RGP

2.  It is a radiologic examination of the ureters
and renal pelvic (collecting system of the
kidney) by retrograde injection of contrast
media through the ureter .
 This procedure is preformed with the
cystoscope .
 The study is performed by the urologist
under the radiologist supervision in the
radiology department.

3.  Cystoscopy – it is the examination of the
bladder and the urether through the
cystoscope .
 Cystoscope – it is a thin endoscope with a
camera lens, it is inserted through the
urethra to visualize the bladder.

4.  When the intravenous pyelography has
failed to visualied the collecting system.
 To evaluate intra-ureteral or intra-pelvic filling
defect .
 Suspected lesion fistula in the urinary tract.
 Suspected urinary tract tumors or stones .
 Hematuria.
 Ureteral strictures.

5.  Blood clotting disorder.
 Cardiopulmonary disorder.
 Suspected pregnancy.
 Obstructive mass in the bladder/urethra.

6.  Fluoroscopy unit with spot film device or image
recorder device.
 Antiseptic solution.
 Local anesthesia.
 Syringe , Gloves.
 Sterile towel and Gauze.
 Saline and Sedative medicine.
 Cystoscope.
 Iodinated contrast media.

7.  Asked the patient to take low residue diet
prior to the examination .
 The laxative may be given for bowel
preparation.
 Drink clear liquids the day before the
examination
 Fasting may be employed for 6-8 hours .
 Ask patient not to eat or drink after midnight.

8.  Pregnancy women should not have a
radiological examination.
 Instructed to remove all metallic objects and
metallic jewelry from the body.
 Asked to stop taking an anticoagulant two
days prior.

9.  On the examination ,technologist should describe
the whole procedure to the patient .
 Obtain written consent from the patient for
permission of procedure .
 The patient is asked to remove the clothing and
wear the hospital gown.
 Placed in the supine position with empty bladder.
 An IV is inserted into the patient arm.
 If necessary, sedative medication is given.

10.  The patient placed in the supine position on the
fluoroscopic table.
 Scount film of abdomen in taken to see the bowel
preparation.
 If residual fecal matter or gasses is present in the
bowel, the examination should be postponed for
the next day.
 If the bowel preparation is good, then the urologist
aoolies the xylocaine jelly on the cytoscope, then
introduces the cystoscope through the urethra and
advances slowly into the patient’s bladder under
the fluroscopic guidance.

11.  After placing the endiscope, the urologist inserted
a cather into the bladder and placed it at the
uretral opening.
 After placement of catheter, the urologist injects
the contrast media through the catheter.
 When the contrast moves retrograde through the
ureters, then the spot films are taken of urinary
system in suspected respiration.
 After completion of spot filming several
radiographs are again taken in supine AP,LAO
and RAO.

13.  After completion of the study, the urologist
withdraws the catheter and endoscope.
 The IV line is removed from the patient .
 The patient advised to fluid fluid intake for
the elimination of contrast from the body.
 Thereafter the patients may be allowed to
leave the examination room.

14.  interventional radiological examination of
upper urinary tract.
 It may be followed by the percutaneous
nephrostomy or ureteral stent placement or
nephrolithotomy.

15.  Urinary tract obstruction due to renal calculi
or mass.
 Urinary diversion.
 Kidney stone treatment through the
percutaneous procedure.
 Urinary tract infection.
 Evaluate the urinary system.

16.  Hypersensitivity to iodinated contrast media.
 Blood clothing disorder .
 Cardiopulmonary disorder.
 Suspected pregnancy.

17.  Total blood cell count.
 Bleeding and clotting time.
 Urine culture and
 KUB plain radiograph

18.  US machine.
 Fluoroscopy machine.
 Local anesthesia.
 18 gauge puncture needle.
 Guide wire, normal saline, gauze.
 Water soluble non-ionic contrast media.
 Sterile towel, antiseptic solution.
 Dilators of multiple gauges
 Pigtail locking-loop catheter 8 french.

19.  Asked the patient to take low residue diet
prior to the examination .
 The laxative may be given for bowel
preparation.
 Drink clear liquids the day before the
examination
 Fasting may be employed for 6-8 hours .
 Ask patient not to eat or drink after midnight.

20.  Pregnancy women should not have a
radiological examination.
 Instructed to remove all metallic objects and
metallic jewelry from the body.
 Asked to stop taking an anticoagulant two
days prior.

21.  On the examination ,technologist should
describe the whole procedure to the patient .
 Obtain written consent from the patient for
permission of procedure .
 The patient is asked to remove the clothing
and wear the hospital gown.
 An IV is inserted into the patient arm.
 If necessary, sedative medication is given.

22.  The patient placed in the supine position on the
fluoroscopic table.
 Scount film of abdomen in taken to see the bowel
preparation.
 Posterior area on 12th rib the must be cleaned with
the antiseptic and local anesthesia is given at
puncture ste.
 Gently inserted an 18/20 gauge needle at the
angle toward the posterior calyx.
 Then the stylet of the needle will be removed and
drains freely.
 The urine sample must be obtained and sent for
culture and sensitivity tests.

23.  After contrast is injected to confirm the correct
position of needle.
 X-rays are taken dye move throught the ureter,
blockage will diagnose.
 The surgeon may place a ureteral stent or place
nephrostomy catheter to relive obstruction.
NEPHROSTOMY PROCEDURE:
 A flexible guide wire is inserted through the
needle.
 After the needle is removed .
 Then dilator is placed over the guide wire.

24.  After a pigtail catheter is inserted into the
renal pelvis over the guide wire.
 Contrast media is administrated to confirm
the correct position od catheter.
 Then guide wire is removed and the catheter
tried up with the suture attach to the external
drainage bag.

26.  Bleeding at the puncture site.
 Infection, at the puncture site.
 Leackage of urine from the kidney, resulting in
the collection of fluid inside the abdomen.
AFTERCARE:
 The patient is kept under medical observation
all vital sign must be monitor.
 Thereafter the patients may be allowed to leave
the examination room.