Retrograde Pyelogram & Stent

What is it?

 

A tube is passed from the bladder into the kidney followed by contrast media injections through the tube to show up the ureter (the tube that carries urine from the kidney to the bladder) and the kidney on X-ray.  A sample of urine from the kidney may be collected.  If a blockage in the ureter is found, a stent (plastic tube) will be put into the ureter to keep the tube open.  The stent is a double pigtail tube that sits in the ureter and is held in place at the kidney end and the bladder end by the shape of the tube to prevent movement.

 

Before the cystoscopy

 

You will be told when to stop eating and drinking prior to the procedure.  You should discuss with Dr Bourne before the procedure if you have any allergies or any medication you are taking, particularly if Aspirin / Arthritis medication or Warfarin.

 

General Risks

• Small areas of the lungs may collapse, increasing the risk of chest infection.  This may need antibiotics and physiotherapy.
  
• Clots in the legs (deep vein thrombosis or DVT) with pain and swelling.  Rarely part of this clot may break off and go t the lungs which can be fatal.
  
• A heart attack because of strain on the heart or a stroke.
  
• Death is possible due to the procedure.  

Risks or this Procedure

 

There are some risks/complications, which include:

• Allergic reaction to the contrast media used as part of the X-ray, which may need emergency treatment.
  
• Rarely damage to the urethra – the passage that brings the urine out of the bladder.  A false passage may be produced causing leakage of urine or in the long term, a narrowing that may affect flow of urine.
  
• Damage may occur to the bladder with puncturing of the bladder.  This may need further surgery.
  
• Swelling at the exit of the bladder which may stop passage of urine.  A tube (catheter) may need to be put in place to drain the urine until the swelling goes down.
  
• Bacteria may get into the blood stream with the development of septicaemia.  Further treatment with antibiotics may be necessary.
  
• The tube may pass outside the ureter into the tissues.  This may need further surgery to remove ad replace the tube.
  
• Bleeding which may stain the urine colour and sometimes cause blockage of urine flow.
  
• Burning and scalding of urine for a few days after the procedure.  This usually settles.
  
• The catheter may not be able to be passed through the ureteric opening and up to the kidney because of a blockage.
  
• The indwelling stent may cause bladder irritation and blood in the urine occasionally.  The stent is usually removed after a few weeks, but may remain in place for months (Max. 6 mths).
  
• Rarely, damage to ureter.  A stricture may form.  Very rarely, an open operation may be required to repair the damage.

I understand that it is impossible to list every possible adverse outcome or complication that could occur and that the condition for which surgery is being performed is not always cured or improved and in some cases, may be made worse.

 

I ACKNOWLEDGE THAT:

 

The Doctor has explained my medical condition and the proposed surgical procedure.  I understand that risks of the procedure, including the risks that are specific to me, and the likely outcomes.

 

The Doctor has explained other relevant treatment options and their associated risks.  The Doctor has explained my prognosis and the risks of not having the procedure.

 

I have received a patient Information Sheet about the procedure and its risks.

 

I was able to ask questions and raise concerns with the Doctor about my condition, the procedure and its risks, and my treatment options.

 

My questions and concerns have been discussed and answered to my satisfaction.

 

I understand that the procedure may include a blood transfusion.

 

I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.

 

The Doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated as appropriate.

 

I understand that no guarantee has been made that the procedure will improve the condition, and that the procedure may make my condition worse.

 

On the basis of the above statement,  I REQUEST TO HAVE THE PROCEDURE.

 

Please notify us or present to the hospital if:

• bleeding persists
• high temperature develops
• bladder irritation continues
• severe abdominal pain

Stop the following TWO WEEKS prior to admission:-

Action Aggrastat Alka-Seltzer Any Aspirins Arixtra Asasantin Aspalgin Aspirina Aspro Clear Aspro Tabs & Capsules Astrix

Bayer Aspirin Bex tablets & Powders Cartia Cardiprin Codiphen Forte Codis Morphalgin Codral Forte Codox Decrin Powder Disprin Disprin Forte

Ecotrin Iscover Persantin Plavix Solcode Solprin Spren Veganin Vincents Tabs & Powders Winsprin

 

Stop the following SEVEN DAYS prior to admission:-

Anti-inflammatory drugs:

 

Acliln ACT-3 Actriprofen Arthrexin Brufen Butazolidin Celebrix Clinoril Clunisol Declofenac Diflunisal Dolobid Fledene Feldene-D Fenac Ibuprofen

Indocid Indomed Indomethacin Inza Ketoprofen Ketoralac Mefenemix Acid Mefic Mobilis Mobilis-D Naprogesic Naprosyn Naproxen Nurofen Orudis Oruvail

Phenylbutazone Piroxicam Ponstan Proxen Rafen Sulindac Surgam Tenoxicam Tiaprofenic Acid Tilcotil Toradol Voltaren Vioxx

 

ANTICOAGULANTS

 

If you are taking MAREVAN, DINDEVAN OR WARFARIN, TICLID, TICLOPIDINE, COUMADIN take half dose for ONE day, FIVE days before the operation, then stop the tablets FIVE days before the operation. Discuss this with your Physician, as some patient Need Heparin injections when they cease taking these tablets. The tablets should not be resumed until TWO weeks after the operation, unless otherwise advised by your Physician or Surgeon.

 

Panadol, Panadeine or Digesic may be taken for pain relief.

 

PLEASE ENSURE DOCTOR IS AWARE OF ALL DRUGS, PILLS, MEDICATIONS ON OR OFF PRESCRIPTION THAT YOU TAKE, EVEN IF THEY ARE NOT ON THE ABOVE LIST.