RETROGRADE
URETHROGRAPHY
Dr.
B.Harikrishna
PGRD
NORMAL ANATOMY OF MALE URETHRA
~17.5 to 20 cms in length
Anterior (Penile and Bulbous)
Contains periurethral littre glands
Posterior (Membranous and Prostatic)
Fossa navicularis (1 to 1.5cms)
Sump and Cone
Cowper glands
Urethral crest
Verumontanum/Seminal colliculus
Prostatic utricle
Ejaculatory ducts
Urethral sphincters
RETROGRADE URETHROGRAPHY
Best initial study for urethral and periurethral imaging in men
Evaluation of urethral injuries, strictures, and fistulas
Contraindications
Acute UTI
Recent instrumentation
PROCEDURE
The external meatus is prepared in a standard sterile fashion for the
placement of a conventional 16-18F foley catheter
The catheter, with both the irrigating syringe and inflating (saline
solution) syringe attached, should be flushed before use.
When the balloon portion of the catheter is seated in the fossa
navicularis of the penile urethra, the balloon is inflated with 1.0–1.5 mL
of saline solution while the port is held with the free hand to partially
inflate the balloon
Lubrication is not recommended because it may prevent the balloon
from remaining in place for optimal occlusion
The patient is placed in a supine 45° oblique position.
The penis should be placed laterally over the proximal thigh with
moderate traction
Then, 20–30 mL of 60% iodinated contrast material is injected under
fluoroscopic guidance so that the anterior urethra is filled
Spot radiographs are obtained when there is visual confirmation of
contrast material flowing into the bladder
MIMICS OF URETHRAL PATHOLOGY IN RGU
BLUNT URETHRAL TRAUMA
Anterior urethral injury Posterior urethral injury
Straddle pelvic injury Crushing force to the pelvic(pelvic
fractures)
POSTERIOR URETHRAL INJURY
Calpinto and Mccallum classification (for posterior urethral injuries)
Goldman et al classification ( anterior + posterior urethral injuries)
Complete disruption of membranous
urethra, which occurs in both type II
and type III urethral injury, may
result in dislocation of bladder out of
the pelvis, which appears as ‘PIE IN
THE SKY’ at excretory urography
(pelvic hematoma)
ANTERIOR URETHRAL INJURY ( TYPE
V)
If the Buck fascia remains intact,
the extravasation is limited to
the space between the Buck
fascia and the tunica albuginea
of the corpus spongiosum.
If the Buck fascia is
ruptured,extravasation of
contrast material will be present
within the confines of the Colle
fascia at urethrography
Traumatic rupture of the female urethra is rare.
Perry and Husmann found type IV urethral injuries in 4.6% of women
with pelvic fracture caused by high-speed motor vehicle accidents.
Late complications associated with
posterior urethral injury include
impotence, incontinence, stricture and
fistula ,
whereas those associated with anterior
urethral injury include stricture and
impotence.
PENETRATING URETHRAL INJURIES
Gun shots or knife wounds
Commonly effect anterior urethra
ACQUIRED INFLAMMATORY DISEASES
Gonococcal (N. gonnorhoeae) and Non Gonococcal urethritis
(C. trachomatis)
Complications include urethral stricture, periurethral abscess, and
periurethral fistulas
Typical urethrographic findings in gonococcal urethral stricture is an
irregular urethral narrowing which is several cms long
Bulbar urethra is the most common area of occurence for the stricture
Associated dilatation of Littre´ glands may be present at urethrography
CONDYLOMA ACUMINATA
viral infection and produce soft, sessile,
squamous papillomas (venereal warts)
Urethral involvement occurs in 0.5%–5% of
male patients.
The diagnostic procedure of choice is voiding
cystourethrography. However, the diagnosis is
often not suspected until retrograde
urethrography has been performed.
The typical urethrographic findings are
multiple papillary filling defects in the anterior
urethra
TUBERCULOSIS
Very rare
Prostatic abscess may rupture into any surrounding structure, which results in
prostatorectal and prostatoperineal urethral fistulas.
Tuberculous urethral strictures result in periurethral abscesses, which, unless treated,
produce numerous perineal and scrotal fistulas.
The end result is watering can perineum.
Retrograde urethrography typically demonstrates an anterior urethral stricture
associated with multiple prostatocutaneous and urethrocutaneous fistulas.
URETHRAL DIVERTICULA
Penoscrotal region Is the most
common site for urethral
diverticula
Due to repeated Urethral
trauma due to cathetrisation
URETHRAL CALCULI
Migrant calculi.
Occasionally,they get lodged at a point of
urethral narrowing such as the
membranous urethra.
Primary (native) formation of a stone
occurs in the urethra when stricture is
present, or urethral diverticulum.
RGU will usually depict a rounded filling
defect in the urethra
Benign Tumors of the Urethra
1. Leiomyoma
2. Fibroepithelial polyps
RGU will usually depict a smooth filling defect in the urethra
Malignant Tumors of the
Male Urethra
The bulbomembranous urethra is
involved most frequently (60%),
80% are squamous cell carcinoma,
15% are transitional cell carcinoma,
and 5% are adenocarcinoma or
undifferentiated carcinoma.
RGU demonstrates focal irregular
narrowing of the urethra
URETHRAL DISRUPTION AFTER
PANCREAS TRANSPLANTATION
Bladder drainage of pancreatic graft exocrine secretions is a common
technique in pancreas transplantation.
Urethral injury and disruption, with urinary extravasation is attributed to
activated proteolytic exocrine enzymes from the transplanted pancreas.
RGU is the imaging method of choice in such cases
POST IRRADIATION URETHRAL
INJURIES
Due to external radiation / prostatic brachytherapy
Includes urethritis, urethral stricture, urethral fistula
COMPLICATIONS OF RGU
Allergic reactions to contrast media
UTI
Urethral trauma/bleed
Intravasation of Contrast
