Urethrography is an X-ray examination procedure that visualizes the urethra after filling it with a contrast agent. Additionally, the bladder, prostate, and genitals are displayed. The method allows the diagnosis of inflammatory diseases, developmental abnormalities, lesions, strictures, tumors and stones of the urethra, adenoma and prostate cancer. Depending on the tasks of the study, ascending and descending urethrography is performed.
Urethrography remains quite a popular diagnostic method today, since the area of the genitourinary organs, both in men and women, is quite difficult to access for other research methods, including ultrasound, CT or MRI. The informative value of this method is very high – it allows you to identify not only lesions of the urethra itself, but also surrounding structures. The most common indications for urethrography are frequent recurrent urinary tract infections, hematuria of unknown origin, pain in the perineum and during urination.
In addition, such a procedure is prescribed in case of suspected abnormalities of the urethra (diverticula, hypospadias), the development of fistulas, tumor processes. The detection of possible fistulas or diverticula of the urethra is the most common indication for urethrography in women. Miction urethrography in men is performed to detect hyperplasia or tumors of the prostate gland or other lesions of the posterior part of the urethra and the neck of the bladder.
Absolute contraindications for urethrography are acute inflammatory lesions of the urethra and bladder (urethritis and cystitis), severe hematuria, indicating bleeding in the lower urinary system and allergy to contrast iodine-containing substances. Under certain conditions, the list of contraindications includes renal insufficiency and endocrine diseases – this refers to mictional urethrography performed by intravenous contrast injection. In women, this procedure is prohibited during pregnancy and during menstruation.
Both retrograde and mictional urethrography do not require special preparation, except in cases when this procedure is combined with excretory urography – then it is necessary to refrain from eating the day before and maintain an optimal water regime. Immediately before urethrography, sedatives and painkillers are administered to the patient – as the latter, it is not recommended to use antispasmodics, since they can distort the results of the study. Also, before starting the procedure, the bladder should be emptied.
Methodology of conducting
Initially, an X-ray image is taken in a direct projection to visualize the structural features of this area. The procedure of ascending or retrograde urethrography begins with the treatment of the urethral orifice area with an antiseptic and the introduction of a special catheter into the urethra of the patient. There is a small balloon at the tip of the catheter, which, if necessary, can be filled with water – after injection to the required depth, the balloon is slightly inflated and thereby the catheter is fixed. After that, the patient lies on his right side and bends his right hip at a right angle. During urethrography, the left leg remains straight.
The next stage of urethrography is the introduction of contrast, during which several X-rays are taken. The first of them is produced at the time of administration of approximately 75% contrast solution, the second – after its complete introduction. As a rule, retrograde urethrography makes it possible to identify the structures of the middle and anterior parts of the urethra, to determine the width of the urethra, the structure of its walls, the presence or absence of diverticula and fistulas with sufficiently high accuracy.
For more accurate visualization of the membranous and prostatic parts of the urethra, mictional urethrography is more preferable – for this, a small amount of contrast is retrograde injected into the bladder or it gets there from the kidneys during excretory urography. After that, the patient is asked to urinate or, in some cases, at least simulate a similar urination effort. At this time, a picture is taken on which the neck of the bladder and the posterior parts of the urethra are well visualized.