This document provides information about an opposing urethrogram procedure used to evaluate and document urethral strictures. It begins with an introduction to urethral anatomy and then describes the indications, contraindications, equipment, and technique for performing an opposing urethrogram. This involves inserting a suprapubic catheter and Foley catheter, filling the bladder with contrast medium under fluoroscopy, and obtaining images to assess any strictures present in the urethra. Potential complications are noted. The concluding sentences state that an opposing urethrogram is the only x-ray procedure that can accurately access the length of a urethral stricture.

1. GOOD MORNING TO ALL….

2. OPPOSING URETHROGRAM (OUG)
MISS . SOWMIYA G,
DRDT 2ND YEAR,
GOVT.KMCH
CHENNAI-10.

3.  The opposing urethrogram is the radiographic study to
evaluate and document the stricture and define the
stricture recurrence.
 Combination of ascending urethrogram (AUG) and
micturating cystourethrography (MCU)
 This procedure helps to access length of the stricture.
INTRODUCTION

4.  The adult male urethra is approximately 18 cm long, with
the posterior urethra comprising the proximal 3 cm.
 The anterior urethra comprising the remaining 15 cm, with
the division point between the two located at the perineal
membrane.
ANATOMY OF MALE URETHRA

5. Posterior urethra:
1) Prostatic urethra
2) Membranous urethra
Anterior urethra:
1) Bulbous urethra
2) Pendulous urethra
3) Fossa naviculari
THE URETHRA SUBDIVIDED INTO FIVE SEGMENTS

6. RADIOGRAPHIC ANATOMY

7. 1) Stricture
2) Urethral trauma
3) Fistulae or false passage
4) Vesico ureteric reflux
5) Study of the urethra during micturition
6) Bladder leak post surgery or trauma
7) Urodynamic studies,e.g.for incontinence.
8) Congenital abnormalities
INDICATIONS

8.  Acute urinary tract Infection
 Recent instrumentation
CONTRAINDICATIONS

9.  High osmolar contrast material or LOCM 300 mg/I
200-300 ml.
 LOCM 200–300mg/I 10-20ml.
 Pre-warming the contrast medium will help reduce
the incidence of spasm of the external sphincter.
CONTRAST MEDIUM

10. CONTRAST MEDIUM

11.  Fluoroscopy unit with spot Film
device and tilting table
 Video recorder (for urodynamics)
 Suprapubic catheter
 Foleys catheter 8-F
EQUIPMENT

12. ALLENGERS 600mA FLUROSCOPY MACHINE

13. Suprapubic catheter Foleys catheter

14.  Shave and clean lower abdomen and pelvis area.
 Take informed consent from patient or stander.
 The patient empties their bladder prior to the examination.
 Preliminary image Coned view of the bladder and Urethra
PATIENT PREPARATION

15.  Patient supine.
 It may be possible to fill the bladder via the
suprapubic catheter. Using aseptic technique the bladder is
catheterized. Residual urine is drained.
 To demonstrate Vesico-ureteric reflux (this
indication is almost exclusively confined to children)
TECHNIQUE

16.  Contrast medium is slowly injected or dripped in with the
patient supine and Bladder filling is observed by intermittent
fluoroscopy.
 It is important that early filling is monitored by fluoroscopy.
 Intermittent monitoring is also necessary to identify transient
reflux. Any reflux should be recorded.

17.  Following of this procedure, then
 Using aseptic technique the tip of the catheter is inserted so
that the balloon lies in the fossa navicularis.
 The catheter is connected to a 20 ml syringe containing
contrast medium and flushed to eliminate air bubbles.
 And its balloon is inflated with 2–3 ml of water to anchor the
catheter and occlude the meatus.

18.  Gentle traction on the catheter is used to straighten the penis
over the ipsilateral leg and prevent urethral overlap.
 Contrast medium is injected under fluoroscopic control
and steep (30–45°) oblique films taken.
 And the patient is instructed to strain

19.  Depending on the clinical indication, ascending
urethrography (AUG) may be followed by descending
micturating cystourethrography (MCU) to demonstrate the
proximal urethra and bladder, assuming there is no
contraindication to bladder catheterization.
Examples :
1. False passage
2. Urethral stricture

20. PROCEDURE
THE STRICTURE

21. Contrast reaction ( due to absorption through bladder mucosa)
Urethral trauma or rupture.
Extravasation of contrast – due to use of excessive pressure
in stricture.
COMPLICATIONS

22. AFTERCARE
Warned - of rare dysuria , retention.
Reflux - Antibiotics.

23. CONCLUSIONS
 Opposing Urethrogram (OUG) is the only procedure in
x-ray to accesses the length of the Urethral stricture.
 And we can calculate and measures the abscesses in male
urethra.

24. THANKING YOU……