Urethrography Procedure Guidelines

Patient Preparation and Technique

The patient should be placed in a position to optimize urethra visualization, and a digital rectal exam should be performed in cases of pelvic trauma to detect prostate elevation, rectal bleeding, or anal-rectal lesions, as recommended by medical guidelines 1
Never attempt urethral catheterization if there is blood in the urethral meatus without first performing retrograde urethrography, according to the World Journal of Emergency Surgery 2, 3, 4

The urethrography procedure involves instilling contrast medium into the urethra under fluoroscopy, using either a balloon catheter or non-instrumentation techniques, with the latter being better tolerated by patients, as stated by the World Journal of Emergency Surgery 2, 3
The contrast medium should be administered under continuous fluoroscopic vision to visualize the entire urethra, as recommended by the World Journal of Emergency Surgery 2, 3
Extravasation of contrast indicates urethral injury: if the contrast fills the bladder, it suggests an incomplete lesion; if it does not fill the bladder, it suggests a complete lesion, according to the World Journal of Emergency Surgery 2, 3

For preoperative evaluation of pelvic fracture injuries, retrograde urethrography should be combined with voiding cystourethrography (VCUG) and/or retrograde cystoscopy, as recommended by The Journal of Urology 5, 6
VCUG allows evaluation of the posterior urethra, bladder neck, and complex distraction defects, according to The Journal of Urology 5, 6

In cases of hemodynamic instability, all urethral investigations should be postponed, and a suprapubic catheter should be placed, as recommended by the World Journal of Emergency Surgery 2, 3
Avoid repeated attempts at catheterization, as they increase patient morbidity and can delay anastomotic reconstruction, according to The Journal of Urology 5, 6

The WSES-AAST guidelines establish that a urethral injury is considered incomplete when contrast extravasation is accompanied by bladder filling, indicating some degree of urethral lumen continuity, in patients with urethral trauma 7, 8, 9
A complete urethral lesion is characterized by contrast extravasation without bladder filling, indicating total disruption of the urethra, in patients with urethral trauma 7, 8, 9

Incomplete urethral lesions generally have a better prognosis than complete lesions, according to the WSES-AAST guidelines, in patients with urethral trauma 7
The management of urethral injuries may differ based on the severity of the lesion, as stated by the WSES-AAST guidelines, in patients with urethral trauma 7, 8
The presence of partial continuity can influence treatment options for urethral injuries, according to the WSES-AAST guidelines, in patients with urethral trauma 7

Distinguishing between complete and incomplete urethral lesions using retrograde urethrography can be challenging and not always accurate, as noted by the WSES-AAST guidelines, in patients with urethral trauma 7, 8
In uncertain cases, flexible urethroscopy may provide additional information to aid in diagnosis, according to the WSES-AAST guidelines, in patients with urethral trauma 7, 8, 9

In hemodynamically unstable patients, all urethral investigations should be postponed and a suprapubic catheter should be placed, as recommended by the WSES-AAST guidelines, in patients with urethral trauma 7, 8