Retrograde pyelogram: what it is, how it is done and what to expect afterwards

The urinary tract includes the two kidneys, the ureters that carry urine from each kidney to the bladder, the bladder and the urethra. In a retrograde pyelogram, contrast dye is introduced from the bladder end, travelling backwards, which is what retrograde means, up the ureter and into the kidney. X-rays are taken as the dye outlines the channels, showing their shape and any blockage.

A hospital leaflet drawing on British Association of Urological Surgeons guidance, titled cystoscopy and retrograde studies, summarises it as taking X-rays of the kidney and/or ureter by injection of dye through a telescope placed into the bladder. In practice the cystoscopy and the retrograde X-ray are done in the same session.

This differs from tests in which dye is given into a vein and passes through the kidneys on its own. Here, a catheter is guided into the ureter and the dye is delivered directly into it.

Spire Healthcare, quoting the British Association of Urological Surgeons, says a retrograde pyelogram may be recommended if other tests have been inconclusive, and that it can help to find the cause of a urinary problem by identifying obstructions such as stones, tumours, blood clots or narrowing in the kidneys or ureters. A referral letter from a consultant or GP is required.

Because the test is invasive, it is usually used when less invasive options have not answered the question or when the urology team wants to treat or sample something during the same procedure. The NHS leaflet notes that alternatives are other forms of X-ray, MRI scan, CT scan or ultrasound, which can be discussed in more detail with a urologist or specialist nurse.

The NHS leaflet we read, which is dated and should be read alongside your own hospital's current instructions, says you will usually be admitted on the same day as the procedure and normally receive a pre-assessment appointment approximately 14 days beforehand. You are asked not to eat or drink for 6 hours before surgery.

It asks you to tell your urologist in advance if you have any of the following: an artificial heart valve, a coronary artery stent, a pacemaker or defibrillator, an artificial joint, an artificial blood vessel graft, a neurosurgical shunt or other implanted foreign body, a prescription for warfarin, aspirin or clopidogrel, or a previous or current MRSA infection. Raise anything from this list at pre-assessment so that the team can plan around it.

Either a full general anaesthetic or a spinal anaesthetic is used, according to the NHS leaflet, which also says antibiotics are usually given beforehand after checking for allergies. A telescope is passed through the urethra to inspect it and the whole lining of the bladder. A catheter is then inserted into the ureter using the telescope, under X-ray guidance. Dye is injected into the catheter to outline the ureter and kidney, and X-ray pictures are usually taken at the time in the operating theatre. Occasionally the imaging is done in the X-ray department through a small catheter left in place.

Spire describes an X-ray machine positioned above the pelvis taking pictures as the dye flows through the bladder and ureters and into the kidneys. The contrast is then drained away and the catheter removed. The doctor studies the pictures to look for any interruption in urine flow. You may be told the result at once, or you may be asked to return to discuss it, particularly if further assessment or surgery is needed.

Spire says that this is a day case and that you will usually need someone to drive you home and stay with you for the first 24 hours. After a general anaesthetic you should not drive, drink alcohol, operate machinery or sign legal documents for 48 hours. You may feel sore, need to pass urine frequently for a few days and notice a burning sensation when you do.

The NHS leaflet groups the possible side effects by frequency. Common effects, affecting more than 1 in 10, are mild burning or bleeding on passing urine for a short time and temporary insertion of a catheter. Occasional effects, between 1 in 10 and 1 in 50, include infection of the bladder requiring antibiotics, being unable to pass the tube into the ureter, and temporary insertion of a ureteric stent. Rare effects, fewer than 1 in 50, include delayed bleeding requiring removal of clots or further surgery, injury to the urethra causing scarring, and hospital-acquired infection.

Both sources advise drinking more fluid, with the NHS leaflet suggesting twice as much as normal for 24 to 48 hours, and seeking help promptly for warning signs. The NHS leaflet lists fever, pain in the area of the affected kidney, severe pain on passing urine, inability to pass urine and worsening bleeding as reasons to contact your GP immediately, and Spire lists feeling unwell, constant pain, high temperature, burning on passing urine and smelly urine as reasons to contact the hospital.