| Retrograde urethrography | |
|---|---|
 Urethrogram showing an urethra stricture in a man. | |
| ICD-9 | 87.76 |
| OPS-301 code | 3-13g |
A retrograde urethrography [1] 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. [2] [3]
Some indications for retrograde urethrogram are: urethral stricture, urethral trauma, urethral fistula and congenital urethral abnormalities. [4] 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. [5]
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. [4]
The subject lies down in a 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 until it is parked inside the navicular fossa. The navicular fossa is located just a short distance proximal to the urethral meatus within the glans penis. 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 preventing contrast material from leaking out from the penis. Contrast material is then injected from the syringe with fluoroscopy to visualise the flow of contrast within the penis. The catheter is gently 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 (penile urethra). [4]
If there is no contraindication to full urinary catheterisation such as false passage or stricture, the urinary catheter should be inserted until the urinary bladder to perform voiding cystourethrography to visualise the prostatic urethra and membranous urethra. Filling up the bladder with contrast material 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 material to flow into the bladder. [4]
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.[ citation needed ]
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. [4]
The urethra 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 connects to the urinary meatus above the vagina, whereas in marsupials, the female's urethra empties into the urogenital sinus.
Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.
In urinary catheterization a latex, polyurethane, or silicone tube known as a urinary catheter is inserted into the bladder through the urethra to allow urine to drain from the bladder for collection. It may also be used to inject liquids used for treatment or diagnosis of bladder conditions. A clinician, often a nurse, usually performs the procedure, but self-catheterization is also possible. A catheter may be in place for long periods of time or removed after each use.
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 sounding is the practice of inserting objects into the urethra for sexual gratification. Urethral dilatation is a urological procedure that uses probes called sounds to enlarge the inside diameter of the urethra and locate obstructions in the urethra, or as a treatment for urethral strictures.
Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladder control, mild lower abdominal pain, and a weak urine stream. Those with long-term problems are at risk of urinary tract infections.
In urology, a Foley catheter is a brand name for one of many brands of urinary catheters (UC). Foleys and their namesakes are indwelling UC, often referred to as an IDCs or the alternative type being an in/out catheters. The foley UC was named after Frederic Foley, who produced the original design in 1929. The UC is a flexible tube if it is indwelling and stays put, or rigid if it is in/out, that a clinician, or the client themselves, often in the case of in/out UC, passes it through the urethra and into the bladder to drain urine.
The Mitrofanoff procedure, also known as the Mitrofanoff appendicovesicostomy, is a surgical procedure in which the appendix is used to create a conduit, or channel, between the skin surface and the urinary bladder. The small opening on the skin surface, or the stoma, is typically located either in the navel or nearby the navel on the right lower side of the abdomen. Originally developed by Professor Paul Mitrofanoff in 1980, the procedure represents an alternative to urethral catheterization and is sometimes used by people with urethral damage or by those with severe autonomic dysreflexia. An intermittent catheter, or a catheter that is inserted and then removed after use, is typically passed through the channel every 3–4 hours and the urine is drained into a toilet or a bottle. As the bladder fills, rising pressure compresses the channel against the bladder wall, creating a one-way valve that prevents leakage of urine between catheterizations.
A urethrotomy is an operation which involves incision of the urethra, especially for relief of a stricture. It is most often performed in the outpatient setting, with the patient (usually) being discharged from the hospital or surgery center within six hours from the procedure's inception.
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, among other disorders. The technique consists of catheterizing the person in order to fill the bladder with a radiocontrast agent, typically diatrizoic acid. Under fluoroscopy the radiologist watches the contrast enter the bladder and looks at the anatomy of the patient. If the contrast moves into the ureters and back into the kidneys, the radiologist makes the diagnosis of vesicoureteral reflux, and gives the degree of severity a score. The exam ends when the person voids while the radiologist is watching under fluoroscopy. Consumption of fluid promotes excretion of contrast media after the procedure. It is important to watch the contrast during voiding, because this is when the bladder has the most pressure, and it is most likely this is when reflux will occur. Despite this detailed description of the procedure, at least as of 2016 the technique had not been standardized across practices.
The navicular fossa is a short dilated portion of the male urethra within the glans penis just proximal to the external urethral meatus. The roof of the fossa is especially dilated, forming a lacuna; medical instruments being inserted into the male urethra should initially be directed towards the floor of the fossa so as not to get snagged at the fossa. It is one of three dilations of the male urethra.
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 sensitivity to touch. The meatus is located on the glans of the penis or in the vulval vestibule.
Urethroplasty is the surgical repair of an injury or defect within the walls of the urethra. Trauma, iatrogenic injury and infections are the most common causes of urethral injury/defect requiring repair. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies. It is probably the only useful modality of treatment for long and complex strictures though recurrence rates are higher for this difficult treatment group.
A prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms (LUTS). Prostatic obstruction is a common condition with a variety of causes. Benign prostatic hyperplasia (BPH) is the most common cause, but obstruction may also occur acutely after treatment for BPH such as transurethral needle ablation of the prostate (TUNA), transurethral resection of the prostate (TURP), transurethral microwave thermotherapy (TUMT), prostate cancer or after radiation therapy.
Urethrostomy is a surgical procedure that creates a permanent opening in the urethra, commonly to remove obstructions to urine flow. The procedure is most often performed in male cats, where the opening is made in the perineum.
Intermittent catheterization is a medical technique used in conditions where patients need either short-term catheter-based management of the urinary bladder or as a daily habit for life. Intermittent catheterization is considered the "gold standard" for medical bladder emptying. Intermittent catheterization can be done by the patient or a caregiver in a home environment.
A urethral bulking injection is a gynecological procedure and medical treatment used to treat involuntary leakage of urine: urinary incontinence in women. Injectional materials are used to control stress incontinence. Bulking agents are injected into the mucosa surrounding the bladder neck and proximal urethra. This reduces the diameter of the urethra and creates resistance to urine leakage. After the procedure, the pressure forcing the urine from the bladder through the urethra is resisted by the addition of the bulking agent in the tissue surrounding the proximal urethra. Most of the time this procedure prevents urinary stress incontinence in women.
A penile injury is a medical emergency that afflicts the penis. Common injuries include fracture, avulsion injury, strangulation, entrapment, and amputation.
The genitourinary tract, or simply the urinary tract, consists of the kidneys, ureters, bladder, and the urethra. The kidney is the most frequently injured. Injuries to the kidney commonly occur after automobile or sports-related accidents. A blunt force is involved in 80-85% of injuries. Major decelerations can result in vascular injuries near the kidney's hilum. Gunshots and knife wounds and fractured ribs can result in penetrating injuries to the kidney.
Penis clamp is an external penis compression device that treats male urinary incontinence. Incontinence clamps for men are applied to compress the urethra to compensate for the malfunctioning of the natural urinary sphincter, preventing leakage from the bladder with minimal restriction of blood flow.
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