What Is A Retrograde Pyelogram?

  • Anit Joseph BAMS, Ayurvedic Medicine/Ayurveda, Rajiv Gandhi University of Health Sciences
  • Rajni Sarma MBBS, MD from North-Eastern Hill University, India

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An imaging examination called a retrograde pyelogram looks inside your kidneys, ureters, and bladder using X-rays.1A unique dye (a "contrast agent") is injected into the ureters during retrograde pyelography. The injected dye gives a better picture of the urinary system, and the contrast image can be viewed on the X-ray. It is similar to an intravenous pyelogram (IVP). However, instead of injecting the dye into the ureter, IVP uses a vein.

Retrograde pyelography has essentially been supplanted by other tests. Retrograde pyelography, however, occasionally provides more detailed images of the upper urinary system. When IVP is unable to produce a clear image, retrograde pyelography is employed. It's helpful in addition to cystoscopy to look for potential cancerous causes of hematuria.3

Uses of retrograde pyelogram

Retrograde pyelography is a useful tool for examining the urinary system's functionality in several situations. This could involve the following:7

  • Assess ureteral blockage
  • Determine if there are stones or tumours
  • To check for hematuria
  • Assist in inserting a catheter
  • Assist with the ureteral stent's installation
  • Assess trauma

When to avoid retrograde pyelogram? 

Retrograde pyelography has no absolute contraindications. As opposed to intravenous pyelography, this test can also be performed on people with impaired renal function. There are certain related contraindications, though, so the test should only be performed when it is thought to be essential and all associated hazards have been considered. Among them are:7

  • Pregnancy–To prevent potential teratogenic consequences, pregnant women should not be exposed to radiation at a dose higher than 50 mSv.
  • Infected urine– Proceed with caution, although the test's advantages exceed its hazards. 
  • Allergy to contrast dye–  The body absorbs very little of the dye, therefore, most with contrast allergy do not experience an anaphylactic reaction. However, sometimes it is suggested to avoid contrast agents if you are allergic to a particular dye.


A urologist will typically do this outpatient test in the operating room. The use of general anaesthesia is common. A long, narrow telescope called a "cystoscope" with a light at the end is inserted via the urethra by the urologist. Subsequently, a tube called a "catheter" is inserted into the ureter. Using the catheter, a dye is delivered into the ureters. Next, the kidneys and ureters are X-rayed. The exam may take fifteen to thirty minutes.3

Contrast agents in retrograde pyelogram

The contrast employed in excretory urography (intravenous urography) is also utilised in retrograde pyelography. There are three kinds of contrast based on osmolality:

  • Iso osmolar
  • Low osmolar
  • High osmolar

Radiographic density rises as osmolarity falls. The doctor usually dilutes the contrast with sterile water to 50% for retrograde pyelography. By reducing the contrast, you may be sure that even the smallest filling flaws will be seen.4 


First, patients must be well-informed about the treatment and its components. It is crucial that kids feel at ease throughout the process and are free to ask any questions they may have of a medical professional.

It is imperative that patients maintain adequate liquid intake during the surgery to prevent dehydration. Depending on the circumstances, patients must often fast from a few hours to the night before the treatment. Also, put on a medical gown if requested to do so, and take off all jewellery6

After changing into a hospital gown, you will be instructed to lie on the table An intravenous (IV) line will be inserted into your hand or arm. You will be instructed to place your feet in stirrups and recline on the X-ray table. Anaesthesia or sedation will be given via the IV line by the anesthesiologist or another medical professional.5

During the procedure

The patient lies face-up on an X-ray table with their legs in stirrups while the operation is performed. An intravenous line may occasionally be placed into their hand or arm to administer a sedative or general anaesthetic for the procedure.

Next, a thin, narrow tube known as a cystoscope, which has a tiny camera at its tip, will be gently pushed up into the urethra until it reaches the bladder. One or both of the ureters may then be treated with a catheter.

After injecting the contrast dye into the renal system and catheters, several X-ray pictures are obtained to track the dye's travel. After that, the catheter is taken out.7


Most patients are able to return home the same day after being admitted to the recovery area, where they will be observed for several hours in case there are any difficulties or signs of improvement.

Urinating could hurt, and a tiny amount of blood in the urine is common in the hours following a cystoscopy. But if it lasts longer than 48 hours, individuals ought to consult a doctor further. Simple analgesic drugs like ibuprofen or paracetamol may be prescribed to treat pain if necessary.7

Before you are discharged from the test location, your urine output will be measured, and your healthcare professional could want you to keep measuring it for a few days. Usually, this entails peeing into a graduated container and noting the volume.5


These issues could arise occasionally:7

  • Sepsis (fever, chills, etc.)
  • Infection of the urinary tract (UTI)
  • Bladder rip
  • Gushing of blood
  • Vomiting or feeling queasy
  • Discomfort or trouble urinating

Rarely, more serious reactions might happen. Among them are:

  • Breathing difficulties
  • Low BP
  • Swelling in the throat or mouth
  • Heart attack3


A radiologist will evaluate the X-rays, which could take several hours or more. Your test may reveal a blockage in your urinary tract that is consistent with a stricture or kidney stones. Your healthcare practitioner may prescribe other tests including imaging tests, such as a CT scan, to obtain more information if the retrograde pyelogram is abnormal.5


How common is retrograde pyelography?

There was once a greater use of retrograde pyelography than there is today. Other imaging methods have frequently taken its place. However, it's still employed in many cystoscopy cases, such as stenting to keep passages open.2

What benefits can a retrograde pyelogram offer?

The following are some benefits of a retrograde pyelogram:2

  • Even if you have a dye allergy, you can still have a retrograde pyelogram because the dye doesn't enter your system.
  • During this procedure, radiation exposure is minimal


To sum up, retrograde pyelograms are useful diagnostic tools that provide information about the structure and operation of the urinary system. Healthcare providers can get accurate and significant results by carefully planning the patient, carrying out the process precisely, and carefully considering any potential consequences. The interpretation of results is crucial in directing further medical decisions. Retrograde pyelograms continue to play a critical role in urological diagnosis, improving patient outcomes and care as technology and medical knowledge progress.

Retrograde pyelograms are safer overall and have higher diagnostic accuracy thanks to ongoing advancements in imaging technology and safer contrast agents. The method is crucial for the thorough assessment of urinary tract problems since it can detect subtle anomalies such as ureteral strictures or blockages.

In addition, current studies in the area seek to investigate novel uses and future adjustments to the process, guaranteeing its continued use in the constantly changing world of medical diagnostics. The continuous optimization of retrograde pyelogram is made possible by the joint efforts of radiologists, urologists, and researchers. This process deepens our understanding of urinary system pathology and improves our therapeutic approaches.

Retrograde pyelograms are becoming more and more effective tools for individualized patient management, and this is further reinforced by their incorporation into multidisciplinary approaches. Overall, this diagnostic technique is a mainstay of urological investigations and makes a substantial contribution to the patient's comprehensive care for disorders of the urinary tract.


  1. Retrograde pyelogram [Internet]. Hopkinsmedicine.org. 2019 [cited 2023 Dec 22]. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/retrograde-pyelogram 
  2. Retrograde pyelogram [Internet]. Cleveland Clinic. [cited 2023 Dec 22]. Available from: https://my.clevelandclinic.org/health/treatments/22684-retrograde-pyelogram
  3. Retrograde pyelography [Internet]. Urologyhealth.org. [cited 2023 Dec 22]. Available from: https://www.urologyhealth.org/urology-a-z/r/retrograde-pyelography
  4. Retrograde pyelography [Internet]. Medscape.com. 2023 [cited 2023 Dec 22]. Available from: https://emedicine.medscape.com/article/2113562-overview
  5. Rod Brouhard E-P. What Is a Retrograde Pyelogram? [Internet]. Verywell Health. 2019 [cited 2023 Dec 22]. Available from: https://www.verywellhealth.com/retrograde-pyelogram-4587585
  6. Jewell T. Retrograde pyelogram [Internet]. Healthline. 2018 [cited 2023 Dec 22]. Available from: https://www.healthline.com/health/retrograde-pyelogram
  7. Yolanda Smith BP. What does retrograde pyelography involve? [Internet]. News-medical.net. 2016 [cited 2023 Dec 22]. Available from: https://www.news-medical.net/health/What-does-Retrograde-Pyelography-Involve.aspx

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Anit Joseph

BAMS, Ayurvedic Medicine/Ayurveda, Rajiv Gandhi University of Health Sciences

Anit Joseph is a skilled Ayurvedic practitioner with a Bachelor's degree from Rajiv Gandhi University of Health Sciences. She excels in diagnosis, herbal remedies, and personalized treatment plans, aiming to empower her clients to achieve holistic wellness through Ayurveda.

my.klarity.health presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
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