TÀI LIỆU HỘI NGHỊ KỸ THUẬT ĐIỆN QUANG VÀ Y HỌC HẠT NHÂN VIỆT NAM LẦN 7 (2019) Nguồn: https://hinhanhykhoa.com/

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RETROGRADE
URETHROCYSTOGRAPHY ONURETHROCYSTOGRAPHY ON
PATIENTS PREPARING FOR
KIDNEY TRANSPLANT
R.T. LẬP – R.T. LỢI – R.T. HUY
DR. THẢO – DR. MINH
INTRODUCTION
• Kidney transplantation is the best treating method forKidney transplantation is the best treating method for
patients with end-stage kidney disease.
• The need for transplantation in patients with kidney
failure is not only critical in Vietnam but also the
world.
• Only about one fifth of the patients’ needs are met.

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INTRODUCTION
• Hue Central Hospital has performed kidney
transplantation surgeries since 2001 up to 4 6 pairstransplantation surgeries since 2001, up to 4-6 pairs
of kidneys are transplanted each week now.
• Retrograde Urethrocystography helps assessing the
morphology, function of the lower urinary tract and
the level of vesicoureteral reflux.
• This is a necessary pre-transplanting technique to
fully evaluate the lower urinary tract and prognosis
after the transplantation.
ANATOMY
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ANATOMY
INDICATIONS
• A t f h l d
CONTRAINDICATIONS
• Assessment of morphology and
function of the urethra and bladder
such as urethral stenosis, cystitis,
bladder tumors, trauma,
diverticulum as well as evaluation
of bladder contractile ability and
the level of vesicoureteral reflux.
• Absolute contraindications: none.
• Relative contraindications: urinary
tract infection, hematuria, tests
should be done if suspected.

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PATIENT PREPRATION
• Patient needs to fast.
• An enema is required. • Ask the patient to
urinate completely.
Step 2 • Explain the
purpose and
technique so that
the patient can
cooperate well.
Step 1 Step 3
1. Fluoroscopy machine (DR & CR)
2. Lead apron, CR cassettes
3. Foley catheter (16 - 18F)
EQUIPMENT
PREPERATION
4. Syringe 10ml, 50ml, needle
5. Infusion tube, tape.
6. Cotton, gauze, gauze with paraffin, holed drapes,
medical gloves and masks
7. IV pole
8. Chamber pot.
9. Saline.
10. Disinfectant : betadine

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CONTRAST AGENT
Iodinated contrast agent:
Ultravist, Xenetix, … 300 or 350
mg I / 1 ml. (Diluted in Saline)
PROCEDURE
1. A radiologist and an R.T follow the procedure administrated by the
Ministry of Health.
2 Take a Plain Abdominal X Ray2. Take a Plain Abdominal X Ray.
3. Carefully sterilize the urinary meatus, remove air from the catheter.
Insert the catheter into the urethra pass 2-3 cm from the navicular
fossa, pump the balloon with 2-3 ml of saline.

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PROCEDURE
3. Retrograde urethrography: assessing the morphology of the entire
urethra.
- Pump slowly while gently pulling the patient’s penis outward and
monitor the patient’s condition.
- If the urethra is narrowed or hard to place catheter, contrast agent can
be pumped directly from the meatus.
- Infusion of saline-diluted contrast agent is possible.
PROCEDURE
Pumping through Foley Catheter Pumping directly through meatus.

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PROCEDURE
- 40-50 ml of Iodinated contrast agent is diluted 1:1 with saline and
pumped into the urethra through the catheter.
- In case the patient has a sphincter reaction in the urethra, ask the
patient to take deep breaths or try to urinate.
- Take an oblique x ray while pumping with the penis at a horizontal
position.
PROCEDURE
• Filled-bladder x ray: infuse the contrast agent in to the bladder until the
patient feels like urinating a lot, then take x rays of the filled bladder
(frontal lateral oblique): evaluate the level of vesicoureteral reflux(frontal, lateral, oblique): evaluate the level of vesicoureteral reflux,
bladder volume and morphology, diverticulum, neurogenic underactive
bladder,…
• Big size films: 30x40 cm, 35x43 cm

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PROCEDURE
4. Urinating x ray:
• With the table nearly upright, take RPO or LPO x ray while holding the
penis horizontally.
• Ask the patient to try to urinate and take x rays. This helps assess the
contractile ability of the bladder, and most importantly to find
vesicoureteral reflux (use a large film if reflux is present).
- The centering point is located between the navel and public joint to
evaluate the entire urethra, the meatus and urination. Then the patient is
asked to urinate completely in the bathroom.
PROCEDURE
5. Empty bladder x ray:
- Take an AP plain abdominal x ray after the patient finished urinating to
assess the entire urinary system.
- This stage helps assess the urine retention of the bladder.

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Vesicoureteral Reflux Grading
• Grade I: the urine flows back into one or both of the ureters but does not reach the
kidney.
• Grade II: urine flows back up to the kidney, but does not cause dilation of the renalGrade II: urine flows back up to the kidney, but does not cause dilation of the renal
pelvis.
• Grade III: there is mild to moderate dilation of the ureter and the renal pelvis.
• Grade IV: the ureter, the renal pelvis and calyces are dilated.
• Grade V: there is severe dilation of the ureters, renal pelvis and calyces.
RESULT
Study of 93 patients with end-stage renal disease assigned Retrograde
Urethrocystography prior to kidney transplant, all patients correctly followed the
procedure and the obtained images achieved diagnostic quality. Success rate is
100%.
In which:
- Urethral spasms occur in 19.4% (all in male patients) leading to the failure
to obtain full urethral imageto obtain full urethral image.
This can be fixed by asking the patients to breathe deeply or try to urinate lightly.

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RESULT
Complications
• Urethral pain is the most common complication, accounting for 83.9%.
H th l l f i i ild t l t d b t ti t I llHowever, the level of pain is mild, tolerated by most patients. In all
cases, the patients are well prepared mentally and handled gently.
• Bleeding is the second most common complication, accounting for
36.6%. In all cases, bleeding is mild and stops after a resting period.
• Infection is an important complication, accounting for 9.7%. Even after
careful sterilization, the infection rate is still high. Antibiotic is used if, g
hematuria or urinating pain is present.
• There are no cases of contrast agent allergy.
RESULT
Pros and cons of the procedure:
Pros:Pros:
• Assessing the morphology and function of the lower urinary tract,
especially the level of vesicoureteral reflux that other techniques
cannot replace.
• Easy-to-access equipment: X ray or fluoroscopy machines,
available consumable materials.
• Simple technique.
• Available Radiologists or R.Ts.
• Low cost.
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RESULT
Cons:
• This is an invasive technique with the use of x ray, injecting contrast
agent through tools, so it has some contraindications (relative): urinary
tract infection, hematuria, urinary tract obstruction, difficult urinating,
injury. The patients is affected mildly by X radiation.
RESULT
Abnormality Quantity (n=17) %
Reflux 7 42,2
Ab l bl dd l 11 64 7
Abnormalities
Abnormal bladder volume 11 64,7
Abnormal morphology 2 11,8
Bladder retention 2 11,8
Reflux grading Quantity
(n=11)
%
Reflux Grading
Reflux side Quantity
(n=7)
%
Right 5 71,4
Left 6 85,7
Both sides 3 42,8
(n 11)
Grade I 3 27,3
Grade II 7 63,6
Grade III 1 9,1
Grade IV 0 0
Grade V 0 0

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IMAGES
RETROGRADE STAGE
IMAGES
FILLED-BLADDER STAGE
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IMAGES
Bladder with high volume
IMAGES
URINATING STAGE
(FEMALE)
URINATING STAGE (MALE)
( )
Reflux when urinating

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IMAGES
BLADDER RETENTION
REFERENCES
1. Lê Trọng Khoan (2010), “Kỹ thuật chụp niệu đạo bàng quang ngược dòng”, Kỹ thuật chụp
niệu đồ tĩnh mạch, Nhà xuất bản Đại học Huế, tr
2. Adnan Simsir, Hamad Dheir (2012), “Evaluation of the Lower Urinary Tract before Renal, ( ), y
Transplantation: To Which Patients? How?”, Open Journal of Urology, 2, pp.127-130.
3. Glazier DB, Whang MI (1996), “Evaluation of voiding cystourethrography prior to renal
transplantation” Transplantation, 62(12), pp.1762-5.
4. John M.Barry (2015), “Diagnosis and management of ureteral complications following renal
transplantation”, Asian Journal of Urology, 2(4), pp.202-207.
5. Nina M. Molenaar, Robert C. Minnee, Frederike J. Bemelman (2017), “Vesicoureteral Reflux
in Kidney Transplantation”, Progress in Transplantation, 27(2) , pp.196-199.
6. Shandera KC, Rozanski TA, Jaffers G (1996), “The necessity of voiding cystourethrogram in
the pretransplant urologic evaluation”. Urology, 47(2), pp.198-200.
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