde pyelogram? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Bleeding

●Infection

●Allergic reaction to the dye

●Trouble urinating

●Injury to the urethra, bladder, ureter, or kidney

When should I call the doctor? — Call for advice if:

●You have pain or discomfort when urinating that lasts more than 1 to 2 days or gets much worse.

●You have "urinary urgency" for more than a day or 2 – This is when you feel like you need to urinate suddenly or in a hurry.

●You see a lot of blood in your urine at once.

●You still see blood in your urine after 5 days.

●You have a fever of 100.4°F (38°C) or higher, or chills.

●You have pain in your belly.

●You cannot urinate.

More on this topic

Patient education: Intravenous pyelogram (The Basics)
Patient education: Cystoscopy (The Basics)
Patient education: Urinary tract infections in adults (The Basics)
Patient education: Blood in the urine (hematuria) in adults (The Basics)
Patient education: Kidney stones in adults (The Basics)
Patient education: Ureteral stent placement (The Basics)
Patient education: Ureteral stent removal (The Basics)
Patient education: Bladder cancer (The Basics)

Patient education: Urinary tract infections in adolescents and adults (Beyond the Basics)
Patient education: Blood in the urine (hematuria) in adults (Beyond the Basics)
Patient education: Kidney stones in adults (Beyond the Basics)
Patient education: Bladder cancer diagnosis and staging (Beyond the Basics)