What is the role of retrograde pyelography in the diagnosis of nephrolithiasis?

Updated: Jun 21, 2018
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
  • Print
Answer

The most precise imaging method for determining the anatomy of the ureter and renal pelvis and for making a definitive diagnosis of any ureteral calculus is not IVP or renal colic CT scanning but retrograde pyelography.

In this study, the patient is taken to the operating room (OR) cystoscopy suite, and an endoscopic examination is performed with the patient under anesthesia. After a cystoscope is placed in the bladder, a thin ureteral catheter is inserted into the ureteral orifice on the affected side. A radiographic picture is taken while contrast material is injected through the ureteral catheter directly into the ureter. Any stone, even if radiolucent, and any ureteral kinks, strictures, or tortuousities that may not be visualized easily on other studies become clearly visible.

Urologists perform retrograde pyelograms when a precise diagnosis cannot be made by other means or when a need clearly exists for an endoscopic surgical procedure and the exact anatomical characteristics of the ureter must be clarified.

Retrograde pyelograms are rarely performed merely for diagnostic purposes, because other less invasive studies are usually sufficient. They are considered essential when surgery is deemed necessary because of uncontrollable pain, severe urinary infection or urosepsis with a blocked kidney, a solitary obstructed kidney, a stone that is considered unlikely to pass spontaneously because of its large size (generally ≥8 mm), or the presence of possible anatomical abnormalities (eg, ureteral strictures).

Retrograde pyelograms can be performed safely both in patients highly allergic to IV contrast media and in patients with renal failure because the contrast medium never enters the bloodstream and therefore requires no renal filtration or excretion and causes no anaphylaxis.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!