Patient Preparation
As per American Urological Association (AUA) guidelines, [10] any patient undergoing a procedure that involves manipulation of the ureter must receive prophylactic antibiotics. Fluoroquinolones and TMP-SMX are the drugs of choice. If these drugs are unavailable or cannot be used because of adverse reactions, aminoglycosides plus ampicillin, first-/second-generation cephalosporins may be used.
Anesthesia
Depending on the reason for performing retrograde pyelography, the patient is typically given general anesthesia.
Positioning
The dorsal lithotomy position is used.
Monitoring & Follow-up
Cystoscopy and retrograde pyelography are typically performed as outpatient procedures. Once the procedure is complete, the patient typically stays in the hospital for a few hours to ensure stability and to ensure that no complications have occurred.
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Pyelovenous Backflow
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Normal Ureteral Orifice
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Open and Closed Ended Catheter
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Duplicated Collecting System
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Renal Pelvic Stone
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Fibroepithelial Polyp on CT scan
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Occlusion balloon catheter used to help obtain antegrade access into the kidney
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Ureteropelvic Junction Obstruction
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Rigid Cystoscope
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Cone tipped catheter into the ureteral orifice during a retrograde pyelogram
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Right Ureteral Stricture
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Right retrograde pyelogram demonstrates large filling defect in midureter due to transitional cell carcinoma
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Retrograde ureterogram reveals smooth narrowing and medial shift of the ureter due to Retroperitoneal Fibrosis
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left proximal ureteral obstruction in a pt s/p gastric banding
