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Pyelogram Antegrade
What is
Pyelogram Antegrade?
A
pyelogram antegrade is a kind of x-ray that is
utilized in order to diagnose an obstruction
found in the upper urinary tract. During the
procedure, fluoroscopy, which is a type of x-ray
"movie" or an ultrasound, which are
high-frequency waves are used. This procedure is
used to visualize the ureters when other
procedures such as intravenous pyelogram and
retrograde pyelogram have not provided enough
definitive information.
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Effects
of Pyelogram Antegrade
Through this procedure, the visualization of the
ureters and the diagnosis of an obstructed upper
urinary tract is made possible.
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Candidates for Pyelogram Antegrade
This procedure is used for patients with
suspected obstruction of the urinary tract
because of a stricture or a narrowing, the
presence of a kidney stone, a blood clot, or a
tumor. In the event of an obstruction, the
injected contrast dye is unable to move properly
through the kidney which is detected on x-ray
images.
Those undergoing surgical treatment, as well as
those who have undergone a surgical treatment
are candidates for a pyelogram antegrade. This
is to assess their kidneys or ureters
preoperatively and postoperatively. If a
blockage is present, a nephrostomy tube may be
inserted at the time of the procedure so that
the flow of urine may be diverted past the
obstruction.
Antegrade pyelogram may be recommended by your
physician for a lot of other reasons besides
those mentioned above.
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Your Consultation
Before
undergoing the procedure, the physician will
give you a background and clarify the procedure
to you. You will also be given the chance to ask
any questions that you might have about
pyelogram antegrade. A consent form will be
given to you for signature giving permission to
proceed with the treatment. It is important that
you read the form carefully and if you see that
something is not clear, feel free to ask
questions. Prior to the procedure, you will need
to fast for a certain amount of time as
indicated by your physician. This could be for a
few hours or overnight.
You should notify your physician if you are
pregnant or if you suspect that you are
pregnant. Any reaction to contrast dye
experienced previously should be informed to
your physician. Notify your physician if there
are any allergies to iodine or seafood. Let your
physician know any sensitivities or allergies to
any medications, latex, tape, and anesthetic
agents both local and general. Make a list of
all medications that you are taking both
prescribed and over-the-counter, as well as
herbal supplements and give this to your
physician.
History of bleeding disorders or if you are
taking blood thinners or anticoagulant
medications, aspirin, or medications that affect
blood clotting should be reported to your
physician prior to undergoing this procedure. It
is possible that you have to stop these
medications temporarily prior to pyelogram
antegrade.
Preoperatively, a sedative is given for you to
be able to relax. Since the sedative can make
you drowsy, arrangements should be made for
someone to drive you home after the procedure.
Antibiotics may be given before and after the
procedure. Other specific preparations may be
requested by your doctor depending on your
medical condition.
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The
Pyelogram Antegrade Procedure
This
procedure may be done on an outpatient basis or
as a part of one's hospital stay. The procedure
may differ depending on the condition and the
practices of the physician.
This
is the usual process followed for an antegrade
pyelogram:
1.
Clothing, jewelry, or objects that could cause
interference with the procedure should be
removed.
2.
A gown
will be given if you are asked to remove your
clothes.
3.
It may
be possible to have an intravenous (IV) line
inserted into your arm or hand.
4.
You
will be requested to lie prone or face down on
the x-ray table. Iodine solution will be wiped
on an area of the skin on your lower back in
order to sterilize the area. Sterile drapes
will be placed around it.
5.
Injection of a local anesthetic is done. A
needle will be advanced into the renal pelvis
and the contrast dye will be injected with the
aid of ultrasound or fluoroscopic guidance. A
little discomfort may be felt during the
injection of the local anesthetic and a brief
feeling of warmth from the contrast dye.
6.
As the
dye travels through the ureters, a series of
x-rays will be taken at timed intervals.
7.
As
soon as the needle has been inserted, a thin
wire may be threaded through the needle allowing
the positioning of catheters, the nephrostomy
tube, or other devices.
8.
In the
case that a nephrostomy is not warranted, the
physician may remove the needle.
9.
Application of a sterile bandage/dressing is
done.
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Recovery
Depending on the type of procedure performed and
the physician's practices will one's recovery
process vary. The patient will be taken to the
recovery room after the procedure for
observation. Once the patient is alert and his
or her blood pressure, pulse, and breathing
stabilize, he or she will be taken to a hospital
room or may be discharged to go home.
The urine output will be closely monitored for
volume and any signs of blood; however, urine
may be red from even a small amount of blood and
is considered normal and does not necessarily
point out a problem. Monitoring the urine output
should be continued even if at home for a day or
so.
One may experience a painful urination. A pain
reliever for soreness may be taken as prescribed
by the physician. Make sure that only
recommended medications are taken as aspirin or
certain kinds of pain medications may increase
the chance of bleeding.
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Risks
There
is a risk for radiation exposure; however, this
is very low as the amount of radiation used
during antegrade pyelogram is considered
minimal. If one is pregnant or suspects that she
is pregnant, it is important to notify the
physician, as radiation exposure at the time of
pregnancy may lead to birth defects. A risk of
allergic reaction is possible if a contrast dye
is used. It is important to inform the physician
for any allergies or sensitivities to
medications, contrast dye, iodine, or shellfish.
Kidney failure or other kidney problems should
be mentioned to the physician as there are cases
wherein the contrast dye can cause kidney
failure especially if the patient is taking
Glucophage, a diabetic medication.
Likely complications in antegrade pyelogram
include but are not limited to bleeding, blood
clots in the nephrostomy tube if placed, or
clots in the bladder, rapid heart rate, low
blood pressure, and electrolyte imbalance
because of a rapid urine loss after the
placement of the nephrostomy tube.
One contraindication for antegrade pyelogram is
patients with blood clotting disorders.
Depending on the patient's medical condition,
other risks are possible. It is imperative that
concerns are discussed with the doctor before
undergoing the procedure.
Frequently Asked Questions
Q:
What is a pyelogram antegrade for?
A:
This procedure is used in order to visualize
ureters and identify any obstruction of the
urinary tract due to a stricture or narrowing, a
kidney stone, a blood clot, or a tumor. It is
also used for the purpose of assessing kidneys
or ureters before and/or after a surgical
procedure.
Q:
What happens during this procedure?
A:
A contrast dye is injected into a segment of the
ureter, a slender tube that transports urine
from the kidney to the bladder, that is closest
to the kidneys called the renal pelvis. Through
x-ray images, the flow of the contrast dye can
then be monitored as it travels from the kidneys
into the ureters and urinary bladder.
Q:
What is an x-ray?
A:
X-rays utilize electromagnetic energy beams that
are invisible in order to create images of
internal tissues, bones, and organs on film. By
means of external radiation, x-rays are made to
create images of the body, its organs, and other
internal structures for diagnostic purposes.
The x-ray passes through body structures onto
plates that are specially treated and a
"negative" type picture is formed. The
structure appears whiter on film if the
structure is more solid.
Q:
What indicates that the procedure turned out
successful or not?
A:
The presence of fever and/or chills, redness,
swelling, bleeding, or other drainage from the
urinary opening should be reported immediately
to the doctor, as well as increased pain in the
area of the urinary opening, increased amount of
blood in the urine, and difficulty in urinating.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
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