Norm of Retrograde Urethrography
Negative for congenital anomaly, diverticula, fistula, obstruction, or stricture. Normal size, shape, and position of the urethra and prostate gland.
Usage of Retrograde Urethrography
Aids in the diagnosis of urethral abnormalities and anomalies, including diverticula, fistula, obstruction, and strictures; evaluation of status after urethral or radical prostate surgery; helps identify the precise anatomic location of the prostate for prostate radiotherapy.
Description of Retrograde Urethrography
Retrograde urethrography is a procedure in which radiographs are taken as radiopaque contrast medium is instilled into the urethra. Autourethrography, in which the client performs the instillation (injection) of the contrast medium, has been found to enhance the client's tolerance, cause less anxiety, and decrease the instance of extravasation of contrast medium outside of the urethra. In addition, the radiologist does not have to remain with the client during x-ray exposure. Retrograde urethrography is primarily performed in males. A double-balloon catheter can be used for retrograde urethrography in women to diagnose a urethral diverticulum. Retrograde urethrography is inferior to magnetic resonance urography if abnormalities in the periurethral tissues are suspected (see Magnetic resonance urography).
Professional Considerations of Retrograde Urethrography
Consent form IS required.
Bladder infection, allergic reaction to contrast medium (itching, hives, rash, tight feeling in the throat, shortness of breath, anaphylaxis), renal toxicity from contrast medium (very unlikely).
Pregnancy, previous allergic reaction to radiographic contrast, renal insufficiency. Sedatives are contraindicated in clients with central nervous system depression.
During pregnancy, risks of cumulative radiation exposure to the fetus from this and other previous or future imaging studies must be weighed against the benefits of the procedure. Although formal limits for client exposure are relative to this risk:benefit comparison, the United States Nuclear Regulatory Commission requires that the cumulative dose equivalent to an embryo/fetus from occupational exposure not exceed 0.5 rem (5 mSv). Radiation dosage to the fetus is proportional to the distance of the anatomy studied from the abdomen and decreases as pregnancy progresses. For pregnant clients, consult the radiologist/radiology department to obtain estimated fetal radiation exposure from this procedure.
- Have emergency equipment readily available.
- Obtain sterile towels, a balloon urinary catheter, 10- and 60-mL syringes, and contrast medium.
- An analgesic or sedative may be prescribed. Monitor respiratory status continually if sedation is used.
- Record baseline vital signs.
- The client should disrobe below the waist.
- If autourethrography is to be performed, the client must be instructed about the dye-instillation technique.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- With the client positioned supine, baseline radiographs of the lower urinary tract structures are taken.
- A catheter filled with radiopaque contrast connected to a special occluding clamp is advanced into the urethra just proximal to the urethral meatus. Alternatively, a catheter filled with radiopaque contrast is advanced into the urethra until the balloon is just proximal to the meatus and then the balloon is partially inflated with air.
- Standard or fluoroscopic radiographs are taken as dye is injected by the radiologist or the client (autourethrography) through the catheter, with the client in various positions.
- The clamp-and-catheter apparatus or the catheter is removed after balloon deflation.
- The client is instructed to urinate to expel the contrast medium.
- Monitor vital signs at the end of the procedure. If deep sedation was used, follow institutional protocol for postsedation monitoring. Typical monitoring includes continuous ECG monitoring and pulse oximetry, with continual assessments (every 5–15 minutes) of airway, vital signs, and neurologic status until the client is lying quietly awake, is breathing independently, and responds to commands spoken in a normal tone.
- Administer analgesic as prescribed.
- See Client and Family Teaching.
Client and Family Teaching
- Expect some discomfort with contrast instillation, but this will be relieved when the radiographs are completed and the catheter is removed.
- Observe for signs of allergic reactions to the contrast (listed above) for 24 hours. Call the physician in the event of itching or hives. Go to the nearest emergency department or call an ambulance for shortness of breath.
- Save all the urine voided. Inspect the urine for quantity and hematuria (pink or red color) for 24 hours. Notify the physician for no urine in 8 hours, less than 1 ounce (30 mL) of urine per hour, or pain with urination.
- Drink 6–8 glasses of water or other fluids during the next 24 hours (when not contraindicated).
- Notify the physician for symptoms of infection: fever, fast heart rate, hypotension (feeling faint, weak, or dizzy), chills, dysuria, or flank pain.
Factors That Affect Results
- Urethral obstruction will block the flow of contrast through the urethra.
- This test is often combined with voiding cystourethrography.