 Antegrade Pyelography
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Antegrade pyelography is an imaging test in which a needle or catheter is placed through the skin into the renal collecting system (inside of the kidney) under imaging guidance.
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At Children's Hospital Boston, antegrade pyelography is performed with the use of ultrasound and x-ray fluoroscopic guidance by a trained pediatric interventional radiologist. Children's Hospital Boston radiologists are specifically trained and experienced in performing interventional procedures on infants and children. Children's Hospital Boston is also staffed by pediatric anesthesiologists, radiologic technologists and nurses who are familiar with these interventional procedures and the necessary associated care. Children's Hospital Boston is equipped with modern ultrasound and x-ray equipment appropriate for performing this procedure.
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Your physician may recommend antegrade pyelography to look for obstructions or blockages of the renal collecting system (part of the urinary tract draining the urine between the kidney and bladder). Specific diagnoses include hydronephrosis, ureteropelvic junction obstruction, and ureterovesical junction obstruction.
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Antegrade pyelography, when performed by an appropriately trained and experienced interventional radiologist, is a safe technique. There may be some discomfort associated with the initial placement of the needle but this is minimized by the administration of general anesthesia or sedation medication and by injection of local anesthetic (numbing medication) into the skin prior to placing the needle.
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You will be given detailed written instructions regarding time and place of arrival and dietary preparation. In general, the patient is asked not to eat solid food for eight hours prior to the procedure and to stop drinking clear fluids three hours before the procedure.
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The patient is asked to lie prone (on the stomach) on an x-ray examination table. The interventional radiologist will examine the patient's kidneys with an ultrasound probe. Once the patient is relaxed, the skin on the patient's back is washed with a special iodine solution and sterile drapes are placed over him/her to prevent infection. After injection of a local anesthetic (numbing medicine), the interventional radiologist will, using ultrasound images for guidance, pass a needle directly into the kidney. This needle is used to inject contrast medium which outlines the collecting system on the x-ray images. The needle can also be used to measure pressures in the kidney in order to determine whether or not the collecting system is truly obstructed (see Whitaker test). In addition, the needle can be exchanged for a catheter if further drainage of urine, balloon dilation of narrowed areas within the ureter, or removal of kidney stones is required.
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Once the needle or catheter has been placed inside the kidney and contrast medium is injected, the resulting x-ray images demonstrate the collecting system inside the kidney. The radiologist can then determine whether the collecting system is blocked, and if so exactly where the obstruction is. As described above, some obstructions can be treated by inflating a balloon across the obstruction and stretching the obstructed area. X-ray pictures can then be repeated to see whether or not the obstruction has been improved.
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The interventional radiologist will discuss the findings and results of this test with you immediately after the procedure.
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To obtain additional information before or after the antegrade pyelogram, contact Children's Interventional Radiology Office at 617-355-6579. The appropriate person will be asked to return your call.
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