What Is a Retrograde Pyelogram?

A retrograde pyelogram is an imaging study of the renal system (urinary tract) using X-ray technology, usually with contrast dye. It shows pictures of the structures of the kidneys, ureters, bladder, and urethra. This test helps healthcare providers identify blockages in the urinary tract and may be used to identify the cause of hematuria (blood in the urine).

During a retrograde pyelogram, dye is inserted through the urethra up the urinary tract toward the kidney to highlight the lining of the urinary tract. The procedure can be done with the assistance of a cystoscopy, in which a camera is inserted into the urethra and bladder to give the healthcare provider a view of the inside of the urinary system.

Purpose of a Retrograde Pyelogram

Your healthcare provider might order a retrograde pyelogram to look for possible blockages in the ureters or kidneys. These can be kidney stones, tumors, cysts, blood clots, or strictures (areas of narrowing of the urinary tract). A retrograde pyelogram is less detailed than newer imaging tests for the renal system.

Retrograde pyelography is often used when an intravenous pyelogram (IVP) is unsuccessful in diagnosing the cause of a blockage or if IVP is not possible. Both forms of pyelogram use an iodine-based contrast dye to help the structures of the renal system show up better on the X-ray. Patients with a mild allergy to iodine and contrast dye might not be able to undergo an IVP because the dye is absorbed into the body.

A few differences between these diagnostic procedures:

• They use the same dye, but with IVP, the dye is injected directly into a vein and travels to the kidneys via the bloodstream. Much less of the dye is absorbed in the body during a retrograde pyelogram.
• Allergic reactions to the dye are less pronounced in retrograde pyelography than in IVP.
• IVP is easier to perform than retrograde pyelography and it can be obtained by a technician. A retrograde pyelogram requires a urologist to administer the dye in an operating room, possibly under general anesthesia.

Blood in the Urine

Bleeding from the urethra or blood in the urine can be a sign of some sort of trauma, irritation, or blockage in the urinary tract or kidneys. To identify the cause, your healthcare provider might order a collection of tests, including retrograde pyelography or cystoscopy.

Kidney Stones

Hard calcium pebbles that can sometimes build up in the renal system are known as kidney stones. Kidney stones can block the flow of urine and cause it to back up into the kidneys, potentially even overflowing into surrounding tissues.

Kidney stones are diagnosed based on symptoms (severe pain) and by viewing the stones on an imaging test, such as IVP or retrograde pyelography.

Stent Placement

A ureteral stent can be placed in the ureter to help urine flow past a narrowed portion of the ureter or past a blockage that won't clear. This can prevent septicemia (a severe systemic infection), which can develop as a result of blockage.

A retrograde pyelogram can be used to outline ureter/kidney anatomy and assist in the placement of the stent. This is done in conjunction with a cystoscopy.

Risks and Contraindications

It is very safe to get a retrograde pyelogram. This is one of the oldest tests used in X-ray imaging.

If you are pregnant, your healthcare provider might recommend postponing this test, if possible, to avoid exposure to X-Ray radiation.

Allergy to Iodine

The most common complications of retrograde pyelography come from reactions to the iodine-based dye used for the test. An allergy can cause an anaphylactic reaction.

Sepsis and Urinary Tract Infection

Placement of the catheter for retrograde pyelogram can introduce contamination that could lead to a urinary tract infection (UTI). In some cases, an infection can develop into sepsis, a systemic reaction to severe infection. Sepsis is a serious, but very rare complication.

Bladder Perforation and Bleeding

It's common to have a small amount of blood in the urine after undergoing a retrograde pyelogram. The urine might appear pink from a small amount of bleeding. Even small amounts of bright red blood are possible.

A rare, potentially severe complication, is a puncture of the bladder wall during the catheter insertion.

Other Complications of Retrograde Pyelography

Patients who are dehydrated might not be able to undergo the test. Feces or gas in the bowels could interfere with the test.

Before the Retrograde Pyelogram

A retrograde pyelogram is usually ordered in advance, so your healthcare provider will be able to discuss the test with you before you get it done. Be sure to ask your practitioner if there is anything specific you need to do before the test.

Timing

You should expect to spend a total of about two hours at your appointment, including paperwork.

A retrograde pyelogram usually takes less than 30 minutes. It can take an hour or more to recover afterward, depending on the type of anesthesia used for the test.

Plan on having someone drive you home after the test. Do not expect to have the results of the retrograde pyelogram before you leave.

Location

A retrograde pyelogram can be performed as an outpatient or as part of a hospital stay. Your healthcare provider might perform the test in a hospital operating room or in an outpatient clinic, depending on the type of anesthesia used.

The room will have a table with stirrups and an X-ray machine.

What to Wear

When you go for your appointment, wear something comfortable and easy to remove. After retrograde pyelography, you could be a little groggy when getting dressed again, so don't wear anything complicated.

Food and Drink

In most cases, your healthcare provider will ask you to fast for a certain amount of time before the test is performed. In some cases, you might be asked to take a stool softener and might even need an enema before the test.

You will be advised to stay well-hydrated.

During a Retrograde Pyelogram

The exact process of the test will vary depending on your condition and how your healthcare provider approaches the procedure. It will also depend on the type of anesthesia used.

Pre-Test

You will be asked to change into a hospital gown and lie down on the table with your feet in the stirrups. You'll receive an intravenous (IV) line in your arm or hand.

You'll be asked to lie on the X-ray table with your feet in stirrups. The anesthesiologist or another healthcare provider will administer a sedative or anesthesia through the IV line.

Throughout the Test

You will most likely not remember the actual test due to the anesthesia. During this part, which could take as little as five minutes and no more than 30 minutes, you will be sedated.

The urologist or radiologist will place a catheter in your urethra and inject the dye. X-rays will be taken, and then the catheter will be removed.

Post-Test

After the test is complete, you will be moved to a recovery area and monitored until the anesthesia wears off. It could take more than an hour for the sedative to wear off enough for you to leave. You will probably receive an antibiotic and possibly something for pain.

Discomfort after the test should be minimal, but there will be some soreness and possibly burning during urination.

After the Retrograde Pyelogram

Once the test is complete, you may be given antibiotics and possibly sent home with pain medication. Urine output will be monitored before you are released from the test site, and your healthcare provider may ask you to continue to measure your urine output for a few days. This usually means urinating into a graduated container and recording the amount.

Managing Side Effects

Your healthcare provider might suggest over-the-counter pain control. If so, only take what the practitioner recommends. Some over-the-counter medications, such as aspirin, can predispose you to bleed.

Interpreting Results

Retrograde pyelography shows the flow of the dye through the urinary tract on an X-ray. If the dye is seen flowing freely through the entire renal system, the test result is negative or normal.

If the dye appears to be blocked and can't flow through the system properly, the result is considered to be abnormal.

Follow-up

The X-rays need to be interpreted by a radiologist, and that could take a few hours or longer. Your test might indicate something blocking your urinary tract that is consistent with kidney stones or a stricture.

If the retrograde pyelogram is abnormal, your healthcare provider might order another imaging test, such as a CT scan, for more detail.

If your test comes back normal, your practitioner may need to do further testing to figure out the cause of your symptoms.

Discuss the results with your healthcare provider and do not be afraid to ask questions. It is important for you to understand what the results mean to you and to your practitioner.

A Word From Verywell

Retrograde pyelography is a diagnostic procedure that can identify blockages In the urinary system. You will have to prepare for the test, and the procedure and recovery can take several hours. Afterward, you might have a little discomfort or blood In the urine, so make sure you know what to expect so you can contact your healthcare providers if you aren't recovering as expected. The results should help guide the next steps In your treatment.