A urethrogram is an X-ray-based examination of the urethra that is virtually exclusively performed on male patients. This fact sheet relates to the treatment being given to a male patient.
The tube leaving the bladder and passing through the prostate and penis is known as the urethra.
A urethrogram is typically performed to determine the exact cause of decreased urine flow, which is typically attributed to urethral strictures. The benign (non-cancerous) enlargement of the prostate gland is the most typical cause of constriction of the urethra in men. The most frequent purpose of a urethrogram is to identify causes of urethral constriction other than benign prostate gland enlargement.
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Why would my doctor refer me to have this procedure?
If you have issues with poor urine flow that your doctor believes are unrelated to the typical prostate enlargement that is frequently observed in older men, he or she may recommend that you have this treatment. Any of these past events, including injuries, prostate surgery, bladder catheterization, and infections, might cause the urethra to narrow.
If there is a suspicion of urethral damage, a urethrogram can also be performed as an emergency procedure.
Patients are most frequently referred to urologists (specialist doctors) for urethrograms. If you have trouble passing pee, your general practitioner could recommend this test before you visit the urologist.
How do I prepare for a urethrogram?
A urethrogram typically requires no additional preparation. Although it is preferable to have any urinary tract infection treated before the surgery, it is possible to have the procedure done while you are still receiving treatment in some circumstances.
You can get information about any necessary preparation for the exam from the hospital radiology department or radiology practice where the operation is being performed.
What happens during a urethrogram?
The radiologist (specialized physician) performing the examination will go over the process with you.
Typically, you will be instructed to empty your bladder, remove your clothing, put on a gown, and lie down on a fluoroscopy table, an X-ray table. This will be in the radiology department or
radiology practice or the hospital’s X-ray department. The radiologist will use a big camera over the table and a screen to view your bladder and urethra while the treatment is being done.
Your lower body will be covered in sterile drapes while an antiseptic solution is used to disinfect your penis and groin. For the procedure, the radiologist will use sterile gloves.
The treatment is often performed by inserting a small catheter (a thin plastic, silicone, or rubber tube) right into the area of the penis where urine exits. To maintain the cathether in place and prevent contrast material from escaping the end of the penis, a tiny balloon will be inflated. Most patients will feel some discomfort while the catheter is inserted and as the tiny balloon is inflated.
Through the catheter, a gentle injection of contrast medium is made. Contrast medium, also known as “contrast” or “X-ray dye” despite the fact that it is a colorless fluid, is a substance that casts a shadow on X-ray images. An X-ray camera is used to take images when this fluid is utilized to fill the urethra. These photos will demonstrate whether the urethra is narrowing, where it is, and how severe it is.
Only the middle and lower portions of the urethra are narrowed in this portion of the test. Often, this provides all the necessary information, but sometimes, when voiding, it is necessary to take photos of the upper urethra (while the urine and contrast is flowing through the urethra from the bladder). This usually entails taking out the first catheter and injecting local anesthetic jelly into the urethra, which lubricates and anesthetizes the urethra and makes it easier to introduce a catheter into the bladder.
Your bladder will be filled with contrast after the catheter has been inserted into it. The catheter will be taken out when you feel the desire to pass urine because it is so full. Images of the bladder will be obtained as needed during this filling phase.
Pushing the tube into your bladder might not be possible or safe if your urethra has a severe constriction. If this is the case, the initial research typically contains sufficient details for the urologist.
After that, the X-ray table will gradually tilt up, bringing you to a standing posture, and you’ll be given a bottle to pee into. More images of your bladder and urethra will be obtained while you are doing this so that it can be determined how well your bladder empties and whether there are any narrowings in the urethra.
Are there any after effects of a urethrogram?
You might notice some blood at the tip of your penis when the urethrogram is finished. You can anticipate some minor discomfort or stinging the first few times you urinate where the catheter was inserted and the balloon was inflated. Additionally, you might pass a tiny bit of blood. You shouldn’t be concerned about this because it is common following catheter insertion and will go away in a day or two.
How long does a urethrogram take?
The study will take between 30 to 60 minutes overall. The time required is based on:
- the purpose of your having the treatment done;
- whether a narrow urethra makes it difficult for the radiologist to try to put the catheter;
- if you experience difficulties emptying your bladder once it has filled.
What are the risks of a urethrogram?
The urethra has been harmed. This is uncommon, but more likely if the urethrogram is done in an emergency situation. This is because, prior to the treatment, the urethral lining is frequently ripped, allowing the catheter to enter through the torn area outside of the urethra.
To avoid further harm that might result from attempting to insert a catheter into the bladder in an emergency scenario, a urethrogram should be performed with the catheter inserted just into the end of the penis. This should reveal any urethral rips. If there is already a rip in the urethra, attempting to introduce a catheter into the bladder risks extending the tear or having the catheter puncture the urethra through the tear. When the urethra is constricted and it is challenging to pass the catheter beyond the constriction, injury may result.
If the urethra is not already torn or severely narrowed before the urethrogram begins, it is extremely uncommon for a urethrogram to harm the urethra.
a urinary infection. Due to the use of sterile techniques, this is also quite uncommon. Following the test, some initial discomfort or stinging is normal. You will experience burning when you pass urine if you do have an infection. You must consult your doctor if this persists for longer than 36 hours as they might recommend antibiotics. Other indications of an infection that you should discuss with your doctor are the need to urinate frequently more than 36 hours after the surgery, as well as a temperature or chills (shivering) at any time following the procedure. If you do experience a fever (a temperature of more than 38C), it’s crucial to visit your general practitioner very away and have your urine examined for signs of infection.
allergy to the contrast agent. As the contrast is not directly injected into a blood artery, this is uncommon but is possible (see iodinated contrast). You must notify the radiologist in advance of the procedure if you are aware if you previously experienced an adverse reaction to iodine-containing contrast. When you book your appointment, you should also let the hospital or radiology office know. If your past reaction was severe, they might decide not to undertake the treatment at all or they might decide that you need to take corticosteroid (steroids) medicine for a day before the procedure.
What are the benefits of a urethrogram?
If there is something wrong with the urethra that might be the source of your symptoms, the urethrogram will reveal it. The optimal way to treat the issue can then be planned by the urologist, depending on the size and location of the constriction.
Who does the urethrogram?
A radiologist, a specialist physician skilled in performing radiology procedures and analyzing X-ray pictures, will perform the urethrogram. The technician who operates the X-ray machine while the test is being performed, the radiographer, and in some circumstances, a radiology nurse, will help the radiologist.
Where is a urethrogram done?
Typically, a urethrogram is performed in an X-ray room with access to fluoroscopy in a hospital radiology department or radiology office. The X-ray images can be viewed on a TV screen while the examination is being done thanks to fluoroscopy equipment. The photos are also kept as a record of the procedure.
When can I expect the results of my urethrogram?
The following factors can affect how quickly your doctor receives a written report on the test or procedure:
- the promptness with which your doctor needs the results;
- the test’s or procedure’s complexity;
- whether the radiologist needs more information from your doctor before the test or operation may be understood;
- whether this test or procedure needs to be compared with past X-rays or other medical imaging (this is frequently the case if you have a disease or condition whose progression is being monitored);
- way your doctor receives the report (i.e. phone, email, fax or mail).
Please feel free to inquire as to when your doctor will receive the written report from the private practice, clinic, or hospital.
It is crucial that you speak with your doctor about the findings, either in person or over the phone, so that they can explain what they mean for you.
How are urethrograms performed?
The most common causes of urethral strictures are trauma, surgery, protracted catheterization, and radiation therapy. A urethrogram is a procedure used to show the location and characteristics of a urethral stricture that is clinically suspected. This test may be appropriate for males with inadequate urine flow who are not suspected to have prostatomegaly. The referral usually comes from a qualified urologist or on their recommendation.
A urethrogram is a contrast urethral examination done under fluoroscopic guidance. This is accomplished by inserting a catheter into the urethral meatus, gently inflating the balloon to create a seal, and then injecting a small amount of contrast material into the urethra while monitoring the image. A voiding study is frequently required and is performed by catheterizing the patient, filling the bladder afterward, withdrawing the catheter, and having the patient void while being imaged with spot films.
What are the prerequisites for having an urethrogram done?
Typically, urethrograms are performed following a specialist referral. Some urologists could consent to a urethrogram after speaking with you on the phone.
A urethrogram should not be performed until the urinary infection has been treated. Antibiotic prophylaxis should be taken into account in patients with recurrent urinary tract infections. The study can be conducted near the conclusion of an antibiotic course for a urinary tract infection.
What are the absolute contraindications for a urethrogram?
Realistically, there are no absolute contraindications. The danger of an adverse reaction is limited because the contrast is not intravenously administered. Patients who have a history of a moderate or severe contrast reaction should be premedicated or a different contrast should be employed, given the theoretical risk of contrast intravasation with urethral mucosal injury.
Unless there are unusual circumstances, such as the likelihood of traumatic catheterization or the failure of catheterization in a patient who needs to be catheterized as part of care, severe urinary tract infection should be treated before a urethrogram is performed.
What are the relative contraindications for a urethrogram?
Patients could be unwilling to have the treatment done because they are embarrassed by it. A thorough explanation and a sympathetic demeanor from the staff members present in the room throughout the process can typically overcome this, though.
What are the adverse effects of a urethrogram?
After catheterization, mild or light haematuria is typical, transient, and rarely problematic if patients are informed to expect it.
Investigation and treatment may be necessary for infections following catheterization. If the treatment is performed with the proper sterile approach, it is extremely uncommon.
An attempted urethrography in the presence of an acute urethral injury may create swelling or oedema and afterwards result in urine retention.
Are there alternative imaging tests, interventions or surgical procedures to a urethrogram?
The ideal method for assessing the female urethra, where the research is typically conducted to ascertain whether a diverticulum is present, is magnetic resonance imaging. A urethrogram in a male provides more useful information regarding the functional flow restriction caused by strictures.
Recently, there has been some interest in using ultrasound to study the urethra. The urethra must still be distended with jelly or fluid, making this procedure just as invasive.
Voiding studies are challenging and should only be conducted by experts in the field.
Further information about urethrogram
In an emergency case, urethrograms can be performed to confirm the presence of a ruptured or partially ruptured urethra. In most cases, all that is required is an ascending research. A suprapubic catheter can be used to manage the patient throughout the acute damage and healing phase while the study can be postponed for a few weeks. An elective repair can also be performed at a later time after the injury. At this point, a urethrogram is frequently helpful for operational planning.
The antegrade urethrogram procedure.
X-ray dye is first injected into the bladder. There are two ways to accomplish this: either the patient already has a suprapubic catheter that was surgically implanted, or a nurse will place a urinary catheter into the bladder through the urethra.
A radiologist performs urethrograms while a radiographer and occasionally a nurse are also present.
A radiologist will examine your images and write a report that will be given to your doctor. On occasion, the radiologist will address you directly while performing the examination.
- Alice Springs Medical Center
- Calvary Adelaide Medical Center
- Noarlunga Medical Center
- Pt Augusta Medical Center
- Lincoln Hospital at Pt
- St Andrew’s Medical Center
What is the purpose of a retrograde urethrogram?
Male patients are the ones who typically undergo a retrograde urethrogram (RUG), a diagnostic procedure used to identify urethral disease such as urethral injuries or strictures.
Does the retrograde urethrogram hurt?
No, there are no injections involved in the operation. You won’t feel anything when the local anesthetic solution is administered; just discomfort. However, the operation could be stopped if you immediately notify your doctor if you experience any pain. There are no negative effects of the contrast agent utilized during this technique. Rarely, you might respond to the local anesthetic itself or the contrast. This may, very infrequently, pose a hazard to life.
How can you tell if your urethra is narrow?
Reduced urine flow is one of the urethral stricture symptoms. incomplete emptying of the bladder stream of urine being sprayed.
A retrograde procedure is what?
An imaging examination called a retrograde pyelogram employs X-rays to examine your bladder, ureters, and kidneys. The lengthy tubes that link your kidneys and bladder are called ureters. The cystoscopy procedure typically includes this test. It makes use of an endoscope, which is a lit, long tube. The doctor performing the cystoscopy has the option of directly injecting contrast dye into the ureters. On an X-ray, the contrast makes certain bodily components appear more distinct. Anesthesia is used during the examination.
How can one urinate retrogradely?
We measure bladder emptying by adding 300 mL of saline retrogradely through the already-installed catheter, then withdrawing the catheter and letting the patient urinate (“retrograde-fill” technique).
A retrograde cystogram is what?
A thorough x-ray of the bladder is called a retrograde cystography. Through the urethra, contrast dye is injected into the bladder. The tube that transfers urine from the bladder to the outside of the body is called the urethra.
What distinguishes antegrade from retrograde pyelography?
Imaging of the urine collecting system is referred to as pyelography (or “pyelogram”).
The phrase is most frequently used in relation to “intravenous pyelography” (or “IVP”). According to others, the term “intravenous urography” is more appropriate for a test that visualizes intravenous contrast as it passes through the kidney parenchyma and into the urine collecting system. Both phrases are frequently used in the same context.
Pyelography can also be carried out antegrade following percutaneous access to the renal upper collecting system or retrograde through a catheter put into the distal ureter (e.g. through a percutaneous nephrostomy).
- backward pyelography
- Prior to pyelography
History and etymology
The name comes from the Greek terms puelos, which means “trough” or “basin” and refers to the urine collecting system, and graphia, which means “writing.”