X-PROC Loopogram at Chughtai Lab

Introduction to X-PROC Loopogram at Chughtai Lab

The X-PROC Loopogram is a highly specialized fluoroscopic imaging procedure performed to evaluate the structure and function of a urinary diversion, most commonly an ileal conduit. An ileal conduit is a surgically constructed pathway created after a patient undergoes a radical cystectomy (removal of the urinary bladder), typically due to bladder cancer, severe trauma, or neurogenic bladder dysfunction. During this surgical reconstruction, a short segment of the small intestine (ileum) is isolated to function as a conduit or “loop” to channel urine from the ureters to an external stoma on the abdominal wall. Over time, complications such as strictures, leaks, or obstructions can develop within this reconstructed system. The X-PROC Loopogram at Chughtai Lab provides a vital diagnostic window, allowing consultant radiologists and urologists to visualize the conduit, the ureteroileal anastomoses, and the upper urinary tract in real-time.

Using advanced digital fluoroscopy technology, the procedure involves the retrograde instillation of a water-soluble iodinated contrast medium directly into the stoma. As the contrast fills the ileal loop and flows backward (refluxes) into the ureters and the renal collecting systems, a series of dynamic X-ray images are captured. This real-time visualization is critical for assessing the patency of the urinary tract, detecting any narrowing or strictures at the surgical connection sites, identifying urinary leaks, and evaluating the overall drainage efficiency of the system. Chughtai Lab, Pakistan’s leading diagnostic network, performs this procedure under strict clinical protocols, ensuring patient safety, comfort, and high-resolution diagnostic imaging that is essential for subsequent urological management.

Clinical Procedure: What to Expect

Patient Preparation

Proper preparation is essential to ensure the safety of the patient and the diagnostic accuracy of the X-PROC Loopogram. Patients scheduled for this procedure at Chughtai Lab should adhere to the following preparation guidelines:

• Urostomy Supplies: Patients must bring a complete spare urostomy pouching system (including the wafer, bag, and adhesive) to the appointment, as the existing appliance will be removed during the procedure.
• Dietary Restrictions: While a strict fasting state is not always mandatory, patients are generally advised to consume a light meal or remain fasting for 2 to 4 hours prior to the procedure to minimize bowel gas, which can obscure fluoroscopic visualization.
• Medication and Medical History: Patients must inform the clinical staff of all current medications. It is particularly critical to disclose any history of allergies, especially prior adverse reactions to iodinated contrast media, or a history of asthma.
• Kidney Function: Although systemic absorption of contrast from an ileal conduit is minimal, patients with a history of severe renal impairment may need to provide recent serum creatinine and Estimated Glomerular Filtration Rate (eGFR) results.
• Pregnancy Screening: Female patients of childbearing age must inform the technologist or radiologist if there is any possibility of pregnancy, as ionizing radiation poses potential risks to the developing fetus.
• Hygiene: The peristomal skin should be clean and free of heavy creams or lotions on the day of the test to facilitate the secure application of temporary catheters and the subsequent replacement pouch.

During the Procedure

The X-PROC Loopogram is performed in a dedicated digital fluoroscopy suite at Chughtai Lab by an experienced radiologist assisted by a radiographer. The procedure is designed to be as comfortable and efficient as possible:

• Positioning: The patient is asked to lie supine (on their back) on the fluoroscopy table. A preliminary scout X-ray is taken to assess the baseline anatomy and check for any overlying bowel gas or pre-existing calcifications.
• Catheter Insertion: The existing urostomy bag is carefully removed, and the skin surrounding the stoma is cleansed with an antiseptic solution. A sterile, soft, flexible catheter (often a small Foley or red rubber catheter) is gently inserted through the stoma into the ileal conduit. If a balloon catheter is used, the balloon is inflated minimally or held gently in place to prevent the backflow of contrast during instillation.
• Contrast Instillation: Under low-dose fluoroscopic guidance, a sterile, water-soluble iodinated contrast agent is slowly infused through the catheter into the ileal loop. The radiologist monitors the flow of contrast in real-time as it fills the loop and refluxes retrogradely into the ureters and up to the kidneys.
• Image Acquisition: Multiple spot films and dynamic images are captured in various projections (such as supine, oblique, or lateral) to thoroughly evaluate the anatomy, the integrity of the surgical connections, and the drainage patterns.
• Duration and Experience: The entire procedure typically takes between 30 to 45 minutes. Patients may experience a mild sensation of fullness or pressure in the abdomen as the contrast is introduced, but the procedure is generally well-tolerated and not painful.
• Post-Procedure Care: Once the necessary images are acquired, the contrast is allowed to drain naturally from the conduit, the catheter is removed, the peristomal area is cleansed, and the patient can reapply their personal urostomy appliance.

When is an X-PROC Loopogram Performed?

Monitoring Post-Surgical Anatomy after Radical Cystectomy

Following a radical cystectomy and the creation of an ileal conduit, patients require long-term surveillance to monitor the structural integrity of the urinary diversion. The X-PROC Loopogram is performed as a routine or indicated follow-up study to establish a baseline of the reconstructed anatomy and to ensure that the ileal loop is functioning as an efficient conduit without abnormal retention or reflux patterns that could compromise renal function over time.

Investigating Suspected Anastomotic Leaks

In the early or late post-operative phases, patients may develop leaks at the surgical junctions where the ureters are joined to the ileal segment (the ureteroileal anastomoses). An anastomotic leak can lead to urinoma formation, peritonitis, or systemic sepsis. Physicians request an X-PROC Loopogram to definitively identify any extravasation of contrast material outside the boundaries of the conduit or ureters, allowing for prompt surgical or interventional management.

Evaluating Ureteral and Conduit Strictures

Chronic inflammation, ischemia, or scar tissue formation at the surgical sites can lead to the development of strictures (narrowing) within the ileal conduit or at the ureteroileal junctions. These strictures obstruct the free flow of urine, leading to upstream pressure. A loopogram is highly effective in demonstrating the exact location, length, and severity of these strictures, which is crucial for planning corrective procedures such as balloon dilation, stenting, or surgical revision.

Diagnosing Recurrent Pyelonephritis and Upper Tract UTIs

Patients with urinary diversions are at an increased risk for urinary tract infections (UTIs). However, recurrent episodes of acute pyelonephritis (kidney infection) suggest an underlying structural issue, such as severe vesicoureteral (or in this case, ureteroileal) reflux, urinary stasis within a redundant loop, or obstruction. The X-PROC Loopogram helps clinicians visualize whether there is excessive, high-pressure reflux or prolonged retention of infected urine within the conduit.

Assessing Unexplained Flank Pain or Hydronephrosis

When routine ultrasound or CT scans reveal new or worsening hydronephrosis (dilation of the renal collecting system) or when a patient presents with persistent flank pain, an X-PROC Loopogram is indicated. It provides dynamic, functional information regarding whether the hydronephrosis is due to a mechanical obstruction (like a stone or stricture) or if it represents a non-obstructive, low-pressure dilation of the chronic post-surgical state.

What Does an X-PROC Loopogram Detect?

The X-PROC Loopogram is a highly sensitive diagnostic tool capable of identifying a wide range of structural and functional abnormalities within a urinary diversion system. Specifically, the procedure can detect:

• Ureteroileal anastomotic strictures (narrowing at the connection between the ureters and the ileal loop).
• Active contrast extravasation indicating an acute or chronic urinary leak.
• Filling defects within the ileal conduit, which may represent urinary calculi (stones), mucus plugs, or tumor recurrence.
• Conduit dysfunction, such as an abnormally elongated, redundant, or dilated ileal loop that causes urinary stasis.
• Stricture or stenosis of the external stoma, limiting the outflow of urine.
• Presence of fistulous tracts communicating between the urinary diversion and adjacent bowel loops or pelvic structures.
• Unilateral or bilateral ureteral reflux, confirming whether contrast freely reaches the renal pelvis.
• Hydroureter (dilation of the ureters) and hydronephrosis (dilation of the renal pelvis and calyces).
• Loss of normal renal calyceal architecture, indicating chronic reflux nephropathy or scarring.
• Extrinsic compression of the conduit or ureters by pelvic masses, lymphadenopathy, or retroperitoneal fibrosis.
• Anatomical deviations or kinking of the ureters post-surgery.
• Incomplete emptying or delayed drainage of contrast from the conduit after catheter removal.

Turnaround Time and Report Access at Chughtai Lab

Chughtai Lab is widely recognized for its efficient workflow, advanced digital reporting systems, and commitment to rapid turnaround times. Following the completion of the X-PROC Loopogram, the captured digital fluoroscopic images are immediately transferred to a high-resolution Picture Archiving and Communication System (PACS). A consultant radiologist specializing in abdominal and genitourinary imaging reviews the dynamic study and drafts a comprehensive, detailed report.

The final verified report, along with high-quality key images, is typically available within 24 to 48 hours. Patients and referring physicians can easily access these reports online through the secure Chughtai Lab web portal or via the Chughtai Lab mobile application. Additionally, physical copies of the report and a CD containing the complete DICOM image files can be collected directly from the diagnostic center where the procedure was performed, ensuring seamless integration into the patient’s ongoing clinical care plan.

X-PROC Loopogram Findings Overview

Structure / Parameter Evaluated	Normal Findings	Possible Abnormal Findings
Ileal Conduit (Loop)	Normal caliber, smooth mucosal contours, prompt emptying of contrast.	Dilated or redundant loop, mucosal irregularities, filling defects (mucus, stones, or tumor).
Ureteroileal Anastomoses	Patent connections with smooth transition of contrast from conduit to ureters.	Stricture, severe narrowing, or complete obstruction at the surgical junction.
Ureters	Normal caliber, symmetric filling, no abnormal deviation or kinking.	Hydroureter, tortuosity, extrinsic compression, or filling defects.
Renal Pelvis & Calyces	Normal cupping of calyces, symmetric retrograde filling without severe dilation.	Hydronephrosis, blunting of renal calyces, clubbing, or delayed drainage.
Contrast Flow & Drainage	Free retrograde reflux into upper tracts and rapid, complete drainage post-catheter removal.	Obstruction to flow, prolonged contrast retention, or high-pressure reflux.
Anatomical Integrity	No leakage; contrast is strictly confined within the urinary tract structures.	Active contrast extravasation indicating a leak, urinoma, or fistulous tract.
Stoma	Patent stomal opening allowing easy catheter insertion and free outflow.	Stomal stenosis, retraction, or parastomal herniation restricting drainage.

Note: Diagnostic findings should always be interpreted by a qualified healthcare professional together with the patient’s symptoms, medical history, physical examination, laboratory investigations, previous imaging studies, and other relevant clinical information. Additional investigations or specialist consultation may be recommended depending on the findings.

Why Choose Chughtai Lab for X-PROC Loopogram?

• Expert Radiologists: The procedure is performed and interpreted by highly qualified consultant radiologists with extensive experience in genitourinary and fluoroscopic imaging.
• State-of-the-Art Digital Fluoroscopy: Chughtai Lab utilizes advanced, low-dose digital fluoroscopy equipment that ensures exceptional spatial resolution while minimizing radiation exposure.
• Strict Infection Control: All procedures are conducted using sterile, single-use catheters and strict aseptic techniques to prevent urinary tract infections.
• Patient-Centric Care: The clinical staff at Chughtai Lab is trained to prioritize patient comfort, dignity, and privacy throughout this specialized procedure.
• Convenient Digital Access: Reports and high-resolution images are accessible online via the Chughtai Lab portal and mobile app, facilitating quick sharing with urologists.
• Nationwide Network: With a presence across major cities in Pakistan, Chughtai Lab offers standardized, high-quality diagnostic services close to home.
• Comprehensive Diagnostic Support: Chughtai Lab provides integrated services, allowing patients to undergo pre-procedure renal function tests and post-procedure follow-ups under one roof.
• Uncompromised Quality Standards: Operating under rigorous internal and external quality control protocols, Chughtai Lab ensures highly accurate and reliable diagnostic reporting.