Name of the Procedure:

Urography, antegrade (antegrade pyelography, antegrade urography)

Summary

Urography, antegrade is an imaging procedure used to visualize the urinary tract, including the kidneys, ureters, and the bladder, by injecting a contrast dye directly into the urinary system and taking X-ray images. It helps doctors diagnose and evaluate conditions affecting the urinary tract.

Purpose

The procedure is performed to diagnose blockages, stones, tumors, or other abnormalities in the urinary tract. It can also be used to assess the function of the kidneys and the drainage system. The primary goal is to provide a clear image of the urinary organs to guide further treatment if necessary.

Indications

• Persistent hematuria (blood in urine)
• Chronic urinary tract infections
• Suspected kidney stones or urinary tract obstruction
• Evaluation of known urinary tract anomalies
• Unexplained flank pain

Preparation

• Fasting may be required for several hours before the procedure.
• Blood tests and imaging studies like ultrasound may be performed beforehand.
• The doctor will review your medications; some, such as blood thinners, may need to be adjusted.
• You may be asked to drink plenty of fluids before the procedure to ensure hydration.

Procedure Description

1. The patient is positioned on an X-ray table.
2. Local anesthesia is administered to numb the area where the needle will be inserted.
3. Under the guidance of fluoroscopy (real-time X-ray), a needle is inserted through the skin into the renal pelvis or upper ureter.
4. A contrast dye is injected through the needle into the urinary tract.
5. X-ray images are taken to visualize the flow of the dye through the renal system.
6. After sufficient images are obtained, the needle is removed, and a bandage is applied to the insertion site.

Duration

The entire procedure typically lasts about 30 to 60 minutes.

Setting

Urography, antegrade is performed in a hospital’s radiology department or an outpatient clinic equipped with fluoroscopy and X-ray facilities.

Personnel

• Radiologist (specializes in imaging)
• Radiologic technologist
• Nurses

Risks and Complications

• Allergic reaction to the contrast dye (rare)
• Infection at the needle insertion site
• Bleeding or bruising
• Temporary discomfort or pain
• Kidney damage (very rare)

Benefits

• Provides detailed images of the urinary tract, aiding accurate diagnosis
• Can identify blockages, stones, and tumors
• Helps guide treatment plans, potentially avoiding the need for more invasive procedures
• Provides functional information about kidney drainage

Recovery

• You may be monitored for a short time after the procedure.
• Instructions to drink plenty of fluids to help flush out the contrast dye.
• Avoid strenuous activities for 24 hours.
• Follow-up appointments may be scheduled to discuss results and further treatment.

Alternatives

• Intravenous pyelogram (IVP)
  • Pros: Non-invasive, contrast injected via a vein.
  • Cons: Less detailed than antegrade urography, potential for same dye reactions.
• Ultrasound
  • Pros: No radiation exposure, non-invasive.
  • Cons: Less detailed than X-ray-based imaging.
• MRI or CT scan
  • Pros: Highly detailed images.
  • Cons: More expensive, availability is limited, contraindications for certain patients (e.g., metal implants for MRI).

Patient Experience

• During the procedure, you may feel a brief sting or pinch from the needle.
• Some patients report a warm sensation when the dye is injected.
• Discomfort is typically minimal and well-managed with local anesthesia.
• Post-procedure, you may feel mild soreness at the injection site, which usually resolves quickly.
• Pain management, if needed, can include over-the-counter analgesics.

By understanding the details of Urography, antegrade, you can be better prepared for what to expect and how to collaborate with your healthcare team for the best outcomes.