Sep 14, 2017 the purpose of this study is to describe our technique for pericatheter retrograde urethrogram pcrug and to evaluate the utility of a pcrug to detect a clinically significant leak after urethral reconstruction. The urethra is the tube that carries urine from the bladder and out the body. If you have any questions about how to prepare for your study, please call md imaging at 5302431297. There are two radiological methods for examination of the male urethra. There is very limited pediatric literature available on this topic, which makes its performance and interpretation challenging. Antegrade cystoscopy is performed through the suprapubic tract using a 19f sheath and a 0 or 30 cystoscope lens. Retrograde urethrography rug is considered to be the best initial study for urethral imaging in men. Retrograde urethrography is considered the gold standard for evaluating stenosis or urethral disease. A urethrogram is usually carried out to show the cause of poor urinary flow thought. To compare examination adequacy and patient discomfort during retrograde urethrography rug performed by using the conventional balloon method versus those of rug and voiding cystourethrography vcug performed with the clamp method of using drip infusion for the administration of contrast material. N2 this analysis was performed to examine the role of retrograde urethography in the planning of prostate cancer irradiation.
The jelly makes it easy to insert the catheter if no urethral injury is detected. Jul 29, 2019 a nuclear medicine thyroid scan uses a radioactive medication radiopharmaceutical to take pictures or images of the thyroid gland. Retrograde pyelography was the first method devised for imaging the urinary collecting system, and until the development of early ivu agents in the 1930s, it was the only way of imaging the collecting system. Therefore, this study was carried out in order to verify whether this technique can be used routinely as a diagnostic tool for the evaluation of the appropriate time for catheter removal after urethroplasty and. A new device for retrograde urethrography in the male. An alternative to fluoroscopic retrograde urethrography is the usguided retrograde filling and distension of the urethra a sonographic urethrogram with saline or us contrast agent using the same technique of retrograde filling and distension of the urethra. The purpose of this study is to describe our technique for pericatheter retrograde urethrogram pcrug and to evaluate the utility of a pcrug to detect a clinically significant leak after urethral reconstruction. A penile clamp for retrograde urethrography using external compression by a balloon cather. Abdominal radiology procedure manual educational goals 2014 v4. Retrograde pyelography radiology reference article. Pdf a perfected device for performing retrograde urethrography.
Retrograde pericatheter urethrography rpu technique and. Retrograde urethrography rug is the most accurate means of diagnosing and classifying urethral trauma currently available but is prone to overdiagnose complete injuries. Sonourethrogram was more proceure and specific in diagnosing urethral stricture disease in our study as compared to ascending urethrogram. The fluoroscopy service is an integral component of the abdominal imaging. Conventional urethrography although the most commonly used technique for diagnosis and characterization of anterior urethral stricture has limitations in. We describe a technique of positive pressure retrograde urethrography using foley catheter and rubber stopper, inexpensive and could be adopted in. Retrograde urethrography rug is the fluoroscopic examination of the urethra via retrograde contrast filling. There is fast growing authorship and readership with jcdr as this can be judged by the number of articles published in it i e. The urinary bladder was opacified by renal excretion of iodine contrast medium administered iv n or through infusion into a suprapubic tube n 1. Through the suprapubic tract ureteric catheter urehrogram passed cystoscopically into the proximal urethra and contrast instilled to visualize the proximal urethra. On initial presentation to the emergency department there are clear indications for performing these procedures. The normal symmetrical cone shape of this part of the urethra described by mccallum 1979 was uneven. Rguprimary imaging modality for evaluating traumatic injuries, inflammatory and stricture diseases of male urethra.
Typically the procedure is performed in men after they have been subjected to a blunt force trauma, but can also be done in women. If there is a urethral stricture a block or closing, urine cannot flow out. Sep 24, 2018 a retrograde urethrogram rug is a diagnostic procedure performed most commonly in male patients to diagnose urethral pathology such as trauma to the urethra or urethral stricture. Sonourethrography is a new technique for imaging the. Antegrade urethrogram delineates the proximal urethral segment till the strictured area. The modifications to the device are shown, and the steps of the technique described. Retrograde urography definition of retrograde urography by. Ascending urethrogram underestimates the length of anterior urethral stricture due to end on view. A total of 343 of these patients underwent rpu 3 weeks postoperatively. Printable version procedure after test printable version home urologic conditions retrograde urethrogram. Talk with your doctor if you have questions about individual health concerns or specific treatment options. This method prevents significant leakage of contrast material during the retrograde injection and provides good anatomical information.
Apr 22, 2020 a retrograde urethrogram is a radiologic procedure performed to examine the integrity of the urethra, a part of the lower urinary tract. The procedure involves the insertion of a foley catheter into the distal urethra and minimally. Retrograde urethrography followed by a micturating urethrogram revealed a stricture in the poste rior aspect of the bulbous urethra. The contrastjelly mix creates a contrast gel that is less likely to leak from the meatus when injected. The anterior urethra extends from the external meatus to the inferior edge of the. When the urethra is studied with instillation of contrast into the distalanterior urethra it has been referred to as.
Achieve 90% score on the stanford radiography and fluoroscopy inservice exam. If a radiological diagnosis is felt to be essential but to be used judiciously, a high index of suspicion is necessary in any patient. Acrsar practice parameter for the performance of adult. Fixation of the catheter is achieved by inflating a balloon in the fossa navicularis, which prevents extravasation on introduction of contrast material. This information sheet relates to the procedure being carried out on a male. A perfected device for performing retrograde urethrography. The role of retrograde urethrography in the planning of.
Urethrography urethrography refers to the radiographic study of the urethra using iodinated contrast media. Overview a retrograde urethrogram rug is a diagnostic procedure performed most commonly in male patients to diagnose urethral pathology such as trauma to the urethra or urethral stricture. In patients of stricture urethra with suprapubic catheter and where the proximal bulbous urethra is not visualized on vcug, antegrade urethrogram using our technique was performed. Step by step instructions on how to perform a retrograde urethrogram in an adult patient. Espr uroradiology taskforce imaging recommendations in. It requires highresolution linear transducers and a penile and transperineal. It is not a good technique to visualize the prostatic urethra in cases of posterior urethral disruption as it is difficult to maintain the ureteric catheter in the posterior uretbrogram and the contrast rapidly enters the bladder without properly filling the posterior urethra figure 2. At the same time, a free text of manuscript is available in html and pdf format. There is very limited pediatric literature available on this topic, which makes its. Many times it falls to the urologist, who may not be immediately available.
An indigenous economic technique of positive pressure. Clinical judgment should guide decisions about contrast quantity and use of infusion or injection technique. Urethrography refers to the radiographic study of the urethra using iodinated contrast media and is generally carried out in males. Please arrive 15 min before your scheduled appointment time. The urethra is the tube that runs from the bladder through the prostate and penis. Definition retrograde urethrography involves the use of xray pictures to provide visualization of structural problems or injuries to the urethra. Abdominal radiology procedure manual educational goals. First, rug is performed to visualize the adequately distended anterior urethra, and vcug is then performed to properly evaluate the posterior urethra, 1, 2. Technical skills by end of the 2nd rotation, the resident should be able to 1. Rug was performed in 42 patients with a mean age of 63. Pdf ascending urethrogram and sonourethrogram in evaluation.
Any information contained in this pdf file is automatically generated from digital. Urethrogram figures 1285 and 1286 is performed by placement of the tip of a foley catheter into the entrance of the urethra, followed by instillation of 50 ml of contrast under low pressure usually gentle hand injection or gravity. The device allows rug to be performed using a balloonless catheter and with assessment of the various problems of the urethra. Retrograde urethrography rgu and micturating cystourethrography mcu by.
It enables anatomic detail in the evaluation of the urethra in boys. Novel pericatheter retrograde urethrogram technique is a. Improper retrograde urethrogram technique leads to incorrect diagnosis article in the journal of urology 1822. Tie a tourniquet below corona so that you can hold the genital, retract genital parallel to femur. Though retrograde urethrography is an examination not frequently performed, there are indications for this study that have remained constant for many years. Introduction retrograde urethrography and voiding cystourethrography modalities of choice for imaging the urethra.
The most widely used technique currently involves a foley catheter conventional technique. To describe the clamp method for optimizing retrograde urethrography rug using a perfected device and a drip infusion system. Excellent resource for radiology residents, technologists, and radi. Position patient in rpo position supported with wedge cushion. Improper retrograde urethrogram technique leads to incorrect. Magnetic resonance urethrography in comparison to retrograde. The standard answer to the question how do you evaluate for it.
Sixty milliliters of iv iopamidol iopamiro 300, bracco was. Conventional urethrography although the most commonly used technique for diagnosis and characterization of anterior urethral stricture has limitations in accurate characterization with associated. Feb 03, 2018 retrograde urethrogram retrograde urethrography best initial study for urethral and periurethral imaging in men and is indicated in the evaluation of urethral injuries, strictures and fistulas. Mar 21, 2017 the standard answer to the question how do you evaluate for it. A simple technique of retrograde urethrography in male infants. Retrograde pericatheter urethrography rpu technique and its. Patient should take nothing by mouth food or drink 4 hours prior to exam. Jeffrey traubici, ruth lim, in comprehensive pediatric nephrology, 2008. This fluid is used to fill the urethra, and pictures or images are taken using an xray camera. Retrograde urography definition of retrograde urography. Apr 12, 2015 step by step instructions on how to perform a retrograde urethrogram in an adult patient. Demonstrate basic knowledge of the equipment used during fluoroscopy.
The present study describes a perfected device for retrograde urethrography rug. Ultrasonographic evaluation of urethral stricture disease. Implication for patient care our study results show that the clamp method increases patient comfort during urethrography, as it is a painless procedure and. Following urethrography, you ascenving right away resume to your everyday activities without any restrictions. Traditionally these two examinations have been carried out as separate procedures.
Nov 27, 2019 ascending urethrogram procedure pdf aka. With these techniques, the voiding, contrastfilled urethra is scanned with 16mdct in approximately 6 sec. Combined simultaneous voiding cystourethrography and retrograde urethrography can provide valuable treatment planning information in male urethral stricture disease. Retrograde urethrography rgu contrast is retrogradely injected with the urethral orifice. Ct voiding urethrography was performed as an independent ct examination n or as part of serial ct examinations n 1. Retrograde urethrography rug and voiding cystourethrography vcug are the modalities of choice for imaging the male urethra. Unfortunately, too few people know how to perform this test, and not all radiologists are familiar. The thinsection transverse images and high scanning speed of ct have led to the development of promising new techniques for urethral evaluation. In the procedure a dye is injected into the urethral opening, and the movement. Guidelines for the evaluation of urethral and bladder. To describe our technique of retrograde pericatheter urethrography rpu and its clinical use after urethroplasty. Therefore, this study was carried out in order to verify whether this technique can be used routinely as a diagnostic tool for the evaluation of the appropriate time for catheter removal after urethroplasty and whether it can predict the success of urethroplasty. Between january and april 2004, 20 men were referred to our institute for management of urethral strictures.
Indications for retrograde urethrography and cystography. This is a diagnostic test for male patients with trauma injury to the urethra. Hence a retrograde urethrogram is essential for diagnosis of urethral injury, or urethral stricture. Joshua broder md, facep, in diagnostic imaging for the emergency physician, 2011. Retrograde urethrogram procedure preparation md imaging. Straight forward, readily available, costeffective examination 12. To compare the clinical relevance of retrograde urethrography rug and magnetic resonance mr urethrography in evaluating male urethral strictures. Retrograde pericatheter urethrography rpu has been reported to be useful in assessing urethral healing at the anastomotic site. A comparative study of sonourethrography and retrograde. Oct 02, 2008 the present study describes a perfected device for retrograde urethrography rug. Retrograde urethrography has been the standard imaging technique for the evaluation of male anterior urethra, which involves use of radiation and contrast medium. We recommend the use of this technique of retrograde urethrography without instrumentation to determine urethral disease when manipulation of the urethra.
Between january 2008 and december 20, 387 patients with urethral stricture underwent urethroplasty at our center. Bedside emergency department procedure where urology not. A retrograde urethrogram is a routine radiologic procedure most typically in males used to image the integrity of the urethra. T1 the role of retrograde urethrography in the planning of prostate cancer radiotherapy. Retrograde urethrogram of a 53 yearold male demonstrating normal anatomy. Terminology when the urethra is studied with instillation of contrast into the distalanterior urethra it has be. The procedure is simple and well tolerated by patients and represents an interesting alternative to the conventional rug technique. This document is for informational purposes only and is not intended to take the place of the care and attention of your personal physician or other professional medical services.
Purpose retrograde urethrography is used, in combination with a doctors observation and other tests, to establish a diagnosis for individuals, almost exclusively men, who. Ask the patient to lie in supine position slightly tilted and legs position as shown in the video. Usually double balloon catheter is required forpositive pressure retrograde urethrography in females. Improper retrograde urethrogram technique leads to. To compare the efficacy of sonourethrogram and ascending urethrogram in the evaluation of stricture urethra. In the setting of suspected trauma to the male urethra, retrograde urethrography is still the study of choice to. Retrograde urethrogram, retrograde cystourethrogram catheter placement.