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.
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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