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Antegrade pyelography, a survey among urologists

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Abstract

Purpose

Antegrade pyelography (APG) is a useful modality for imaging the upper urinary tract. Little scientific evidence exists concerning optimal pressure while performing an APG. Methods of implementation seem to vary between hospitals as no specific guideline exists. Our aim was to describe current practice patterns in pre-procedural prophylaxis, describe methods of contrast administration, and estimate rate of complications during APG as reported by urologist, in order to stimulate discussion on defining guidelines.

Methods

A digital questionnaire with 16 questions concerning APG was set out among EAU members via an ESUI twitter link. Fifty urologists from different centers responded. Outcomes were use of antibiotics, used pressure in upper urinary tract, and estimated urosepsis prevalence. Percentages and confidence intervals (95% CI) were calculated.

Results

Forty-two percent (95% CI 30–56) of respondents stated that antibiotic prophylaxis was always administered. Fifty-two percent (95% CI 38–65) of urologists sometimes performed a pre-procedural culture. Seventy percent (95% CI 56–81) indicated that administration of contrast during APG was performed using a syringe. A local guideline was only used in 8% of cases (95% CI 2.8–17.9) The self-estimated average percentage of urosepsis as a result of performing an APG was mentioned to be 4% (range 0–20%).

Conclusion

Despite a considerable risk of urosepsis, no guideline or consensus exists on how to perform APG. This is urgently needed in order to prevent complications. Low response rate is a major limitation of these findings.

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References

  1. Singh I, Strandhoy JW, Assimos DG (2012) Pathophysiology of urinary tract obstruction. In: Kavoussi LR, Novick AC, Partin AW, Peters CA (eds) Campbell-Walsh urology, 10th edn. Elsevier Saunders, Philadelphia, pp 1087–1121

    Chapter  Google Scholar 

  2. Gerst SR, Hricak H (2008) Radiology of the urinary tract. In: Tanagho E, McAningh J (eds) Smith’s general urology, 17th edn. McGraw Hill, San Francisco, pp 58–104

    Google Scholar 

  3. American Association of Urology. https://www.auanet.org/education/clinical-practice-guidelines.cfm

  4. Nederlandse Vereniging voor Urologie. www.nvu.nl/en-us/kwaliteit/richtlijnen/actuelerichtlijnen.aspx

  5. European Society of Radiology. https://www.myesr.org/cms/website.php?id=/en/eu_affairs/clinical_audit_guidelines.htm

  6. Society of Interventional Radiology. http://www.sirweb.org/clinical/

  7. Cardiovascular and Interventional Radiological Society of Europe. http://www.cirse.org/index.php?pid=755

  8. Djajadiningrat RS, van Dijk LC, Roshani H (2016) Pressure and antibiotic prophylaxis during antegrade pyelography: closer considerations. Tijdschr voor Urol 6:50–53. https://doi.org/10.1007/s13629-016-0127-2

    Article  Google Scholar 

  9. Shafik A (1998) Ureteric profilometry: a study of the ureteric pressure profile in the normal and pathologic ureter. Scand J Urol Nephrol Suppl 32:14–19

    Article  CAS  Google Scholar 

  10. Roshani H, Dabhoiwala NF, Dijkhuis T, Lamers WH (2002) Intraluminal pressure changes in vivo in the middle and distal pig ureter during propagation of a peristaltic wave. Urology 59:298–302. https://doi.org/10.1016/S0090-4295(01)01550-3

    Article  CAS  PubMed  Google Scholar 

  11. Ryan PC, Maher K, Hurley GD, Fitzpatrick JM (1989) The Whitaker test: experimental analysis in a canine model of partial ureteric obstruction. J Urol 141:387–390

    Article  CAS  Google Scholar 

  12. Koff SA, Thrall JH (1981) Diagnosis of obstruction in experimental hydroureteronephrosis. Urology 17:570–577. https://doi.org/10.1016/0090-4295(81)90079-0

    Article  CAS  PubMed  Google Scholar 

  13. Johnston RB, Porter C (2014) The Whitaker test. Urol J 11:1727–1730

    PubMed  Google Scholar 

  14. Oratis AT, Subasic JJ, Hernandez N et al (2018) A simple fluid dynamic model of renal pelvis pressures during ureteroscopic kidney stone treatment. PLoS One 13:1–13. https://doi.org/10.1371/journal.pone.0208209

    Article  CAS  Google Scholar 

  15. Thüroff J, Gillitzer R (2008) Percutaneous endourology & ureterorenoscopy. In: Tanagho E, McAningh J (eds) Smith’s general urology, 17th edn. McGraw Hill, San Francisco, pp 114–134

    Google Scholar 

  16. Kashi SH, Irving HC, Sadek SA (1993) Does the Whitaker test add to antegrade pyelography in the investigation of collecting system dilatation in renal allografts? Br J Radiol 66:877–881. https://doi.org/10.1259/0007-1285-66-790-877

    Article  CAS  PubMed  Google Scholar 

  17. Whitaker RH (1973) Methods of assessing obstruction in dilated ureters. Br J Urol 45:15–22

    Article  CAS  Google Scholar 

  18. Heimbach D, Bäumler D, Schoeneich G, Hesse A (1998) Percutaneous chemolysis—an important tool in the treatment of urolithiasis. Int Urol Nephrol 30:655–664

    Article  CAS  Google Scholar 

  19. Farrell TA, Hicks ME A review of radiologically guided percutaneous nephrostomies in 303 patients. J Vasc Interv Radiol 8:769–74

  20. Wah TM, Weston MJ, Irving HC (2004) Percutaneous nephrostomy insertion: outcome data from a prospective multi-operator study at a UK training centre. Clin Radiol 59:255–261. https://doi.org/10.1016/j.crad.2003.10.021

    Article  CAS  PubMed  Google Scholar 

  21. Hausegger KA, Portugaller HR (2006) Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications. Eur Radiol 16:2016–2030. https://doi.org/10.1007/s00330-005-0136-7

    Article  PubMed  Google Scholar 

  22. (2009) Richtlijn Bacteriële urineweginfecties bij adolescenten en volwassenen. In: Ned. Ver. voor Urol. www.nvu.nl/en-us/kwaliteit/richtlijnen/actuelerichtlijnen.aspx

  23. Tandoğdu Z, Bartoletti R, Cai T, Çek M, Grabe M, Kulchavenya E, Köves B, Menon V, Naber K, Perepanova T, Tenke P, Wullt B, Johansen TE, Wagenlehner F (2016) Antimicrobial resistance in urosepsis: outcomes from the multinational, multicenter global prevalence of infections in urology (GPIU) study 2003–2013. World J Urol 34:1193–1200. https://doi.org/10.1007/s00345-015-1722-1

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Heleen Hidskes for her corrections and advice on English writing.

Author information

Authors and Affiliations

  1. Department of Urology, Haga Teaching Hospital, The Hague, The Netherlands

    Rosa S Djajadiningrat & Hossain Roshani

  2. Department of Urology, Institute Paoli-Calmettes, Marseille, France

    Jochen Walz

  3. Department of Intervention Radiology, Haga Teaching Hospital, The Hague, The Netherlands

    Lukas C van Dijk

Authors
  1. Rosa S Djajadiningrat
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  2. Jochen Walz
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  3. Lukas C van Dijk
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  4. Hossain Roshani
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Contributions

RS Djajadiningrat: protocol/project development, data collection or management, data analysis, and manuscript writing/editing.

LC van Dijk: manuscript writing/editing.

J Walz: protocol/project development and manuscript writing/editing.

H Roshani: protocol/project development and manuscript writing/editing.

Corresponding author

Correspondence to Rosa S Djajadiningrat.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was not applicable, as no patients were included in this study.

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Djajadiningrat, R.S., Walz, J., van Dijk, L.C. et al. Antegrade pyelography, a survey among urologists. Ir J Med Sci 189, 843–848 (2020). https://doi.org/10.1007/s11845-020-02180-z

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  • DOI: https://doi.org/10.1007/s11845-020-02180-z

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