Retrograde urethrography is a specialized X-ray procedure that visualizes the male urethra to diagnose conditions like strictures, injuries, and urinary tract infections. The procedure involves patient preparation, catheter insertion, contrast agent administration, and monitoring for complications. It aims to assess urethral structure and function, assisting in treatment planning for various urological issues.

1. Retrograde Urethrography
Presenter: Dr. Dheeraj Kumar
MRIT, Ph.D. (Radiology and Imaging)
Assistant Professor
Medical Radiology and Imaging Technology
School of Health Sciences, CSJM University, Kanpur
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 1

2. Retrograde Urethrography
Retrograde Urethrography is a specialized
X-ray procedure used to visualize the male
urethra, which is the tube that carries urine
from the bladder to the external body
opening. This procedure is typically
performed to diagnose and evaluate various
conditions and abnormalities within the
urethra, such as strictures, obstructions, or
injuries.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 2

3. Purpose
The primary purpose of
Retrograde Urethrography is to
assess the structure and function
of the urethra. It helps in
diagnosing conditions that may
cause pain, difficulty urinating, or
other urinary problems in males.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 3

4. Indications
Retrograde Urethrography is
commonly used to diagnose
conditions such as urethral strictures
(narrowing of the urethra), trauma or
injury to the urethra, congenital
abnormalities, and recurrent urinary
tract infections.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 4

5. Urethral Strictures
Urethrography helps identify the
location, length, and severity of
strictures, guiding treatment
decisions such as dilation or
surgery.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 5

6. Trauma or Injury
• Explanation: In cases of trauma or
injury to the pelvic region, such as
accidents or falls, the urethra can
be damaged. This procedure helps
assess the extent of the injury and
guides surgical repair if necessary.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 6

7. Congenital Abnormalities
• Explanation: Some individuals are born
with congenital (present from birth)
urethral abnormalities. Retrograde
Urethrography is used to diagnose these
conditions, such as urethral diverticula or
congenital strictures.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 7

8. Recurrent Urinary Tract Infections (UTIs)
• Explanation: Frequent UTIs
may be caused by an
underlying urethral issue. This
test can identify any structural
problems or obstructions that
could contribute to recurring
infections Representative retrograde urethrography of a recurrent case. (A)
Preoperative retrograde urethrography in a patient with a tight 1-cm
bulbar urethral stricture following prolonged indwelling urethral catheter.
(B) Normal retrograde urography 2 weeks after excision and end-to-end
anastomosis. (C) Retrograde urography 4 months after primary
anastomosis showed a recurrent stricture at the previous anastomotic
site. Single direct-vision internal urethrotomy was unsuccessful. (D)
Retrograde urethrography 3 weeks after substitution urethroplasty with
ventral buccal mucosa onlay graft.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 8

9. Voiding Difficulties
• Explanation: Men experiencing
difficulties with urination, such as a
weak stream or incomplete
emptying of the bladder, may
undergo Retrograde Urethrography
to determine if there are any
anatomical issues affecting
urination.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 9

10. Hematuria (Blood in Urine)
• Explanation: Blood in the urine
can have various causes,
including urethral problems.
This test can help identify the
source of bleeding, such as
urethral injury or abnormal
blood vessels.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 10

11. Evaluation Before Urological Procedures
• Explanation: Before certain
urological procedures like
urethral surgery or the placement
of urinary catheters or stents,
Retrograde Urethrography is
performed to assess the urethra's
condition and plan the
intervention.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 11

12. Imaging Equipment and Contrast Agents
• Equipment: Describe the radiographic
equipment used in retrograde urethrography,
including the X-ray machine, fluoroscopy,
and image intensifiers.
• Contrast Agents: Explain the types of
contrast agents used, their properties, and
how they enhance imaging. Mention any
considerations for contrast allergies or
sensitivities.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 12

13. Foley catheter
• A Foley catheter is a thin,
sterile tube inserted into
the bladder to drain urine.
• Because it can be left in
place in the bladder for a
period of time, it is also
called an indwelling
catheter.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 13

14. Patient Preparation
• Ensure the patient is informed about the procedure and its purpose.
• Obtain informed consent from the patient.
• Explain the procedure to the patient and address any concerns.
• Instruct the patient to fast for several hours before the procedure to
minimize the risk of aspiration during the use of contrast agents.
• Emphasize the importance of emptying the bladder before the examination
to optimize imaging quality.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 14

15. Procedure Steps
• Provide a step-by-step guide to the
retrograde urethrography
procedure. This can include:
• Patient positioning
• Catheter insertion
• Contrast agent administration
• Imaging and fluoroscopy techniques
• Post-procedure care
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 15

16. Radiographic Equipment Setup
• Position the X-ray machine and fluoroscopy equipment in a manner
that allows clear visualization of the urethra.
• Ensure the equipment is calibrated and functioning correctly.
• Check the availability of contrast agents and ensure they are properly
stored and prepared.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 16

17. Patient Positioning
• Place the patient in a supine or
lithotomy position, depending on the
clinical scenario and the specific area
of the urethra to be examined.
• Immobilize the patient and ensure
they are comfortable during the
procedure.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 17

18. Catheter Insertion
• Sterilize the genital area and the urethral meatus
to minimize the risk of infection.
• Insert a sterile catheter gently into the urethra.
• Secure the catheter in place to prevent
accidental removal during the procedure.
• Depending on the specific case, a Foley
catheter or a specialized catheter with a balloon
may be used.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 18

19. Contrast Agent Administration
• Connect a syringe with a radiopaque
contrast agent to the catheter.
• Slowly inject the contrast agent into the
urethra while monitoring the flow under
fluoroscopy.
• Continue injecting until the urethra is
adequately filled with contrast, ensuring
that it flows into the bladder.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 19

20. Post-procedure Care
• After completing the imaging, carefully remove the catheter.
• Monitor the patient for any immediate adverse reactions.
• Provide post-procedure instructions to the patient, such as drinking
fluids to flush out any residual contrast material.
• Address any discomfort or concerns the patient may have.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 20

21. Imaging and Fluoroscopy
• Initiate fluoroscopy to visualize the contrast
within the urethra.
• Record images at various angles to capture
different views of the urethra.
• Assess the flow of contrast to identify any
obstructions, strictures, or abnormalities.
• Continuously monitor the procedure on the
fluoroscopy screen.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 21

22. Normal Anatomy and Variants
• Anatomy of the Male Urethra: Present
detailed illustrations and radiographic
images depicting the normal anatomy of
the male urethra.
• Common Anatomical Variants:
Highlight variations that radiologists may
encounter, emphasizing the need for
familiarity with both typical and atypical
anatomy.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 22

23. Common Pathologies Detected
The various pathologies that can be detected through retrograde urethrography, such as:
• Urethral strictures
• Urethral diverticula
• Urethral trauma
• Neoplastic lesions
• Infections
• Fistulas
• Other relevant conditions
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 23

24. Common Complications
• Allergic Reactions:
• Some patients may be allergic to the contrast agent used. This can result in mild to severe allergic reactions,
including itching, rash, or even anaphylaxis.
• Safety Measure: Prior to the procedure, assess the patient's history for allergies and administer premedication if
necessary. Be prepared to manage allergic reactions promptly.
• Infection:
• The introduction of catheters into the urethra increases the risk of infection, including urinary tract infections.
• Safety Measure: Strict aseptic techniques, including sterilization of catheters and the genital area, should be
maintained throughout the procedure to minimize the risk of infection.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 24

25. • Hematuria:
• Hematuria, or blood in the urine, can occur due to urethral trauma or other complications
during the procedure.
• Safety Measure: Use gentle catheter insertion techniques, and carefully monitor the patient for
any signs of bleeding during the procedure. Address any bleeding promptly.
• Urethral Injury:
• The insertion of a catheter carries the risk of urethral injury, particularly in patients with
strictures or anatomical abnormalities.
• Safety Measure: Careful catheter insertion and monitoring of the catheter's path are essential.
Use appropriate catheter sizes and lubricants to minimize trauma.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 25

26. Safety Measures
• Patient Assessment:
• Thoroughly assess the patient's medical history, including allergies and previous
adverse reactions to contrast agents.
• Ensure patients are adequately informed about the procedure and potential risks.
• Aseptic Technique:
• Maintain strict aseptic techniques during catheter insertion to prevent infection.
• Use sterile equipment, gloves, and drapes.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 26

27. • Contrast Agent Selection:
• Choose contrast agents with the lowest risk of allergic reactions for sensitized
patients.
• Be prepared with emergency medications and equipment to manage allergic
reactions.
• Catheter Insertion:
• Select an appropriate catheter size and ensure it is inserted gently and carefully.
• Monitor the catheter's progress during insertion to minimize trauma.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 27

28. • Post-procedure Monitoring:
• Keep patients under observation for a period after the procedure to detect any immediate
complications.
• Educate patients on post-procedure care, including increased fluid intake.
• Emergency Preparedness:
• Have emergency equipment and medications readily available to manage complications
such as allergic reactions or hematuria.
• Documentation:
• Maintain detailed records of the procedure, including any complications and how they
were managed.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 28

29. References
• Smith's Textbook of Endourology, Arthur D. Smith, Glenn M. Preminger, Gopal H. Badlani, Louis R. Kavoussi, 2019 Publisher:
Wiley,ISBN-13: 978-1119245273
• Hinman's Atlas of UroSurgical Anatomy, Greg T. MacLennan, MD, 2011. Publisher: Saunders, ISBN-13: 978-1416029713
• Smith, A. D., & Badlani, G. H. (2004). Imaging of the male urethra. Urologic Clinics of North America, 31(2), 207-217. doi:
10.1016/j.ucl.2004.02.002
This article provides an overview of imaging techniques for the male urethra, including RGU, and discusses its diagnostic utility in
various conditions.
• Wein, A. J., Kavoussi, L. R., Partin, A. W., & Peters, C. A. (Eds.). (2015). Campbell-Walsh Urology (11th ed.). Elsevier.
The "Campbell-Walsh Urology" textbook is a comprehensive resource for urological procedures, including RGU. It covers the
procedure, indications, and clinical applications in detail.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 29

30. Thank You
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 30

31. Q&A Session
Continue the question-and-answer session with the students audience,
addressing any additional queries or comments.
18/08/2023 Retrograde Urethrography By- Dr. Dheeraj Kumar 31