Imageing Antegrade Pylogra

Antegrade Pyelogram

Objectives

In cases of:

•   Poor or nonvisualised of urinary system on excretory urography.

•   Opacification of upper urinary tract for evaluating site and nature of obstruction.

•   To obtain urine specimen for cytology or culture.

Patient Preparation

•   Blood prothrombin time

•   Antibiotic cover if required

•   Fasting for 6 hours

•   Surgical cleaning and draping of the site of drainage.

Position

Prone with sandbag under abdomen.

Anesthesia

•   IV sedation with diazepam

•   Local infiltration analgesia with 1% xylocaine, 10 ml

•   General anesthesia may be required for infants and uncooperative children.

Instruments

•   22 G, 20 cm long needle with stilet

•   20 ml syringe

•   50-100 ml of urografin 60%.

Procedure

   1.  Sonographic guidance.

   2.  Choose calyx to be punctured.

   3.  Puncture should be laterally as possible, through renal parenchyma.

   4.  Puncture chosen calyx under screening guidance with
22 G needle.

   5.  Check position of needle tip within the pelvicalceal system.

   6.  Remove stilette of needle.

   7.  Aspirate urine with a 20 ml syringe.

   8.  Measure volume of urine aspirated.

   9.  Urine may be sent for bacteriology, cytology, chemistry.

10.  Inject urografin through the needle, under US monitoring. Total volume of urografin injected should be less than the volume of aspirated urine.

11.  Withdraw the needle.

12.  Shift patient to the fluoroscopy site.

13.  Radiographs of the opacified renal collecting system various position, including delayed errect films.

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