Synonym/Acronym
Pyelography, retrograde.
Rationale
To assess urethral patency in order to evaluate the success of surgical interventions on patients who have urethral structures or other anomalies that interfere with urination.
Patient Preparation
There are no food, fluid, or activity restrictions unless by medical direction.
Regarding the patient’s risk for bleeding, the patient should be instructed to avoid taking natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Note the last time and dose of medication taken. Protocols may vary among facilities.
Normal Findings
- Normal size, shape, and course of the membranous, bulbar, and penile portions of the urethra in male patients.
- If the prostatic portion can be visualized, it also should appear normal.
Study type: X-ray, special/contrast; related body system: Urinary system.
Retrograde urethrography uses contrast medium, either injected or instilled via a catheter into the urethra, to visualize the membranous, bulbar, and penile portions, particularly after surgical repair of the urethra to assess the success of the surgery in male patients. The posterior portion of the urethra is visualized better when the procedure is performed with voiding cystourethrography. The procedure is mostly performed on men; in women, it may be performed after surgical repair of the urethra to assess the success of the surgery and to assess structural abnormalities in conjunction with an evaluation for voiding dysfunction.
Contraindications
Pregnancy is a general contraindication to procedures involving radiation.
Patients with conditions associated with adverse reactions to contrast medium (e.g., asthma, food allergies, or allergy to contrast medium). Patients with a known hypersensitivity to the medium may benefit from premedication with corticosteroids and diphenhydramine; the use of nonionic contrast or an alternative noncontrast imaging study, if available, may be considered for patients who have severe asthma or who have experienced moderate to severe reactions to ionic contrast medium.
Patients with bleeding disorders, because the puncture site may not stop bleeding.
Factors That May Alter the Results of the Study
- Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images.
- Inability of the patient to cooperate or remain still during the procedure, because movement can produce blurred or otherwise unclear images.
Abnormal Findings Related to
- Congenital anomalies, such as urethral valves and perineal hypospadias
- False passages in the urethra related to failed catheterization event
- Prostatic enlargement
- Tumors of the urethra
- Urethral calculi
- Urethral diverticula
- Urethral fistulas
- Urethral strictures indicated by a narrowing and lacerations
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
- Discuss how this procedure can assist in assessing the urethral patency.
- Explain that the procedure takes about 30 to 60 min and is performed in a cystoscopy room or radiology department.
- Review the procedure with the patient.
- Explain that pregnancy testing may be required.
- Explain that prior to the procedure, laboratory testing may be required to determine the possibility of bleeding risk (coagulation testing).
- Explain that contrast medium will be injected, by Foley catheter, in retrograde fashion.
Procedural Information
- Baseline vital signs are recorded and monitored throughout the procedure.
- Positioning for this procedure is on the table in either a supine position or obliquely at a 45-degree angle with the bottom leg flexed at 90 degrees at the knee and the top leg out straight.
- Female patients are advised that the procedure may be done using a double balloon to occlude the bladder neck from above and below the external meatus.
- A single plain film is taken of the bladder and urethra prior to the administration of contrast.
- A catheter filled with contrast medium is inserted until the balloon reaches the meatus to eliminate air pockets.
- The patient is advised that some pressure may be experienced when the catheter is inserted and contrast medium is instilled.
- After three-fourths of the contrast medium is injected, another image is taken while the remainder of the contrast medium is injected.
Potential Nursing Actions
Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
Safety Considerations
- Anticoagulants, aspirin, and other salicylates should be discontinued by medical direction for the appropriate number of days prior to a procedure where bleeding is a potential complication.
After the Study: Implementation & Evaluation Potential Nursing Actions
Avoiding Complications
- Monitor the patient for complications related to the procedure.
- Administer ordered antihistamines or prophylactic steroids if the patient has an allergic reaction.
Treatment Considerations
- Follow postprocedure vital sign and assessment protocol.
- Resume usual diet, fluids, medications, or activity, as directed by the health-care provider.
- Monitor fluid intake and urinary output for 24 hr after the procedure.
- Decreased urine output may indicate impending kidney injury.
Safety Considerations
Clinical Judgement
- Consider ways to assist in adaptation to inconsistent urinary function.
Follow-Up and Desired Outcomes
- Acknowledges the importance of drinking plenty of fluids to prevent stasis and to prevent the buildup of bacteria.