RGP.pptx

RGP

1. RETROGRADE PYELOGRAPHY & ANTEGRADE PYELOGRAPHY/ PERCUTANEAOUS NEPHROSTOMY:

2. RETROGRADE PYELOGRAPHY – INTRODUCTION : It is a radiologic examination of the ureters and renal pelvic (collecting system of the kidney) by retrograde injection of contrast media through the ureter . This procedure is preformed with the cystoscope . The study is performed by the urologist under the radiologist supervision in the radiology department.

3. Cystoscopy – it is the examination of the bladder and the urether through the cystoscope . Cystoscope – it is a thin endoscope with a camera lens, it is inserted through the urethra to visualize the bladder.

4. INDICATION: When the intravenous pyelography has failed to visualied the collecting system. To evaluate intra- ureteral or intra-pelvic filling defect . Suspected lesion fistula in the urinary tract. Suspected urinary tract tumors or stones . Hematuria . Ureteral strictures.

5. CONTRAINDICATION: Blood clotting disorder. Cardiopulmonary disorder. Suspected pregnancy. Obstructive mass in the bladder/urethra.

6. EQUIPMENT: Fluoroscopy unit with spot film device or image recorder device. Antiseptic solution. Local anesthesia. Syringe , Gloves. Sterile towel and Gauze. Saline and Sedative medicine. Cystoscope . Iodinated contrast media.

7. PATIENT PREPARATION: Asked the patient to take low residue diet prior to the examination . The laxative may be given for bowel preparation. Drink clear liquids the day before the examination Fasting may be employed for 6-8 hours . Ask patient not to eat or drink after midnight.

8. Pregnancy women should not have a radiological examination . Instructed to remove all metallic objects and metallic jewelry from the body. Asked to stop taking an anticoagulant two days prior.

9. PROCEDURE: On the examination ,technologist should describe the whole procedure to the patient . Obtain written consent from the patient for permission of procedure . The patient is asked to remove the clothing and wear the hospital gown. Placed in the supine position with empty bladder. An IV is inserted into the patient arm. If necessary, sedative medication is given.

10. The patient placed in the supine position on the fluoroscopic table. Scount film of abdomen in taken to see the bowel preparation. If residual fecal matter or gasses is present in the bowel, the examination should be postponed for the next day. If the bowel preparation is good, then the urologist aoolies the xylocaine jelly on the cytoscope , then introduces the cystoscope through the urethra and advances slowly into the patient’s bladder under the fluroscopic guidance.

11. After placing the endiscope , the urologist inserted a cather into the bladder and placed it at the uretral opening. After placement of catheter, the urologist injects the contrast media through the catheter. When the contrast moves retrograde through the ureters , then the spot films are taken of urinary system in suspected respiration. After completion of spot filming several radiographs are again taken in supine AP,LAO and RAO.

12. AFTERCARE: After completion of the study, the urologist withdraws the catheter and endoscope. The IV line is removed from the patient . The patient advised to fluid fluid intake for the elimination of contrast from the body. Thereafter the patients may be allowed to leave the examination room.

13. ANTEGRADE PYELOGRAPHY/ PERCUTANEAOUS NEPHROSTOMY –INTRODUCTION : interventional radiological examination of upper urinary tract. It may be followed by the percutaneous nephrostomy or ureteral stent placement or nephrolithotomy .

14. INDICATION: Urinary tract obstruction due to renal calculi or mass. Urinary diversion. Kidney stone treatment through the percutaneous procedure. Urinary tract infection. Evaluate the urinary system.

15. CONTRAINDICATION: Hypersensitivity to iodinated contrast media. Blood clothing disorder . Cardiopulmonary disorder. Suspected pregnancy.

16. PRE-PROCEDURE INVESTIGATION: Total blood cell count. Bleeding and clotting time. Urine culture and KUB plain radiograph

17. EQUIPMENT: US machine. Fluoroscopy machine. Local anesthesia. 18 gauge puncture needle. Guide wire, normal saline, gauze. Water soluble non-ionic contrast media. Sterile towel, antiseptic solution. Dilators of multiple gauges Pigtail locking-loop catheter 8 french .

18. PATENT PREPARATION: Asked the patient to take low residue diet prior to the examination . The laxative may be given for bowel preparation. Drink clear liquids the day before the examination Fasting may be employed for 6-8 hours . Ask patient not to eat or drink after midnight.

19. Pregnancy women should not have a radiological examination . Instructed to remove all metallic objects and metallic jewelry from the body. Asked to stop taking an anticoagulant two days prior.

20. PROCEDURE: On the examination ,technologist should describe the whole procedure to the patient . Obtain written consent from the patient for permission of procedure . The patient is asked to remove the clothing and wear the hospital gown. An IV is inserted into the patient arm. If necessary, sedative medication is given.

21. The patient placed in the supine position on the fluoroscopic table. Scount film of abdomen in taken to see the bowel preparation. Posterior area on 12 th rib the must be cleaned with the antiseptic and local anesthesia is given at puncture ste . Gently inserted an 18/20 gauge needle at the angle toward the posterior calyx. Then the stylet of the needle will be removed and drains freely. The urine sample must be obtained and sent for culture and sensitivity tests.

22. After contrast is injected to confirm the correct position of needle. X-rays are taken dye move throught the ureter , blockage will diagnose. The surgeon may place a ureteral stent or place nephrostomy catheter to relive obstruction. NEPHROSTOMY PROCEDURE: A flexible guide wire is inserted through the needle. After the needle is removed . Then dilator is placed over the guide wire.

23. After a pigtail catheter is inserted into the renal pelvis over the guide wire. Contrast media is administrated to confirm the correct position od catheter. Then guide wire is removed and the catheter tried up with the suture attach to the external drainage bag.

24. COMPLICATION: Bleeding at the puncture site. Infection, at the puncture site. Leackage of urine from the kidney, resulting in the collection of fluid inside the abdomen. AFTERCARE: The patient is kept under medical observation all vital sign must be monitor. Thereafter the patients may be allowed to leave the examination room.

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