Retrograde Pyelogram

A retrograde pyelogram (RPG) is a test that creates an image of the parts of your urinary system. A healthcare provider uses X-rays and injects a dye (contrast agent) into your ureters to get clear pictures. Providers can usually see the entire ureter with this test.

You may have this test on one or both ureters. If you have it on both sides, it’s a bilateral retrograde pyelogram.

Another name for this procedure is retrograde pyeloureterogram.

A retrograde pyelogram takes 30 minutes or less and can provide answers for your urinary issue. You won’t feel pain during the test.

When is this test performed?

Your provider might order a retrograde pyelogram if:

• You may have damaged your ureter
• You may have a blockage or narrow spot in your ureter
• You may have stones or tumors in your kidneys, ureters or bladder
• Your provider needs to have a good image to place a ureteral stent or do a ureteroscopy

Providers used retrograde pyelography more often in the past than they do now. Today, they use other imaging technologies instead (like a CT urogram). But providers still use a retrograde pyelogram with cystoscopy in many cases, like stenting to keep passageways open.

How does a retrograde pyelogram work?

A healthcare provider uses a cystoscopy that will allow them to place the tube used to inject the dye into the upper part of your urinary tract.

“Retrograde” means that the flow of the dye is going back into your system, instead of outward as urine (pee) normally flows. “Pyelogram” refers to the images of a specific part of your kidney called the renal pelvis, an area near where the ureter attaches.

How do I prepare for retrograde pyelography?

Before you have the test, you’ll talk with your provider about your symptoms, medical condition, and the medicines and over-the-counter products you’re taking. It’s especially important that your doctor knows about pregnancy, blood thinners and allergies.

Your provider may want to do a urinalysis to check for a urinary tract infection. Having a UTI is usually a contraindication (reason to avoid) a retrograde pyelogram. This is because the test can make a UTI worse.

You can expect to have some type of anesthesia, so you’ll need someone to drive you home the same day. You won’t need to stay overnight.

Your healthcare provider will tell you if and when you’ll have to stop eating and drinking the night before the test and if you’re able to take your usual medications.

On the day of your test, leave your jewelry and valuables at home. Don’t bother with lotions or makeup. Wear loose and comfortable clothing.

What to expect during the test

After you arrive at the hospital or surgery center, a provider will:

1. Give you a hospital gown to change into
2. Put an intravenous (IV) line in your arm (you’ll get general anesthesia or regional anesthesia)
3. Take you to an operating room and transfer you to an operating table, where they may ask you to put your feet in stirrups.
4. Pass the cystoscope and instruments through your urethra and then position them in one of your ureters
5. Push the dye into your ureter while taking care to avoid air bubbles
6. Take a series of X-rays of your kidneys and ureters
7. Remove the scope and anesthesia

With the cystoscope and instruments, your provider can treat some of the urinary conditions the test might find. For instance, they might be able to remove stones, take care of a blood clot or place a stent. In these cases, a provider will do that procedure before removing the scope and anesthesia.

What are the risks of this test?

Retrograde pyelograms are very safe, and the level of radiation is low for this test. But no procedure is without risk. Risks include:

• Issues with anesthesia
• Reaction to the dye
• Nausea and vomiting
• Urinary tract infections
• Possible damage to parts of your urinary tract, including your bladder and ureters

What to expect after a retrograde pyelogram

After this test, a provider will:

1. Take you to a recovery unit for monitoring until you come out of the anesthesia, and your blood pressure and breathing are fine
2. Check your urine (pee) for signs of blood (they’ll also keep track of how much you’re peeing)
3. Give you information on any medications you should take or avoid, what you can and can’t eat, and when you should call the office
4. Let you know when you can leave with your designated driver

What is the recovery time for a cystoscopy retrograde pyelogram?

You should be able to go back to work or school in a few days. But your recovery may depend on whether or not your provider performed other procedures.

You can return to normal eating, and you should stay hydrated.

If your provider asks you to, you may need to keep track of your urine output and quality after going home.

What type of results do you get and what do the results mean?

Your results depend on the reason a provider performed retrograde pyelography. Your provider may tell you your urinary tract looks normal. Or they may inform you that they found damage, a blockage, a stone or a tumor in part of your urinary system. They may say they were able to get a good image to use for a procedure you needed.

The next steps will depend on what your provider found. They can talk with you about what they recommend.

When should I call my healthcare provider?

Call your provider after a retrograde pyelogram if you:

• Develop a fever
• Have chills or begin shaking
• Find it difficult to pee
• Have extreme pain when you pee
• Experience increased bleeding