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Introduction ⬇

A retrograde pyelogram is an x-ray test of the kidneys, ureters, and bladder that generally confirms IVP findings and is indicated when IVP yields insufficient results because of kidney nonvisualization (congenital kidney absence), decreased kidney blood flow that impairs kidney function, obstruction, kidney dysfunction, presence of calculi, or patient allergy to IV contrast material. This x-ray examination of the upper urinary tract begins with cystoscopy to introduce ureteral catheters up to the level of the renal pelvis. Following this, iodine contrast is injected into the ureteral catheter, and x-ray images are then taken. The chief advantage of a retrograde pyelogram lies in the fact that the contrast substance can be indirectly injected under controlled pressure so that optimal visualization is achieved. Kidney function impairment does not influence the degree of visualization. See Chart 10.2 for additional tests that are used to examine the urinary system.

Procedure ⬆ ⬇

  1. This examination is usually done in the surgical department in conjunction with cystoscopy (see Chapter 12).

  2. Sedation and analgesia may precede insertion of a local anesthetic agent into the urethra (see Sedation and Analgesia in Chapter 1). General anesthesia may be required if the patient is not able to cooperate fully with the procedure.

  3. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Procedural Alert

  1. Renal function tests of blood and urine must be completed before this examination is done.

  2. Assess whether the patient is allergic to iodine. If iodine contrast sensitivities are known or suspected, inform the radiology department before study.

  3. Refer to Clinical Alerts for Cystoscopy in Chapter 12.

Clinical Implications ⬆ ⬇

GU system imaging results may reveal the following conditions:

  1. Intrinsic abnormality of ureters and kidney pelvis (e.g., congenital defects)

  2. Extrinsic abnormality of the ureters (e.g., obstructive tumor or stones)

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose and procedure of the test. Screen female patients for pregnancy status. If positive, advise the radiology department.

  2. The patient or other authorized person must sign and have witnessed a legal consent form before the procedure.

  3. Follow iodine contrast test precautions. A recent creatinine level may be required by the radiology department to evaluate the kidney’s ability to clear the contrast.

  4. Have the patient fast from food and fluids after midnight before the test.

  5. Administer cathartic drugs, suppositories, or enemas as ordered.

  6. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed.

  2. Observe the patient for signs of allergic reaction to iodine contrast.

  3. Check vital signs frequently for the first 24 hours following the test. Follow institutional protocols if general anesthetic agents were administered.

  4. Record accurate urine output and appearance for 24 hours following the procedure. Hematuria or dysuria may be common after the examination. If hematuria does not clear and dysuria persists or worsens, notify the healthcare provider. Instruct the patient to do the same.

  5. Administer analgesic agents as necessary. Discomfort may be present immediately following the examination and may require a prescription analgesic (e.g., codeine).

  6. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆ ⬇

Because barium may interfere with test results, these studies must be done before barium x-rays are performed.

Reference Values ⬆

Normal

Normal contour and size of ureters and kidneys