Urethrography retrograde

Retrograde urethrography is commonly considered the imaging modality of choice to evaluate urethral injury. The sensitivity of this technique, however, is controversial. While some authors assess that virtually all urethral injury can be identified (Koifman et al. 2003), in other published series a lower efficiency has been demonstrated (Mydlo et al. 1998). 

Traditional radiological exams such as retrograde urethrography and micturition cystourethrography are considered the standard imaging techniques for... 

Retrograde urethrography is commonly used to explore the anterior urethral anatomy and pathologies, but recently sonourethrography has been increasingly proposed. The latter is able to study the urethral mucosa and the periurethral tissues possibly involved in urethral pathologies such as strictures, diverticula, trauma and tumors, which cannot be detected radiographically or at urethroscopy. 

Stenoses due to pelvic fracturing, on the other hand, affect almost exclusively the membranous urethra. They can be easily investigated with retrograde urethrography and voiding cystourethrography, but are difficult to explore with sonourethrography. 

Retrograde urethrography is the best way to study fistulae located under the striate sphincter of the urethra since it can visualize the fistula, the concomitant cavities and passage of the contrast agent into adjacent organs. 

Retrograde urethrography is rarely indicated, and retrograde or suprapubic VCU should be preferred in most patients. Such an examination is usually performed to rule out a ruptured urethra in an adolescent. A Foley catheter is inserted in the distal urethra. The balloon is then inflated in the fossa navicularis, and the urethra is slowly and retro-gradely injected. Lateral and oblique pictures are taken. In most instances, the posterior urethra is not opacified. This should not be considered abnormal. 

Fig. 25.13. Retrograde urethrography. Urethral stenosis following a long-standing urethral catheterization for cardiac surgery. Note reflux into the prostatic ducts...

Fig. 25.15. Complete disruption of the membranous urethra in an adolescent boy shown by retrograde urethrography (arrow). Note the inflated balloon of the Foley catheter in the fossa navicularis...

---