The document discusses retrograde urethrography (RGU) and its associated risks, including the potential for mucosal edema and complications from injecting contrast fluid. It highlights the importance of antibiotic cover in certain cases and the efficacy of cystography for diagnosing pelvic fractures, particularly in patients with hematuria. Additionally, it notes the incidence of urinary tract infections and reactions to contrast mediums in patients undergoing these procedures.

1. RETROGRADE
URETHROGRAPHY

21. • Some institutes prefer not to use local anaesthetic while
inserting the Foley’s as it is hypothesized to cause mucosal
edema, increased permeability, vascular stasis and poor
retention of the balloon which may slip out during the
study.
• RGU is not a physiologic examination.
• The increased pressure used to inject the contrast into the
urethra can cause marked urethrovascular, lymphatic and
peri-urethral extravasation esp in cases of inflammation
and stricture.
• Hence antibiotic cover against gram negative sepsis is
indicated for the same

28. TRATTNER CATHETER
(Double balloon catheter study)

40. FUHRMAN et al
• Demonstrated that cystography in patients who presented
with gross hematuria associated with pelvic fractures
yielded positive results
• Cystography for pelvic fractures not associated with gross
hematuria could be omitted with no significant loss of
diagnostic ability with a large monetary saving and no
compromise in care.

46. RGU in post-operative patients

49. 1) UTI
• 6% incidence
• Avoid in active infections and immediately after
vesicourethral instrumentation (McAlister et al)
2) Reaction to contrast medium
• Incidence of 0.26% (Weese et al)
• Absorption through the bladder wall or inflamed or
damaged urethral lining (Dewan et al)
• Premedication with IV fluids is a reasonable approach
in patients with significant prior reaction to contrast.
• In children with VP shunts, always use non-ionic
contrast media
• Use diluted solutions (10-20%)