This document discusses the considerations and precautions for retrograde urethrography (RGU), noting that local anesthetic may cause issues such as mucosal edema. It highlights the need for antibiotic coverage due to potential complications like extravasation during contrast injection, and touches upon the role of cystography in pelvic fractures, indicating it can often be safely omitted. Additionally, it reports on complications related to urinary tract infections and reactions to contrast media, offering recommendations for patient management.

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%)