Retrograde urography is an invasive procedure for X-ray examination of the ureters, renal pelvis and cups, in which a contrast agent is injected using a ureteral catheter. The method reveals the stenosis of the pelvic-ureteral system, pelvic tumors, X-ray negative ureteral concretions. Retrograde urography can be unilateral and bilateral, with different catheter insertion heights, with liquid and gaseous contrast media.
Indications
There are a number of indications for retrograde urography. It is prescribed when:
- chronic pyelonephritis;
- urolithiasis;
- blood clots in the urine;
- renal colic;
- violations of urine outflow;
- renal abnormalities;
- lowered or “wandering” kidneys;
- injuries;
- recovery after kidney surgery.
Retrograde urography is a quick way to get a complete picture of the development of the disease. Urgent retrograde urography is performed with severe and sudden pain in the lumbar region, which lasts more than two hours.
- Kidney prolapse. Kidney prolapse, or nephropotosis, is characterized by increasing signs. At first, they appear only after physical labor, then more often, and in the last stages – almost constantly.
- Congenital pathologies of the urinary system. They are accompanied by various symptoms: from pain to hematurgy and vomiting attacks. In such diseases, doctors prescribe alternative diagnostics, for example, ultrasound.
- The presence of a tumor. A benign or malignant tumor is a contraindication for contrast diagnosis. In the initial stages, it may not manifest itself in any way. Then there are pain in the lower back, swelling of the lower extremities, weight loss.
- Urolithiasis. It is accompanied by pain in the lower abdomen, giving into the uterus and ovaries, problems with urination, blood clots in the urine. In severe cases, there are attacks of nausea and vomiting. With kidney stones, the pain becomes stronger with physical labor, and the urine becomes dark red from the discharge of blood.
- Hydronephrosis. Hydronephrosis is the expansion of the renal pelvis due to pathologies of urine outflow. Symptoms of the disease are pain, bloody discharge in the urine and an increase in the size of the kidneys. The pain can be from mild to very severe, sometimes renal colic of low intensity occurs.
- Renal colic. The main symptom of the disease is acute attacks of pain in the kidney area, resembling labor pains. The pain can radiate to the shoulder joint, leg and even the knee area. It all depends on its intensity and the degree of violation of the outflow of urine.
Preparation
Retrograde ureteropyelography is a technique that does not require complex preparation. The main thing is to clean the intestines of feces and gases completely. To do this, preparation for retrograde urography implies the following:
- Three days before the diagnosis, do not eat fresh vegetables and fruits, bread, dairy products and carbonated water. It is recommended to drink activated charcoal tablets and chamomile tea without sugar.
- Drink a laxative 24 hours before the procedure.
- In the evening, clean the intestines with an enema.
- Three hours before the procedure, clean the intestines again with an enema.
It is useful for elderly people to walk more often to facilitate the release of gases. Especially if they take medications containing iodine. If it was not possible to get rid of gases completely, you can drink a large amount of water before the procedure. This will displace the gases – they will easily come out. Before the X-ray, you need to take off all the jewelry, remove the phone.
Methods of conducting
How is urography performed with contrast? The patient lies down on the couch. A contrast solution is injected into the tub under low pressure. No more than six milliliters – according to the size of the tub itself. If you inject more solution, the pelvis will stretch, acute pain will begin. There should be no pain in the lower back during retrograde urography and after. As soon as the substance is injected, the doctor takes X-rays, where he can see changes in the kidneys. On average, the process lasts from an hour to two and a half hours until the solution is completely removed.
Possible complications
Complications may occur during and after diagnosis. This is:
- stretching of the renal pelvis;
- pelvic-renal reflux;
- pain in the lumbar region;
- allergic reactions.
Sometimes bruises and blood clots appear at the puncture site. If the ureter is damaged, the solution can get into other areas or kidney tissues. At the same time, the body temperature rises. If sterility has not been observed, an infection can get inside.
- Pelvic-renal reflux. It is characterized by painful urination. It is the kidneys that hurt. Also possible: hypertension, hyperthermia, a feeling of chills, a change in the color and structure of urine (foam formation), headache and thirst.
- Stretching of the pelvis. If the pelvis is stretched, then there is an acute pain in the lower back. Next, the urine acquires a dark red hue. There may be delays in urination due to blood clots that block the urethra.
- Lower back pain. Pain sensations of varying intensity, more often – aching, sometimes – sharp and stabbing. They can last ten minutes or two hours.
- Allergy, up to the development of anaphylactic shock. Before the procedure, the patient must necessarily warn the doctor if he is allergic to medications. Otherwise, allergies are possible: itching, sneezing, lacrimation, Quincke’s edema and even anaphylactic shock.
Contraindications
It is forbidden to do retrograde urography when:
- pregnancy;
- intolerance to iodine;
- bleeding;
- kidney failure;
- thyrotoxicosis;
- tumors of the adrenal glands;
- poor blood clotting.
Also, you can not do urography with contrast to people who have taken the drug “Glucophagus”. If there are contraindications, retrograde urography is replaced with other diagnostic methods.
- Adrenal gland tumor. In case of adrenal tumors of any type, diagnosis with contrast is prohibited. The disease manifests itself in different ways. Pressure increases, anxiety increases, neuromuscular impulses are disrupted. There is pain in the chest area, shortness of breath. Diabetes mellitus may develop.
- Pregnancy. In any trimester of pregnancy, the procedure is prohibited. Usually it is replaced by ultrasound.
- Internal bleeding of an unclear nature. If a person has bleeding of internal organs for an unknown reason, then it is impossible to conduct a retrograde examination. Signs of bleeding may be: tachycardia, weakness, severe hypotension, loss of consciousness, pallor.
- Low blood clotting. It is characterized by prolonged bleeding, hematomas of unknown origin. Often the nose bleeds. Women have very heavy menstrual bleeding.
- Kidney failure. It can be chronic and acute. The main signs are weakness, rapid fatigue, poor appetite, constant diarrhea, nausea and vomiting, muscle cramps, urine volume decreases significantly per day.
