3. Definition
A retrograde urethrogram is a routine radiologic procedure
(most typically in males) used to image the integrity of
the urethra by using iodinated contrast media.
6. Contrast medium
RGU
• HOCM or LOCM ; 20ml
MCU
HOCM or LOCM ; 150ml
Amount 200 to 500ml (dilute with
normal saline)
7. Equipment
Fluoroscopy unit with spot film device and tilting table
Video recorder
Jaques or foley catheter
In small infants a fine (5-7F) feeding tube is adequate
Syringes
Xylocaine jelly 1-2%
10. Technique
Patient lies supine on the x-ray table
Retract the fore skin and clean the tip of penis with betadine or
antiseptic solution.
Inject a small amount of local anesthetic into the urethra with a 8-
F Foley catheter or syringe and balloon is inflated with 1-3 ml of
water.
Local anesthesia helps to relax the sphincter as the patient may
contract it during the procedure thus leading to a diagnosis of a
stricture
Contrast medium is injected under fluoroscopy control and films
are taken
The male urethra is best seen in the oblique position. • Female
urethra is best seen in lateral or anteroposterior position .
11.
12. Imaging
The view of films:
30 left anterior oblique with right leg abducted and knee
flexed
Supine PA
30 right anterior oblique with left leg abducted and knee
flexed
17. MCU is a fluoroscopic study of the lower urinary tract in
which contrast is introduced into the bladder via a catheter
Voiding cystourethrogram demonstrates the lower urinary
tract and helps to detect the existence of any vesico-urethral
reflux, bladder pathology and congenital or acquired of
bladder outflow tract.
MCU
20. Technique
The bladder is filled with the contrast media using
foley catheter(5-7F)
After the bladder is filled to its capacity; then the
patient is asked to void(micturate)
AP with full bladder for demonstration of the presence
or absence of VUR.
both obliques to demonstrate bilateral vesicoureteric
junctions.
post void film to check for a ureterocoele.
23. Films taken
Lateral bladder
Lateral bladder,
straining-catheter is
then removed
Lateral bladder
during micturation
24.
25. Aftercare
No special aftercare is necessary, but patients and
parents of children should be warned that dysuria,
possibly leading to retention of urine, may rarely be
experienced. In such cases a simple analgesic helpful
and children may be helped by allowing them to
micturate in a warm bath.
26. Complication
Contrast reaction (due to absorption through bladder
mucosa) • UTI • Urethral trauma. • Intravasation of
contrast – due to use of excessive pressure in stricture.
Due to the contrast medium
i. Adverse reactions may result from absorption of
contrast medium by the bladder mucosa. The risk is
small when compared with excretion urography.
ii. Contrast medium induced cystitis
27. Due to the technique
Acute urinary tract infection
Catheter trauma- may produce dysuria, frequency
haematuria and urinary retention
Complications of bladder filling e.g, perforation from
overdistension- prevented by using a non-retaining
catheter, e.g. Jaques
Catheterization of vagina or an etopic urethral orifice
Retention of a foley catheter