Urology/Anesthia for procedure
QUESTION: Dr. Goldstein;
Can a Retrograde Pyelogram be done with only inserting numbing gel into the penis? I have had Colonoscopy, Rigid Cystoscope and Vasectomy done with no anesthia. Where are these usually done,like radiology dept, physicians office? Does a Rigid scope have to be used or flexible a possibility? How does this compare to IVP?What is the prep required?
ANSWER: Mike, the choice of anesthesia (or lack of same) varies with the physician and the procedure. Most colonoscopies are done with IV sedation. Most cystoscopies are done with topical anesthesia. This is the placement of a local anesthetic gel into the urethra which numbs the urethral lining (mucosa). Most vasectomies are done under local anesthesia which entails the injection of a local anesthetic (such as Novocaine or Carbocaine) into the scrotal skin and vas deferens. Most retrograde pyelograms are done in a cystoscopy suite that is equipped with radiologic capabilities. It involves passing a cystoscope into the bladder, viewing the ureteral orifice, and then either passing a small ureteral catheter into the kidney or placing a bulb tipped catheter into the ureteral orifice through the cystoscope. After this, contrast is injected to outline the interior of the kidney (pelvis and calyces) and ureter. Usually this is done through a rigid cystoscope as the lumen of most flexible cystoscopes will not accommodate a ureteral or bulb tipped catheter. This is slightly more uncomfortable than a plain cystoscopy so if topical anesthesia is not sufficient, it can be done either with IV sedation, general or even spinal anesthesia. No preparation is generally necessary for a retrograde pyelogram. This type of x-ray is usually done if imaging of the kidney and/or ureter (such as via IVP, CT or MRI) does not provide adequate definition of the interior of the collecting system. Such a finding could indicate a stone or tumor inside the pelvocalyceal system or ureter. In such a case. a retrograde pyelogram usually ensures very adequate filling to better define the anatomy and possible pathology. I hope this clarifies the situation for you. Good luck.
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QUESTION: Dr. Goldstein:
Thank-You for your response. I want to clarify. I have ALREADY had colonoscopy,Rigid Cystoscopy and Vasectomy, I referred to them to show my high pain tolerance. My question was,Cat Scan showed possible Splenule and possible Upper Pole Right Kidney Simple Cyst, I am allergic to Iodine so would Retrograde Pyelogram be the next procedure to confirm this or show what actually is wrong and could it be done WITHOUT anesthia.I realize this procedure uses dye but does not go into Bloodstream.Would a Pet scan be an option?
How difficult are these abnormalities to diagnose with 100% accuracy?
Mike, from the information provided, I do not believe a retrograde pyelogram in indicated. If it was necessary, it certainly is safer than an IVP in an individual allergic to iodine. However, even with a retrograde pyelogram there is still the risk of an allergic reaction although much less than with an IVP.
A splenule is just a small accessory spleen. Although this is not my expertise, I believe it is of no clinical significance. Apparently, your doctor wants to further evaluate the possible cyst on the upper pole for the right kidney to be sure it is a benign lesion.
Simple renal cysts are exceedingly common and almost always benign. Most, as in your case, are discovered incidentally by imaging studies such as ultrasound, CT scan or MRI. There are established radiologic criteria for denoting a lesion as a simple benign cyst. However, some tumors may appear similar to cysts on imaging and do not fulfill all the criteria to call them benign with certainty. These are termed "complex cysts". If there is any question of a cyst being "simple", further investigation is needed. As you have already had an CT, the next step would be either an ultrasound or MRI. These usually can differentiate with certainty the benignity of a renal cystic lesion. A retrograde pyelogram would be of no use in the evaluation of this lesion as it merely highlights the interior of the kidneys collecting system and these cystic lesions are in the meat of the kidney itself (the so called parenchyma).
If there is still doubt, either aspiration of the "cyst" fluid for cytologic examination, biopsy or open surgical exploration is indicated. They may occur inside of the kidney (intra-renal) or come off the external surface of the kidney (exophytic). They almost never cause symptoms and, therefore, this type does not require treatment. Rarely, they may become quite large and compress surrounding structures. If so, they may cause discomfort (either type) or obstruct urine flow (usually from the intra-renal variety) from the kidney. In these cases, treatment is indicated. This may take the form of needle aspiration alone (which provides only temporary relief as the fluid always recurs), aspiration with the instillation of a sclerosing agent (which damages the lining of the cyst to prevent it from re-secreting fluid) or surgical removal of the cyst (leaving the kidney intact).