Procedure to perform digital retrograde ureteroscopy

The article is professionally consulted by Dr. Nguyen Dinh Hung - Diagnostic Imaging - Department of Diagnostic Imaging - Vinmec Hai Phong International General Hospital.

Digital retrograde pyelonephritis aims to investigate the morphology of the upper urinary tract, through contrast injection upstream of the ureteral catheter. This method is performed in the case of renal radiographs but intravenous drugs do not penetrate to detect the pyelonephritis. In addition, it is possible to detect ureteral contrast stones, detect obstruction, or ureters due to stones or other causes.

All cases where CT Scanner, UIV or imaging cannot be clearly seen can be indicated for retrograde ureteral ureteroscopy. The cases of dumb kidney, anuria, high ureteral tumor, ureteral fistula at the request of the treating doctor are indicated by digital imaging of the ureter of the renal pelvis upstream.
This method is contraindicated for patients with cystitis, urinary tract infections, urethritis, because it can cause the risk of retrograde pyelonephritis. Patients with bladder tumors also need contraindications to retrograde ureteroscopy.

Performing this method is a specialist doctor, a technician with the support of a nursing doctor specializing in urology. With the full preparation, the means to perform digitized retrograde pyelonephritis are x-ray machine, cystoscope, film, film printer, image storage system are connected.
Consumables during retrograde pyelonephritis include:
● Syringe 10; 20ml
Needle 18-20G
Water-soluble iodine contrast agent
Antiseptic for skin and mucous membranes
Distilled water or physiological saline
● Gloves, caps, surgical masks
● Set of bean trays, surgical forceps
● Cotton, surgical gauze.
● Medicine box and emergency equipment for contrast drug accidents.
● Chevassu catheter or ureteral catheter with contrast
● Lead
The patient needs to urinate before taking the pyelonephritis upstream before going to the imaging table. The patient received fecal enemas before retrograde pyelonephritis. The doctor needs to explain the scan procedure to the patient so that the patient is psychologically prepared.

At the same time, the patient or family member must sign a commitment to the procedure before taking the scan. The patient's request for a retrograde pyelonephritis was done with basic tests, including a urinalysis to make sure there was no suspicion of infection.

Unprepared abdominal film right before the test helps to determine the constant, accurately localize and find abnormal calcifications in the abdomen ● Performed in the operating room with strict sterilization regime
Patient Urethral anesthesia
● Complete cystoscopy, identify two ureteral openings
● Use a rigid endoscope or a flexible bronchoscope to insert the catheter into the parietal ureter, withdraw slightly to block the ureteric orifice to avoid regurgitation reverse contrast, monitor under magnifying screen
Push air out of catheter
Inject contrast agent slowly at low pressure, monitor under magnifying screen, when feeling resistance, stop pumping and take pictures film immediately
● During injection, if the patient shows pain, or on the bright screen, the drug is regurgitated into the renal tubules, the pump must be stopped
● To show the fullness of the ureter, it takes about 2 - 5ml. A full calyx of the kidney requires about 4-10ml.
● Take a large film 30x40cm or 35x43cm. Shoot straight full of medicine and shoot in front right and left front. Film taken 5 minutes after contrast removal to ensure good ureteral catheterization.
● In case of ureteral stenosis, you can use a wire to pass through the narrowing of the ureter, then thread the catheter up with the wire and inject contrast material to investigate the narrowing.

The image shows the ureter with regular border, contrast agent in the ureter on the bright screen, the ureteral junction and the ureter cross the iliac artery. ● The morphology of the renal pelvis and ureter is similar to the image on the venous urogram, even more clearly.
● Abnormal images of the urinary tract include dilatation, narrowing, obstruction, convex, defect, and compression.
Ureteral motility is assessed only during contrast removal.
● Contrast stasis in the presence of urinary tract obstruction.

Digitalization of the retrograde ureteral ureter may fail because the urethral catheter or ureteral catheter cannot be placed. The condition of not intubating the ureter may be due to the patient having bladder tumor, prostate tumor, cystitis, ureteral stricture after surgery or radiation therapy. Besides, the patient may feel pain, so it is necessary to prepare psychologically and the doctor needs to perform gentle and careful manipulations.
In addition, the patient may experience injury due to the procedure, so during the procedure, it is necessary to ensure the correct technique and gentleness, avoiding the use of metal conductors.
In which infection is an important complication, which can occur even with careful disinfection. Patients can take antibiotics before and after the test.

Retrograde pyelonephritis is not a complicated technique, but it also requires a team of radiologists and full and modern medical facilities and Vinmec is the place to meet all the requirements. In this technical method, from modern medical equipment of international standards to a team of highly skilled doctors, professional working and control processes.
For undiagnosed or untreated patients: A general examination using other routine methods is necessary to detect abnormalities. Then, if required, a retrograde pyelonephritis to aid in the diagnosis and treatment will be comprehensively evaluated and the best treatment plan will be established, minimizing the possible risks. during treatment as well as evaluating treatment outcomes. The purpose of diagnosis and treatment with the highest efficiency is consistent with the spirit of: CUSTOMER CENTRAL that the Vinmec hospital system is building.
At Vinmec International General Hospital, digital imaging of the ureter and renal pelvis is performed upstream for accurate results, clear images, supporting effective diagnosis and treatment for patients.
Doctor Nguyen Dinh Hung has over 10 years of experience in the field of diagnostic imaging (Ultrasound, CT, MRI). Trained and practiced on hepatobiliary interventional radiology at Bach Mai Hospital (Intervention under ultrasound guidance, DSA, CT...) and deployed at the Diagnostic Imaging Department of Viet Tiep Hospital Hai Phong. Currently, he is a doctor at the Diagnostic Imaging Department of Vinmec Hai Phong International General Hospital.