Retrograde Urethrogram

We had a GSW to the penis with a positive RUG with a nice image.

A nice review of Gunshot Wounds to the penis is at: Journal of Trauma 2008: 64; 1038-1042


RETROGRADE URETHROGRAPHY
Retrograde urethrogram is the best study for visualizing the anterior male
urethra. It is valuable in diagnosing a urethral disruption after a blunt or
penetrating trauma to the pelvis and in evaluating many urethral structural
abnormalities, such as strictures, diverticula, fistulas, and anterior urethral
valves.

Indications:

Suspected urethral injury after trauma
Evaluation of anterior urethral stricture
Possible urethral diverticulum

Contraindications:
Acute urethritis

Anesthesia:
None
Equipment:

Urethral catheterization kit (includes Foley catheter, povidone-iodine solution,
lubricating jelly, 10-ml syringe with sterile normal saline, gloves, sterile
towels, and urinary drainage bag)
Water-soluble contrast agent
Catheter-tip syringe
Fluoroscopy or radiography equipment

Positioning:
Supine for catheter insertion, lateral decubitus for radiographs
Technique:

Place sterile towels around the penis.
Test the balloon of the catheter, lubricate the catheter with lubricating jelly,
and set it aside on the sterile field.
Retract the foreskin (if present). Grasp the penis laterally with the nondominant
hand and place it on moderate stretch perpendicular to the body.
Swab the glans with povidone-iodine with the dominant hand. Observe sterile
technique at all times.
Lubricate the catheter with lubricating jelly and grasp with the dominant hand.
Using steady, gentle pressure, advance the catheter until the balloon is
inserted 2-3 cm into the fossa navicularis
Gently inflate the balloon with 1-2 ml normal saline until it tamponades the
urethral lumen.  Hold penis on slight tension at 45 degree angle toward one of the patient's shoulders.
Inject 30-35 ml of water-soluble contrast agent, and obtain appropriate radiographs.  Dye must reflux into bladder if urethrogram is completely negative for injury.
Caution: Avoid excessive force or overdistension of the urethra to prevent
contrast extravasation to the corpus spongiosum or penile vasculature.
After confirming a satisfactory radiographic evaluation of the urethra, deflate
the balloon and remove the catheter.
Replace the foreskin to prevent a paraphimosis.
If complete urethral stricture or severe urethral disruption is confirmed, consider placing a percutaneous suprapubic cystostomy.

Thanks to Dr. Marie Ziesat for this post.