Indications :

1. Strictures.

2. Urethral tears.

3. Congenital abnormalities.

4. Periurethral or prostatic abscess.

5. Fistulae or false passages.

6. Foreign body urethra.

7. Neoplastic lesions of urethra.

8. Stone urethra.

9. Pelvic fracture and suspected urethral injury.

Contraindications:

1. Acute urinary tract infection.

2. Recent Instrumentation.

Contrast used : HOCM or LOCM 200-300%  20ml.

Equipment :

1. Tilting radiography table with fluoroscopy unit and spot film device.

2. Foley’s catheter or penile clamp.

Patient preparation : None.

Prelim film : Coned supine PA of bladder base and urethra.

Technique :

1. The patient lies supine on the x-ray table.
2. Using aseptic technique the penile clamp is applied or the tip of the catheter isinserted so that the balloon lies in the fossa navicularis and its balloon is inflated with 1-2ml of water.
3. Contrast medium is injected under fluoroscopic control and film taken in the following positions :

(a)   30^o LAO with right leg abducted and knee flexed.

(b)   Supine PA.

(c)   30 ^o RAO with left leg abducted and knee flexed.

4. Ascending urethrography should be followed by MCUG or excretory MCUG to demonstrate the proximal urethra. Occasionally a urethral fistula or

periurethral abscess is seen only on the voiding examination. Reflux of contrast medium into dilated prostatic ducts is also better seen during micturition.

SONO-URETHROGRAPHY

A new method has been designed for urethral studies, it is sono-urethrography (S.U). It is much better in detection of anterior urethral strictures than x-ray urethrography. It is slightly less efficient in the detection of posterior and bulbar urethral strictures1. Not only the whole length of stricture is seen but extent of periurethral fibrosis is also seen with this method of examination.

Sono-urethrography is used for an accurate prediction of stricture length.

It shows clearly periurethral strictures including the urethral wall, corpus spongiosum, corpus cavernosa, bulb and external urinary sphincter. It is unsatisfactory in detection of membranous urethral stricture.

This investigation is not very helpful for posterior urethral strictures.

Picture 1.

Urethrogram showing stricture of anterior penile urethra.

Picture 2.

Urethrogram shows normal urethra.

Picture 3.

Urethrogram shows posterior urethral valve. ( presents due to congenital anomaly in a man)

Picture 4.

Image from ascending urethrography in a male patient with an “open-book” pelvic fracture from trauma shows the posterior urethra (arrow), which appears stretched but intact (Goldman type I injury), with no evidence of contrast material extravasation.

Picture 5.

Image from ascending urethrography shows an area of contrast material extravasation (white arrow) indicative of injury to the posterior urethra, with an intact urogenital diaphragm (black arrow). These findings signify a Goldman type II injury.

How Ascending Urethrogram is reported?

Sample report.

Name : ?

I/C : ?

ASCENDING URETHROGRAPHY 10.10.10

Procedure :

Approximately 10mls Omnipaque introduced into the urethra via 8F Foley’s cathether. No immediate complications encountered.

Findings:

The penile and bulbous urethra are normal in caliber.

The prostatic and membranous urethra are significantly narrowed (smooth outline) due to external compression by the enlarged prostate.

Proceeded to MCUG.

Procedure:

400 mls of diluted Omnipaque is introduced into the bladder via 8F Foley’s catheter.

Findings:

1. Normal filling of bladder seen.

2. There is no evidence of reflux during filling or micturation.

3. Prostatic,membranous,bulbous and penile urethra are normal in calibre.

There is dilatation of the bladder neck and associated with extravasation of contrast into the venous plexus within the prostate, seminal vesicle and penis.

(Patient was able to micturate intermittently with great effort)

IMP:
External compression on the posterior urethra by prostate.

Reporting radiologist(10.10.10)

Reference :

1. Diagnostic Radiology : A textbook of medical imaging, Grainger and Allison.
2. Diagnostic efficacy of echographic urethrography in the study of urethral stenosis by Fernandez Fernandez A. Ramirez Esteban et al.
3. Sono-urethrography in the evaluation of urethral strictures. Gupta S. Majumdar B. Tiwari A. Gupta RK et al.
4. A Guide to Radiological Procedures, Stephen Chapman, Richard Nakielny.
5. http://radiographics.rsna.org/content/28/6/1631.figures-only.