What Is a Urethrogram?
A urethrogram or a retrograde urethrogram is performed most commonly in males to diagnose the problems of the urethra and urethral pathologies, including trauma and urethral strictures (narrowing of the urethra). Urethrogram allows the doctor to detect the location of the stricture, which most commonly occurs due to trauma, prolonged catheterization, surgery, and radiation therapy. Males having difficulties in passing urine and are not diagnosed with prostatomegaly or benign prostatic hyperplasia are the best candidates for this procedure. However, this procedure can only be done after a urologist has referred the patient. Urethrogram or urethrography is a contrast study mainly done under fluoroscopic control. It is a simple procedure for placing a catheter into the urethral opening. The balloon at one end of the catheter is inflated to form a seal. Then, a small amount of contrast material is injected into the urethra with the help of a catheter. Sometimes, the patient might be asked to urinate after the procedure for the voiding study.
What Are the Indications of a Urethrogram?
Urethrogram is a simple procedure usually done at the doctor’s office. However, it is specifically indicated under the following situations:
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Trauma - Trauma is the most common indication of urethrogram. This is because the blood in the urethral opening due to blunt or penetrating trauma can cause difficulty passing urine. People with blood in the urine due to penile fracture are more likely to undergo a urethrogram. One of the most important relative indications of a urethrogram is to detect the floating prostate. Normally, the prostate gland remains firm when the doctor performs the digital rectal examination. However, the problem arises when the prostate gland is mobile, leading to urethral anomalies. Therefore, a urethrogram is done to diagnose the exact cause of urethral injuries.
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Lower Urinary Tract Problems - Patients with a medical history of urethral stricture, urinary urgency symptoms, and incomplete bladder emptying.
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Postoperative Evaluation - Urethrogram is commonly performed after a urethroplasty and other surgical procedures to evaluate the condition of the urethra.
What Are the Contraindications of Urethrogram?
Studies report that there are no absolute contraindications of urethrogram. As the contrast material is not injected intravenously, the risk of infection or systemic reaction is negligible. However, patients with a medical history of severe or moderate contrast reaction must be premedicated, or an alternative contrast medium must be used. People suffering from severe urinary tract infections must be treated immediately before performing a urethrogram. Sometimes, the doctor might recommend the patient be premedicated with steroids, histamine-1 blockers, or histamine-2 blockers to reduce the chances of allergic reactions. Some patients might feel embarrassed due to the procedure and might be unwilling to undergo the same. However, this feeling can be overcome by providing a piece of thorough and accurate information about the procedure.
How Is the Urethrogram Performed?
Urethrogram is a simple procedure that can be performed without anesthesia. The local anesthetic Lidocaine can be directly instilled into the urethra before the procedure, but that is not preferred nowadays. This is because the anesthetic gel would enter the urethral mucosa in case of disruption. In addition, if the patient suffers from urethral stricture, the anesthetic gel might complicate the instrumentation procedure. Therefore, the following pieces of equipment are generally used in the procedure:
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Radiopaque contrast material.
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A fluoroscopic X-ray machine.
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Foley catheter.
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Catheter tip syringe.
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5 mL syringe to fill the balloon attached to the catheter.
The patient is asked to lie on his back with his legs flexed at 90 degrees. The catheter is inserted into the patient’s urethra. Radioactive material is injected through the catheter into the urethra. Before the insertion of the catheter, the urethral opening and the penile foreskin are cleaned with an antiseptic. The balloon is filled with saline solution or radioactive material when the catheter is inserted in a suitable position. The urethra must not be overfilled as the urethra might rupture. The doctor obtains X-ray images as the urethra gets filled with the contrast medium. The patient must try to remain stable throughout the procedure so the doctor can obtain the static images.
What Are the Complications or Adverse Effects of the Urethrogram?
Though complications rarely occur after a urethrogram, the patient might have mild or minor hematuria (blood in the urine) after the catheter is inserted. However, this problem occurs rarely and for a short duration. After the procedure, patients suffering from urinary tract infections must be warned and asked to undergo proper investigation and treatment. If the patient suffers from an acute urethral injury, urethrography must be avoided as it might cause severe urinary retention, swelling, or edema.
What Other Imaging Procedures Can Be Used as an Alternative to Urethrogram?
Several procedures can be used as an alternative to urethrogram. Some of them are listed below:
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CT (Computed Tomography) Scan - A CT scan is an effective procedure that helps diagnose the problems of the urethra and can be done easily at the doctor’s office. The main advantage of this procedure is that it does not require any injection of the contrast medium. Instead, the patient is simply laid on a table that goes into a device where the X-rays are taken. These X-rays are effective diagnostic aids because they allow the doctor to get three-dimensional access to the urologic system, including the urethra.
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MRI (Magnetic Resonance Imaging) - It is similar to a CT scan, the only difference being it uses a magnetic field and radio waves simultaneously to produce the images of the urologic system.
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Ultrasound - Ultrasound is a widely recommended procedure for obtaining images of the urethra because it is safe for pregnant females and children. However, it might not produce as clear images as the CT scan and the MRI scan. It is a simple procedure wherein the doctor first applies a gel to the patient’s stomach and moves the tip of the transducer over the gel. The sound waves from the transducer bounce back and produce images on the monitor.
Conclusion:
Urethrogram is an effective and widely used procedure to diagnose urethral problems, including urethral strictures and ruptured urethra. Though other alternative procedures are available, urethrogram is commonly preferred due to its simplicity and minimal invasiveness. Therefore, patients suffering from urethral problems must consult a urologist to learn more about the urethrogram procedure.
