A retrograde urethrography is a routine

radiologic Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiatio ...

procedure (most typically in males) used to image the integrity of the

urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra con ...

. Hence a retrograde urethrogram is essential for diagnosis of urethral injury, or

urethral stricture A urethral stricture is a narrowing of the urethra, the tube connected to the bladder that allows the passing of urine. The narrowing reduces the flow of urine and makes it more difficult or even painful to empty the bladder. Urethral stricture i ...

Uses

Some indications for retrograde urethrogram are: urethral stricture, urethral trauma, urethral fistula and congenital urethral abnormalities. There is no absolute contraindication for retrograde urethrogram. There are several relative contraindications such as: allergy to contrast agents, acute urinary tract infection, and recent instrumentation of urethra.

Procedure

A low osmolar contrast agent with concentration of 200 to 300 mg per ml with volume of 20 ml can be used in this study. Warming the contrast medium before infusion into the urethra can help to reduce the chance of getting spasm of external urethral sphincter. The subject lie down on supine position. An 8 Fr Foley catheter is connected to a 50 ml syringe. The syringe is flushed to remove any air bubbles within the Foley catheter and the syringe. The tip of the catheter is then inserted into the urethra using

aseptic technique Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deriv ...

until it park inside the navicular fossa. Fossa navicularis is located just a short distance proximal to

urethral meatus The urinary meatus, (, ) also known as the external urethral orifice, is the opening of the urethra. It is the point where urine exits the urethra in both sexes and where semen exits the urethra in males. The meatus has varying degrees of sensiti ...

within the

glans penis In male human anatomy, the glans penis, commonly referred to as the glans, is the bulbous structure at the distal end of the human penis that is the human male's most sensitive erogenous zone and their primary anatomical source of sexual p ...

. The balloon of the Foley catheter is then inflated with 2 to 3 ml of water to anchor the catheter and occlude the meatus, thus prevent contrast from leaking out from the penis. Contrast is then injected from the syringe with

fluoroscopy Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and function ...

to visualise the flow of contrast within the penis. The catheter is gentlely pulled to straighten the penis over the leg of the same side to prevent the overlapping of any pathology in the posterior urethrae. Spot images are taken at 30 to 45 degrees to visualise the entire

spongy urethra The spongy urethra (cavernous portion of urethra, penile urethra) is the longest part of the male urethra, and is contained in the corpus spongiosum of the penis. It is about 15 cm long, and extends from the termination of the membranous po ...

(penile urethra). If there is no contraindication to full urinary catheterisation such as false passage or stricture, the urinary catheter should be inserted until

urinary bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...

to perform

voiding cystourethrography In urology, voiding cystourethrography (VCUG) is a frequently performed technique for visualizing a person's urethra and urinary bladder while the person urinates (voids). It is used in the diagnosis of vesicoureteral reflux (kidney reflux), amon ...

to visualise the

prostatic urethra The prostatic urethra, the widest and most dilatable part of the urethra canal, is about 3 cm long. It runs almost vertically through the prostate from its base to its apex, lying nearer its anterior than its posterior surface; the form of ...

and

membranous urethra The membranous urethra or intermediate part of male urethra is the shortest, least dilatable, and, with the exception of the urinary meatus, the narrowest part of the urethra. It extends downward and forward, with a slight anterior concavity, be ...

. Filling up the bladder with contrast without full catheterisation (the end of catheter inside the urethra) is also possible if the subject is able to relax the bladder neck to allow contrast to follow into the bladder. If a urethral injury is suspected, a retrograde urethrography should be performed before attempting to place a Foley catheter into the bladder. If there is a urethral disruption, a suprapubic catheter should be placed.

Complications

Among the possible complications are: urinary tract infection, urethral trauma, and intravasation of contrast medium (contrast going into blood vessels) if excessive pressure is used to overcome a stricture.

References

External links

New England Journal of Medicine procedure videos: Male Urethral catheterization

Ohio State University Patient Education Materials: Retrograde Urethrogram
Projectional radiography Urologic imaging Urethra {{Treatment-stub

Uses

Procedure

Complications

See also

References

External links