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At least 19 recordsLinked to original sources
PubMed1980

[Combined intravenous arteriography and pyelography in renovascular hypertension. II. Comparison of its cost-effectiveness ratio with that of the classical approach (i.-v. pyelography +/- Seldinger arteriography) (author's transl)].

The cost of the systematic radiological examination of 100 hypertensive patients in the search of renovascular hypertension reaches 118 330 F, for the classical approach based on selecting the indications of the Seldinger arteriography on the urographic signs and even 164 950 F when these indications are broadened. The systematic examination of 100 hypertensives by the combined intravenous arteriography and pyelography costs 108 240 F when only one film is taken and 120 910 F when 6 films are taken. The effectiveness for the diagnosis of the 11 renovascular diseases present in 100 hypertensive patients, is measured by the recognition of 8.6-9.1 of them by the classical approach and 10.4-10.9 by the combined intravenous arteriography and pyelography. The effectiveness for the diagnosis of the 2,3 cases of renovascular hypertension present in 100 hypertensive patients is measured by the recognition of 1.8 -1.9 of them by the classical approach and 2.1-2.27 by the combined IV arteriography and pyelography. The cost of finding a patient with curable renovascular hypertension is respectively 51 543 F and 53 264 F with the routine intravenous arteriography according to the number of films and 65 738 and 86 815 F for the classical approach according to wether the indications of the Seldinger arteriography have purely urographic or also clinical basis. In conclusion, the combined intravenous renal arteriography and urography is a method more reliable and less expensive to diagnose renovascular disease and hypertension than the classical approach selecting the seldinger arteriography on the urographic and clinical data. Furthermore, this technic prevents arterial catheterism complications and allows a non traumatic follow-up of the non operated stenosis which may threaten the life of the kidney, as well as the operated or dilated ones.

Cost-Benefit Analysis↗
PubMed2003

Antegrade pyelography for suspected ureteral obstruction in cats: 11 cases (1995-2001).

OBJECTIVE: To determine sensitivity and specificity of radiography, ultrasonography, and antegrade pyelography for detection of ureteral obstructions in cats. DESIGN: Retrospective study. ANIMALS: 11 cats. PROCEDURE: Medical records of cats that had radiography, ultrasonography, and antegrade pyelography performed for suspected ureteral obstructions were examined. Ultrasound-guided pyelocentesis and fluoroscopic-assisted antegrade pyelography were performed on 18 kidneys in 11 cats. Obstructive ureteral lesions were confirmed in all cats by surgical or necropsy examination. Sensitivity and specificity of survey radiography, ultrasonography, and antegrade pyelography for identification of ureteral obstructions were calculated. Surgical or necropsy findings were used as the standard for comparison. RESULTS: All cats were azotemic. Mean +/- SD serum creatinine and BUN concentrations were 10.2 +/- 6.1 and 149 +/- 82 mg/dL, respectively. Fifteen of 18 ureters were found to be obstructed at surgery or necropsy. Sensitivity and specificity were 60 and 100% for radiography and 100 and 33% for ultrasonography, respectively, in identification of ureteral obstructions. Leakage of contrast material developed in 8 of 18 kidneys during antegrade pyelography and prevented diagnostic interpretation in 5 of 18 studies. For the 13 diagnostic studies, specificity and sensitivity were 100% by use of the antegrade pyelography technique. Correct identification of the anatomic location of the ureteral obstruction was obtained in 100% of diagnostic antegrade pyelography studies and in 60% of radiography or ultrasonography studies. CONCLUSIONS AND CLINICAL RELEVANCE: Antegrade pyelography can be a useful alternative in the diagnosis and localization of ureteral obstructions in azotemic cats, although leakage of contrast material may prevent interpretation of the study.

Animals↗
PubMed1984

Intrarenal backflow during retrograde pyelography following kidney transplantation.

At the transplantation center of Rigshospitalet , Copenhagen, retrograde pyelography is routinely performed via a ureteral catheter inserted during the operation. Ninety-nine retrograde pyelographies performed within the first days after renal transplantation were reviewed. The clinical records of 30 additional patients who had not been subjected to pyelography were also reviewed. Intrarenal backflow (IRB) was seen in 14 per cent of the pyelograms. Upper urinary tract obstruction (29 cases) was observed with equal frequency in the groups with and without IRB. No relationship was observed between IRB and length of warm and cold ischemia of the graft, urinary tract infection (UTI), donor kidney age and graft function on the day of retrograde pyelography. In 40 per cent of the grafts with irreversible rejection within 60 days after transplantation IRB was found at pyelography in the first days after operation. IRB occurred in only 5 per cent of the kidneys with good long term function. Most frequently IRB was localized to the upper pole but was also observed in other parts of the kidney. IRB may be an early radiographic sign of an impending and irreversible graft rejection. There was no evidence that retrograde pyelography increased the frequency of UTI or the number of episodes of irreversible rejection.

Cadaver↗
PubMed1989

Intravenous pyelography: the case against its routine use.

PURPOSE: To critically appraise four common uses of intravenous pyelography in adults. DATA IDENTIFICATION: We reviewed the literature on the use of intravenous pyelography for four clinical indications. STUDY SELECTION: We analyzed the literature to determine the proportion of intravenous pyelograms producing clinically useful information (yield) in four clinical situations. The best estimate of its accuracy (sensitivity and specificity) for associated pathologic findings was determined. The implications of using the test on the outcomes of patients and costs were evaluated. RESULTS OF DATA SYNTHESIS: The yield of significant abnormalities in patients having prostatectomy is small; intravenous pyelography does not specifically indicate ureteral obstruction, and is not sensitive or specific enough for screening for urinary tract malignancies. Many false-positive results, little benefit, and significant costs can be expected. When used before hysterectomy, intravenous pyelography does not reduce injury to the ureters, and the yield of unexpected abnormalities is small. The use of the test to screen for unexpected anatomic abnormalities in adult women after urinary tract infections has not led to improved outcomes or prevention of impaired renal function. Acquired causes of obstruction will be suggested by the history or physical examination. In hypertensive adults, intravenous pyelography is not accurate enough in detecting renal artery stenosis or in predicting favorable outcomes of renal artery surgery. Also, large costs are generated by high false-positive rates, and candidates for successful surgery are not reliably identified. CONCLUSIONS: Selective use of intravenous pyelography is recommended for patients before prostatectomy or hysterectomy, in women after urinary tract infections, and in adults whose hypertension may have a renovascular cause. Use should be reserved for patients whose history and physical examination raise specific questions for which this test could provide an answer that would affect treatment.

Cost-Benefit Analysis↗
PubMed2001

MR pyelography in 115 patients with a dilated renal collecting system.

PURPOSE: To evaluate the accuracy of MR pyelography in the assessment of hydroureteronephrosis. MATERIAL AND METHODS: One hundred and fifteen patients, with variable degree of hydroureteronephrosis demonstrated by US and urography were subjected to MR pyelography obtained by means of two ultra-fast sequences. RESULTS: Of the 228 kidneys examined, the collecting systems of 130 kidneys were dilated and correctly identified on MR pyelography, with only 2 false-positive results. The specificity of MR pyelography in detecting hydronephrosis was 98%. Accuracy in revealing level of obstruction was 100%. Sensitivity in detecting stones, strictures and congenital ureteropelvic junction obstructions was respectively 68.9%, 98.5% and 100%. CONCLUSION: MR pyelography can rapidly and accurately depict the morphological features of dilated urinary tracts with information regarding the degree and level of obstruction, without using contrast medium or ionizing radiation.

Adolescent↗
PubMedDate not supplied

Intrarenal backflow during retrograde pyelography with graded intrapelvic pressure. A radiologic study.

Intrarenal backflow (IRB)--a form of pyelorenal backflow where contrast material appears in the renal parenchyma during retrograde pyelography--seems to be the same phenomenon as intrarenal reflux (IRR), sometimes observed during micturating cystography in children or animals with vesicoureteral reflux. Retrograde pyelography experiments were performed on baby pigs to study the relationship between renal pelvic pressure and IRB. Intrapelvic pressure was raised to 30-35 mm Hg (moderate) or 70-75 mm Hg (high) for 5 minutes. IRB developed in only four of 12 kidneys at moderate pressure but in all six kidneys at high pressure. Similar experiments were conducted on kidneys which had been rendered temporarily ischemic prior to retrograde pyelography. Twenty-seven kidneys were so studied 30 minutes after a 30- or 60-minute period of ischemia. With moderate and high pressure retrograde pyelography, all kidneys developed IRB. The most intense and widespread IRB occurred after 60 minutes of ischemia and at high pressure. IRB localized to the upper pole most frequently but was also observed in other portions of the kidney. The effect of IRB upon renal blood flow (RBF) was determined with electromagnetic flow probes during the same experiments. IRB caused a 16% mean decrease in RBF at moderate pressures and a 57% mean decrease in RBF at high pressures and was independent of preceding ischemia. It is concluded that both raised intrapelvic pressure and preceding renal ischemia are important factors determining the degree of IRB during retrograde pyelography and that backflow itself causes decreased RBF.

Animals↗
PubMed1981

Skinny needle pyelography. An advance in uroradiology.

Diagnostic puncture of the renal pelvis with a fine-gauge needle inserted under radiological and ultrasound control, has been performed in more than 100 cases. The method is safe, easy to perform for those trained in imaging modalities, and causes little discomfort. Pyelography and pressure flow studies can be made and urine specimens obtained from the upper urinary tract. Skinny needle pyelography is indicated in unilateral non-visualization of the ureter on intravenous pyelography, in acute oliguric renal failure when ultrasound reveals dilated ureters, and when retrograde pyelography is not feasible. The method is cost-effective, as it can be performed on outpatients as a follow-on procedure after intravenous pyelography or renal ultrasound scanning.

Acute Kidney Injury↗
PubMed1980

[Percutaneous antegrade pyelography with a fine needle].

In 15 patients the percutaneous antegrade pyelography with thin needle was performed for the clarification of a mute kidney and a urinary stasis kidney. The two groups of diseases could not be clarified by means of the methods of the conventional urography. The retrograde pyelography was intentionally given up. By means of the percutaneous antegrade pyelography we could clarify a mute kidney in 8 cases and in 4 cases a urinary stasis kidney. In 3 cases with mute kidney we did not succeed in the demonstration of the renal calyces. No complications appeared. In strong indication the percutaneous antegrade pyelography is an evident diagnostic measure by great security, little stress for the patient and little cost. Despite modern investigation methods including sonography and computer tomography is referred to the fields of application of the percutaneous antegrade pyelography.

Biopsy, Needle↗
PubMed1982

Radioisotope antegrade pyelography in ureterovesical obstruction.

A radioisotope renal scan is commonly used for renal investigation and is especially useful in frequently encountered allergic patients for whom conventional IV pyelography could be hazardous. When retrograde pyelography is technically not feasible in such patients, radioisotope antegrade pyelography provides an effective means for diagnosing, localising and delineating the nature of ureteral obstructions. A case is described of post-operative ureterovesical obstruction with severe septic complications, requiring emergency nephrostomy. Radioisotope antegrade pyelography (nephrostography) with 99mTc-DTPA clearly demonstrated the obstruction and following ureteral reimplantation confirmed free outflow.

Female↗
PubMed2000

Surveillance of upper urinary tract transitional cell carcinoma: the role of ureteroscopy, retrograde pyelography, cytology and urinalysis.

PURPOSE: A select group of patients with upper tract transitional cell carcinoma are treated with ureteroscopic resection. We determine the validity and accuracy of urinalysis, bladder cytology, upper tract biopsy/cytology and retrograde pyelography for the detection of recurrent upper tract transitional cell carcinoma compared to endoscopic findings. MATERIALS AND METHODS: Patients with ureteroscopically treated upper tract transitional cell carcinoma were followed with surveillance every 3 to 6 months. Surveillance included urinalysis with dipstick and microscopic examination, bladder cytology, retrograde pyelography read by a urologist and radiologist, and ureteropyeloscopy with cytology and biopsy of suspicious areas. Not all results were available for all surveillance procedures. Measures of sensitivity and specificity for the aforementioned surveillance procedures were determined relative to endoscopic findings that were defined as the standard. Confidence intervals were also estimated. Initially, a generalized estimation equation approach was used to take into account the clustering of repeated testing within patients. The accuracy of each procedure was also calculated. RESULTS: There were 23 patients with previously resected low grade upper tract transitional cell carcinoma who underwent a total of 88 surveillances in 30 months. A total of 56 of 88 (64%) recurrences were detected ureteroscopically, including 11 (12%) associated bladder recurrences. In patients who did not have bladder recurrences urinalysis had a sensitivity of 37.5% but specificity was 85%, while bladder cytology had a sensitivity of 50% and specificity was 100%, and retrograde pyelography read in the endoscopy room revealed a sensitivity of 71.7% and specificity of 84.7%. Ureteroscopic biopsy/cytology had a sensitivity and specificity of 93.4% and 65.2%, respectively. CONCLUSIONS: Our findings indicate that compared to ureteroscopy, urinalysis, bladder cytology, retrograde pyelography and ureteroscopic cytology/biopsy are less valid and accurate in detecting upper tract transitional cell carcinoma recurrences. Based on our data we recommend ureteroscopic evaluation as an essential procedure for the surveillance of patients treated endoscopically for upper tract transitional cell carcinoma.

Biopsy↗
PubMed1987

The value of retrograde pyelography for fractionally visualized upper tracts on excretory urography in the evaluation of hematuria.

A 5-year retrospective study of 131 hematuria patients (23 with gross and 108 with microscopic hematuria) undergoing retrograde pyelography solely for fractional visualization of the upper tracts on excretory urography revealed no tumors or other significant pathological condition in the 187 renal units (56 bilateral cases) studied. A review of our cases of upper tract urothelial cancer since 1955 revealed 36 patients with complete records of the urological evaluations. None of the cases was diagnosed by retrograde pyelography for fractionally visualized excretory urography and 3 were within 9 months of a previously normal excretory urogram alone or with retrograde pyelography. We believe that retrograde pyelography done solely to evaluate a fractionally visualized upper tract may miss subtle lesions and it should not terminate the evaluation. We recommend that excretory urography, cystoscopy and voided urine cytology studies be performed initially and, if normal, they should be repeated in 6 and 12 months before upper tract urothelial tumors are ruled out.

Adult↗
PubMed2003

ARF after retrograde pyelography: a case report and literature review.

Acute renal failure (ARF) occasionally occurs after intravenous injection of contrast medium, but complications are rare after retrograde pyelography. After reviewing the reports in the English-language literature, the authors found very few on those complications after retrograde pyelography. The authors present a patient who had ARF after the technique. The patient had a history of hypopharyngeal cancer with underlying serum creatinine level at the high end of the normal limits. Bilateral flank pain and decreased urine amount were noted soon after the procedure of retrograde pyelography. Subsequently, blood urea nitrogen and creatinine levels both elevated, and hemodialysis was needed. Several days later, diuretic phase took place. Thereafter, the symptoms subsided gradually. Pyelorenal extravasation of contrast medium was remarkable during the procedure. There was no evidence of hydronephrosis during the course of ARF. Early awareness and management may prevent the complications of ARF such as acute lung edema and hyperkalemia. Therefore, clinical physicians should be aware of the occurrence of ARF and its clinical presentation after performing retrograde pyelography.

Acute Kidney Injury↗
PubMed1999

Antegrade pyelography before pyeloplasty via dorsal lumbar incision.

PURPOSE: The need for contrast imaging of the ureter before routine pediatric pyeloplasty is controversial. We evaluated the use of antegrade pyelography for upper tract imaging before pyeloplasty via dorsal lumbar incision. MATERIALS AND METHODS: The records of all patients who underwent pyeloplasty from April 1994 through April 1998 at our institution were reviewed. The findings and outcome of patients with presumed ureteropelvic junction obstruction in whom antegrade pyelography was performed under the same anesthetic were assessed, and those in whom this procedure changed the planned operative approach were identified. RESULTS: Antegrade pyelography was performed without complication in 72 patients before planned pyeloplasty and 2 attempts were unsuccessful. In 10 cases (14%) plans for dorsal lumbar incision were abandoned based on findings of renal malrotation in 3, ureteral stricture in 2, ureterovesical junction obstruction in 2, unusually low or high position of the ureteropelvic junction in 1 each, and concurrent ureteropelvic and ureterovesical junction obstruction in 1. The study was misinterpreted in 1 case of renal malrotation and 1 case of horseshoe kidney, and the dorsal approach was used. In 1 of these cases conversion to an anterior approach was required. A nonobstructing ureterovesical junction was seen in 2 other patients who had ureteropelvic junction obstruction with mild ureteral dilatation on ultrasound. CONCLUSIONS: The dorsal lumbar incision may provide inadequate exposure in certain patients with upper tract obstruction. Antegrade pyelography is a simple, safe and useful technique to visualize the collecting system before planned pyeloplasty via dorsal lumbar incision, allowing the surgeon to choose a more suitable operative approach or procedure when warranted.

Adolescent↗
PubMed1988

Urinary obstruction in renal transplants: diagnosis by antegrade pyelography and results of percutaneous treatment.

We reviewed our experience with 51 renal transplants to evaluate the accuracy of antegrade pyelography as compared with that of sonography and nuclear renography in the diagnosis of transplant obstruction. Also, the results of percutaneous treatment were analyzed in 44 of these patients. Obstruction was clinically suspected in all of the patients (increased serum creatinine levels and decreased urine output). Antegrade pyelography showed obstruction in 44 (86%) of the 51 patients, and nephrostomy drainage catheters were inserted. Sonography showed pyelocaliectasis in all 49 cases in which it was performed; in 42, the pyelocaliectasis was due to obstruction (14% false-positive rate). Nuclear renography showed obstruction in only six (18%) of 33 cases in which it was performed; all six cases proved to be obstructed (0% false-positive rate and 82% false-negative rate). Twenty-two (50%) of the 44 patients treated with nephrostomy drainage were managed successfully without surgical intervention; seven of these 22 required balloon dilation of ureteric strictures in addition to catheter decompression of the collecting system. The average duration of catheterization required for successful percutaneous treatment was 35 days. This experience suggests that antegrade pyelography has a definite role in the workup of patients suspected of having renal transplant obstruction. The percutaneous access permits successful catheter drainage. Compared with antegrade pyelography, sonography is reasonably accurate in determining the presence of urinary obstruction, although false-positive diagnoses are found in a substantial number of patients. Nuclear renography is not, however, a useful indicator of obstruction owing to its high false-negative rate. Percutaneous treatment of urinary obstruction in transplantation patients proves successful in approximately 50% of cases.

Humans↗
PubMed1979

[Percutaneous translumbar pyelography -- a method for the diagnostic clarification of obstructive uropathy (author's transl)].

Percutaneous translumbar pyelography is indicated when excretory has failed to demonstrate the cause or site of obstructive uropathy and retrograde pyelography is impossible, undesirable or contraindicated. Under prophylactic treatment with antibiotics translumbar antegrade pyelography is safe, simple and accurate and in selected cases the only diagnostic method to establish exact diagnosis without which appropriate therapy cannot be planned. The method is described and the results of 30 percutaneous translumbar pyelographies obtained from 2603 angiographies over 12 years are reported.

Biopsy, Needle↗
PubMed1977

Evaluation of ureteral obstruction by early intravenous pyelography.

Acute ureteral obstruction was studied in dogs by intravenous pyelography at two, four, six, nine, 12, 24, 48 and 168 hours after total occlusion of the ureter. Ureteral obstruction was correctly diagnosed in all instances, if intravenous pyelography was performed within nine hours from the time of obstruction and if a two hour sequence roentgenogram was obtained. A variably diagnostic rate of 36 to 75 per cent occurred when intravenous pyelography was delayed until 12 hours or later. In ureters with a positive diagnosis, 65 per cent were correctly identified on the 15 minute film, 98 per cent on the one hour film and 100 per cent on the two hour film. Intravenous pyelography should be performed immediately after the onset of renal insufficiency to obtain maximal information, as deterioration in renal function from total ureteral obstruction rapidly causes inadequate excretion and concentration of contrast material and prevents visualization of an obstructed collecting system.

Acute Disease↗
PubMed1977

Exacerbation of diabetic renal failure following intravenous pyelography.

Twenty-two of 29 (76 per cent) diabetic patients with a creatinine level of more than 2 mg/100 ml had exacerbation of renal failure following intravenous pyelography. In nine patients this was irreversible. Particularly at risk seem to be patients with early onset diabetes (less than 40 years), and those patients with severe renal failure (creatine over 5 mg/100 ml). No less that 15 of 16 (93 per cent) such patients had problems after intravenous pyelography; of these, nine (56 per cent) had irreversible deterioration. This report, in context with the increasing number of case reports of similar findin.gs, indicates that intravenous pyelography is dangerous in patients with juvenile onset diabetes who have a creatinine level of more than 5 mg/100 ml.

Adult↗
PubMed1994

Pediatric pyeloplasty: is routine retrograde pyelography necessary?

To evaluate the necessity for retrograde pyelography in the preoperative evaluation of children undergoing pyeloplasty, we reviewed the records of 108 consecutive patients (age range 5 days to 18 years, median 1 year) who underwent pyeloplasty at our institution during a 6-year period. The routine preoperative evaluation consisted of a renal/bladder sonogram, furosemide renal scan (99mtechnetium-diethylenetriaminepentaacetic acid or 99mtechnetium-mercaptoacetyltriglycine) and voiding cystogram. No other imaging studies were obtained in 95 patients (88%). Other upper tract studies usually performed before referral included excretory urography in 9 cases and computerized tomography in 5. Preoperative retrograde pyelography was only performed in 1 symptomatic patient before referral to our institution. Surgical findings confirmed obstruction at the ureteropelvic junction in all patients. Undetected ureteral dilatation, which might suggest undiagnosed distal obstruction, was not encountered. After pyeloplasty 2 patients were lost to followup, renal drainage improved in 104 (98%) and drainage failed to improve in 2 of whom 1 (0.9%) required reoperation. All patients who presented with symptomatic uretero-pelvic junction obstruction experienced postoperative resolution of the presenting complaints. Our series demonstrates that routine retrograde pyelography to define the level of obstruction is not necessary for successful primary pyeloplasty. In experienced hands and with careful attention to detail, the combination of renal/bladder sonography and diuretic renography can reliably exclude the possibility of distal obstruction in children with hydronephrosis before pyeloplasty.

Adolescent↗