Retrograde urethrogram

A retrograde urethrogram is a routine radiologic procedure (most typically in males) used to image the integrity of the urethra. Hence a retrograde urethrogram is essential for diagnosis of urethral injury, or urethral stricture.

Process

The procedure involves the insertion of a Folly catheter into the distal urethra and minimally inflating it. This is followed by instillation of 30mL of water soluble contrast and a plain radiograph is obtained. No attempt at insertion a bladder catheter should be made in case of suspect urethral injury, until negative retrograde urethrogram is obtained eg., no spillage of the contrast dye seen on radiograph, to avoid further damaging a urethral injury.

It is used when there is suspicion of urethral trauma, such as a history of trauma to the area followed by pain, inability to void urine, or the presence of blood at the urethral meatus, a scrotal hematoma, free-floating prostate on rectal examination.

If a urethral injury is suspected, a retrograde urethrogram should be performed before attempting to place a Foley catheter. If there is a urethral disruption, a suprapubic catheter should be placed.

Leakage of the dye at any point between the bladder and tip of the penis suggests urethral injury (usually secondary to pelvic trauma) and is an indication for surgical intervention.

External links

• New England Journal of Medicine procedure videos: Male Urethral catheterization
• Ohio State University Patient Education Materials: Retrograde Urethrogram