Urology Care Foundation - What is Retrograde Pyelography?

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Retrograde Pyelography

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What is Retrograde Pyelography?

Retrograde pyelography is a form of x-ray used to get detailed pictures of the upper urinary tract, including the ureters and kidneys.

Retrograde pyelography uses a special dye ("contrast agent") injected into the ureters through a small catheter that is inserted during cystoscopy (a scope that is placed through the urethra into the bladder). The dye makes the ureters and kidneys more easily seen on the x-ray. This test is like an intravenous pyelogram (IVP). But with IVP, the dye is injected into a vein instead of the ureter.

Newer tests have mostly replaced retrograde pyelography. But, retrograde pyelography can sometimes show better detail in the upper urinary tract and is commonly used during endoscopic procedures of the ureter and kidney. Retrograde pyelography is used when IVP doesn’t give a very good picture. It’s also useful along with cystoscopy to check for a cause of hematuria, like cancer.

What is the Upper Urinary Tract?

The upper urinary tract includes the kidneys and ureters.

The kidneys are two bean-shaped organs, each about the size of a fist. They’re found in your back on either side of the spine. Healthy kidneys clean waste products from the blood by making urine. The urine flows down two, 10 to 12-inch-long tubes called ureters, into the bladder.

The bladder can stretch out to hold urine until you’re ready to drain it. The tube that carries the urine from the bladder out of the body is called the urethra.

Diagram of the Male and Female Urinary Tracts

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Procedure

This outpatient test is most often done by a urologist in the office or operating room. Anesthesia is often used, either with local or general based on the circumstances. The urologist inserts a long, thin telescope with a light at the end ("cystoscope") through the urethra. Then they place a tube ("catheter") up into the ureter. A dye is injected into the ureters through the catheter. X-rays are then taken of the ureters and kidneys. The test can take 15 to 30 minutes.

Risks

Pyelography is thought to be mostly safe. The major risk is a reaction to the iodine-based contrast dye.

Minor reactions include hot flashes, nausea and vomiting. These can often be treated well with antihistamines. There’s also a chance of urinary tract infection or pain.

In very rare cases, more severe reactions can occur. These include:

  • Trouble breathing
  • Low blood pressure
  • Swelling of the mouth or throat
  • Heart attack

Be sure to tell your health care team and the radiologist about your history with allergies.

More Information

The amount of radiation used in this test is rather low. Women who are (or may be) pregnant should tell their urologist before the test.

Updated October 2024. 

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