Name of the Procedure:

Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (e.g., ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access.

Summary

An antegrade nephrostogram and/or ureterogram involves injecting a contrast dye into the kidney through a new access point to visualize the urinary tract, including the renal pelvis, ureters, and bladder, using imaging techniques like ultrasound and fluoroscopy.

Purpose

This procedure is used to diagnose and evaluate issues within the urinary tract, such as blockages, strictures, or other abnormalities. The goal is to provide a detailed view of the urinary pathways to guide further treatment.

Indications

• Unexplained flank pain
• Suspected urinary tract obstructions or strictures
• Evaluation of hydronephrosis (swelling of the kidney due to urine buildup)
• Post-surgical assessment of urinary tract integrity
• Follow-up for known conditions affecting the urinary tract

Preparation

• Fasting may be required for a few hours before the procedure.
• Adjustments in blood-thinning medications may be necessary.
• Pre-procedure imaging tests such as a CT scan or ultrasound to locate the kidney and planned access point.

Procedure Description

1. The patient is positioned, and the area around the kidney is sterilized.
2. Local anesthesia is administered to numb the insertion site.
3. Using ultrasound guidance, a needle is inserted into the kidney to access the renal pelvis.
4. Contrast dye is injected through the needle, filling the urinary tract.
5. Fluoroscopy (live X-ray) images are taken to visualize and diagnose any abnormalities within the renal pelvis, ureter, and bladder.
6. The needle is then removed, and a bandage is applied to the insertion site.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is performed in a hospital's radiology department or in an outpatient radiology clinic equipped with fluoroscopy and ultrasound imaging.

Personnel

• Interventional radiologist
• Radiologic technologist
• Nurse or medical assistant

Risks and Complications

• Infection at the access site
• Bleeding or hematuria (blood in the urine)
• Allergic reaction to the contrast dye
• Injury to the kidney or urinary tract
• Rarely, formation of a fistula (abnormal connection between organs)

Benefits

• Provides detailed images of the urinary tract for accurate diagnosis.
• Helps guide further treatment decisions.
• Minimally invasive with a relatively quick recovery time.

Recovery

• The patient may need to rest for several hours post-procedure.
• Drinking plenty of fluids to flush out the contrast dye is recommended.
• Mild discomfort at the insertion site may occur, which can be managed with over-the-counter pain relievers.
• Follow-up imaging or consultations may be scheduled to discuss the findings.

Alternatives

• Retrograde pyelogram: A similar imaging procedure where contrast dye is injected from the bladder side.
• CT or MRI scans: Non-invasive imaging techniques that also provide detailed views of the urinary tract.
• Ultrasound only: Less detailed than the nephrostogram but useful for initial evaluation.

Patient Experience

During the procedure, the patient will feel minimal discomfort due to the local anesthesia. Some pressure may be felt when the needle is inserted. Afterward, there may be mild soreness at the insertion site and possible blood-tinged urine for a short time.

Pain management includes over-the-counter pain relievers, and comfort measures such as applying a cold pack to the insertion site if necessary.