What is X-ray cystoscopy and retrograde pyelogram?

A cystoscopy is a procedure that uses a thin camera (cystoscope) inserted through the urethra to examine the bladder. 

A retrograde pyelogram is an X-ray test performed during cystoscopy, where a special contrast dye is injected into the ureters, the tubes that run from your kidneys to your bladder. This helps the ureters and kidneys show up more clearly on X-ray images.

What does having an X-ray cystoscopy and retrograde pyelogram involve?

The procedure is carried out in hospital, under general anaesthetic (where you’re asleep throughout) or spinal anaesthetic (where you’re awake but sedated and numbed from the waist down). A cystoscope is passed through your urethra into the bladder, and small tubes (catheters) are then gently inserted into one or both ureters. Contrast dye is injected and X-ray pictures are taken to show the ureters and kidneys in detail.

Who is it for?

Your kidney doctor may recommend this test if other imaging tests have suggested a narrowing or blockage that may be affecting the flow of urine, or if you have symptoms such as recurrent infections or blood in your urine.

It might also be suggested if you’re allergic to the contrast dye used in imaging tests or have reduced kidney function, so are unable to have dye through a vein (intravenously). While this procedure uses contrast dye, only a small amount is absorbed by the body, so it is less likely to cause a reaction.

Is it safe? Are there any alternatives?

This procedure is generally safe. You may experience mild burning or bleeding on passing urine for a short time afterwards, and there’s a small risk of a bladder infection, which may need to be treated with antibiotics.

Delayed bleeding or injury to the urethra are possible, but rare.

A reaction to the contrast dye is much less likely than when it’s given through a vein, although it’s still possible.

Your healthcare team will discuss your personal situation and explain the potential risks.

Potential alternatives may include other imaging tests, such as MRI, ultrasound and CT scans.

Where will the cystoscopy and the retrograde pyelogram take place?

The procedure is usually carried out in an operating theatre. 

A urologist performs the cystoscopy and the retrograde pyelogram, and a radiographer usually manages the imaging.

What happens before the procedure? 

You’ll have a pre-assessment, either on the day you’re admitted or at a separate appointment beforehand. Your healthcare team will check your general health and carry out some basic investigations. Make sure you tell the urologist if you have a stent, a pacemaker or any other implanted devices. You’ll also be asked about any medication you take.

The team will discuss the different anaesthetic options. You’ll usually be asked to stop eating and drinking for several hours before either a general or spinal anaesthetic, and you may be asked to pause certain medications before the procedure. Follow the guidance from the hospital.

If you’re on dialysis, your kidney team will help plan the procedure around your schedule.

What happens during the cystoscopy and the retrograde pyelogram?

• Just before the procedure, you’ll usually be given injectable antibiotics to help prevent infection, and you may be given a medication that will help you feel relaxed and sleepy.
• When you’re taken to the theatre, you’ll be given the anaesthetic – either a full anaesthetic, which makes you go to sleep throughout, or a spinal anaesthetic, where you’ll be awake but unable to feel anything from the waist down.
• During the procedure, a telescope is inserted into your bladder through your urethra.
• A long, thin catheter is passed into the ureter, with X-ray imaging guiding it into the right position.
• Contrast dye is injected through the catheter so the ureter and kidney can be clearly seen.
• Images are taken and if any abnormality is seen, a smaller telescope may be passed up towards the kidney so the team can see the area in more detail.
• Sometimes, an abnormality may be biopsied or treated.
• You may have a stent put into the ureter to open up a narrowed or blocked area. This is usually temporary.
• You might also have a temporary bladder catheter, which will be removed afterwards.
• The procedure may take anywhere between 15 and 90 minutes, depending on the complexity.

What happens immediately after the procedure?

You’ll be taken to the recovery room and monitored while you wake up, then you’ll go back to the ward. On average, people stay in hospital for one day. Normally, you can go home once you’ve passed urine.

You’ll be encouraged to drink plenty of water to help flush the bladder and reduce discomfort.

What should I expect when I get home?

For the first couple of days, you’ll be advised to have double the amount of fluids you’d usually drink (follow the specific guidance you’re given).

It’s normal to have some mild discomfort when you pass urine, and you may need to empty your bladder more often. You may also notice small amounts of blood in your urine.

Hospital staff will explain potential signs of an infection to look out for. These include fever, worsening bleeding, and severe pain on passing urine.

How will I get the results?

The urologist may discuss the initial findings with you on the day but a full written report from the imaging will be sent to the doctor who referred you.

You may have a follow-up appointment to discuss next steps, which may include further tests or treatment.

Is there anything else I need to know?

Avoid driving for the first 24 hours after a general anaesthetic, and make sure you have someone with you for the first night at home.

If you have a ureteric stent placed, you will receive additional information about symptoms and follow-up.

Publication date: 02/2026

Review date: 02/2029