When is RUPG prescribed?
RUPG is indispensable when excretory urography and CT with contrast are impossible (decreased renal function, allergy to intravenous contrast) or do not provide an answer: with hydronephrosis of unknown cause, suspected stricture or ureterocele, filling defect, urinary fistula, to assess the extent of narrowing before plastic surgery. The contrast is injected into the ureter and not into the blood, so the load on the kidneys is minimal. If an obstacle is identified, the study can immediately proceed to stenting.
Indications
- blood in the urine from one kidney when cystoscopy and CT did not find the cause;
- filling defect of the ureter or pelvis on CT scan - suspicion of a tumor of the upper urinary tract;
- narrowing (stricture) of the ureter - assessment of the extent before surgery;
- ureteral or kidney stone - diagnosis with simultaneous crushing;
- control after treatment of a tumor of the pelvis or ureter;
- unclear enlargement of the kidney (hydronephrosis) to clarify the level and cause of the obstruction (RUPG).
How it goes
Retrograde ureteropyelography is performed in an X-ray room under local anesthesia: a thin catheter is inserted into the mouth of the ureter through a cystoscope, a contrast agent is supplied through it, and the images clearly show the ureter, pelvis and calyces - narrowings, defects, stones. The procedure takes 15–20 minutes and often precedes ureteroscopy.
Ureteroscopy is performed under spinal or general anesthesia: a rigid (for the lower and middle third) or flexible (for the upper third and kidney) ureteroscope with a video camera is inserted into the ureter through a guide. The doctor examines the mucous membrane, takes a biopsy with forceps in case of a suspicious area, and immediately performs contact lithotripsy in case of a stone. Once the swelling or biopsy is complete, a stent is placed for 1-2 weeks. Duration: 20–40 minutes.
Preparation and recovery
Before the procedure: ultrasound of the kidneys, MSCT (preferably with contrast if a tumor is suspected), general analysis and urine culture - in case of infection, first treatment, general blood test, coagulogram, creatinine (with contrast). Check with your doctor if you are allergic to iodine. During anesthesia - 6-8 hours on an empty stomach.
After: in the first 1–2 days, there may be a burning sensation and blood in the urine; with a stent, there may be an urge and discomfort in the lower back. Drink more water, take the prescribed antibiotic; If you have a fever, contact the clinic. The biopsy result is ready in 7–10 days.
Ureteroscopy in Tashkent
In the clinics below, ureteroscopy is performed with rigid and flexible endoscopes with the possibility of biopsy, laser lithotripsy and stenting in one procedure; RUPG is performed in the X-ray operating room. Prices according to the clinic’s price list; Anesthesia and stent are paid separately.
