Difference between revisions of "Antegrade pyelography"
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The procedure can be started in supine position. It can be done in a clean technique (not necessarily sterile) with gloves and radiation protection. | The procedure can be started in supine position. It can be done in a clean technique (not necessarily sterile) with gloves and radiation protection. | ||
*Generally use low radiation dose fluoroscopy with normal dose single projections. | *Generally use low radiation dose fluoroscopy with normal dose single projections. | ||
| − | *Close any | + | *Close any bladder catheter in order to easier detect any contrast ending up in the bladder. |
==Procedure with established nephrostomy== | ==Procedure with established nephrostomy== | ||
| + | [[File:Society for Fetal Urology (SFU) grading of hydronephrosis.jpg|thumb|150px|SFU grading of [[hydronephrosis]].]] | ||
*Take an initial anteroposterior image including the presumed locations of the kidney, ureter and urinary bladder. | *Take an initial anteroposterior image including the presumed locations of the kidney, ureter and urinary bladder. | ||
*Infuse iodinated contrast, usually at least a volume corresponding to about 15 ml of 240mg/ml iodine. Observe both the imaging and whether the patient develops flank pain. Optionally, note how much contrast has been infused at that point. | *Infuse iodinated contrast, usually at least a volume corresponding to about 15 ml of 240mg/ml iodine. Observe both the imaging and whether the patient develops flank pain. Optionally, note how much contrast has been infused at that point. | ||
*Note the following: | *Note the following: | ||
:*Location of the tip of the catheter in the kidney | :*Location of the tip of the catheter in the kidney | ||
| − | :*Any visible hydronephrosis or hydroureter | + | :*Any visible hydronephrosis or hydroureter. If present, also note: |
| + | ::*Severity of the hydronephrosis | ||
| + | ::*Any caliber change, or most distal part reached by contrast. | ||
:*Any contrast outside the catheter or urinary tract, including leakage along the outside of the catheter | :*Any contrast outside the catheter or urinary tract, including leakage along the outside of the catheter | ||
:*Flow into the urinary bladder (see below if none). | :*Flow into the urinary bladder (see below if none). | ||
| + | After the procedure, open up any closed bladder catheter. | ||
===If contrast does not reach the urinary bladder=== | ===If contrast does not reach the urinary bladder=== | ||
| Line 29: | Line 33: | ||
*Catheter tip location | *Catheter tip location | ||
*Any visible hydronephrosis or hydroureter | *Any visible hydronephrosis or hydroureter | ||
| + | :*If present, grading of any hydronephrosis | ||
*Location of the most distal part reached by contrast, or caliber change | *Location of the most distal part reached by contrast, or caliber change | ||
*Even absence of leakage | *Even absence of leakage | ||
Revision as of 17:53, 30 April 2019
Author:
Mikael Häggström [notes 1]
Contents
Preparation
The procedure can be started in supine position. It can be done in a clean technique (not necessarily sterile) with gloves and radiation protection.
- Generally use low radiation dose fluoroscopy with normal dose single projections.
- Close any bladder catheter in order to easier detect any contrast ending up in the bladder.
Procedure with established nephrostomy
- Take an initial anteroposterior image including the presumed locations of the kidney, ureter and urinary bladder.
- Infuse iodinated contrast, usually at least a volume corresponding to about 15 ml of 240mg/ml iodine. Observe both the imaging and whether the patient develops flank pain. Optionally, note how much contrast has been infused at that point.
- Note the following:
- Location of the tip of the catheter in the kidney
- Any visible hydronephrosis or hydroureter. If present, also note:
- Severity of the hydronephrosis
- Any caliber change, or most distal part reached by contrast.
- Any contrast outside the catheter or urinary tract, including leakage along the outside of the catheter
- Flow into the urinary bladder (see below if none).
After the procedure, open up any closed bladder catheter.
If contrast does not reach the urinary bladder
Infuse as much contrast as still comfortable by the patient. Observe the most distal part reached by contrast, and the shape thereof. Zooming in on this segment may detect subtle passage. Also turn your eye to the nephrostomy for leakage.
Obtain new projections after:
- Having the patient in a more standing position.
- Having the patient cough.
Report
The report may be a chronological description of the procedure, and should include:
- Catheter tip location
- Any visible hydronephrosis or hydroureter
- If present, grading of any hydronephrosis
- Location of the most distal part reached by contrast, or caliber change
- Even absence of leakage
Optionally also:
- If obstructed:
- Classification as partial or complete (that is, some or no passage of contrast)
- Shape of the ureter at the obstruction.
- Volume of contrast infused.
- Provocation with standing or coughing.
The tip of the nephrostomy is located in an inferior calyx. |
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
_grading_of_hydronephrosis.jpg){kind=link}