Antegrade pyelography
Author:
Mikael Häggström [notes 1]
Contents
Preparation
The procedure can be started in supine position. It can be done in a clean technique (not necessarily sterile) with gloves and radiation protection.
- Generally use low radiation dose fluoroscopy with normal dose single projections.
- Close any indwelling urinary bladder catheter in order to detect any contrast ending up in the bladder.
Procedure with established nephrostomy
- Take an initial anteroposterior image including the presumed locations of the kidney, ureter and urinary bladder.
- Infuse iodinated contrast, usually at least a volume corresponding to about 15 ml of 240mg/ml iodine. Observe both the imaging and whether the patient develops flank pain.
- Note the following:
- Location of the tip of the catheter in the kidney
- Any visible hydronephrosis or hydroureter
- Any contrast outside the catheter or urinary tract, including leakage along the outside of the catheter
- Flow into the urinary bladder (see below if none).
If contrast does not reach the urinary bladder
Infuse as much contrast as still comfortable by the patient. Observe the most distal part reached by contrast, and the shape thereof. Zooming in on this segment may detect subtle passage. Also turn your eye to the nephrostomy for leakage.
Obtain new projections after:
- Having the patient in a more standing position.
- Having the patient cough.
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
