Urethrogram

Urethrogram is a diagnostic procedure to examine the urethra. Genital Urethrogram is almost always carried out on male patients with symptoms such as dribbling of urine, sense of incomplete bladder emptying, hesitancy, poor stream, urinary urgency, urinary frequency, poor bladder emptying etc.

In many patients, the most prominent indication is potential urethral stricture disease. Genital Urethrogram is an essential tool for doctors for careful examination of the images followed by best interpretation so as to plan appropriate course of treatment. In males, the urethra is the tube that caries urine and semen through the penis, outside the body. Genital Urethrogram involves taking an X-ray of the tube. Measuring 20 cm in length, there are two divisions:

Anterior ( penile and bulbar)
Posterior ( membranous and prostatic)

What is Genital Urethrogram ?

The diagnostic X-ray procedure, Urethrogram is done to study the urethra. It can be either retrograde Urethrogram or antegrade urethrogram. It may take 30-60 minutes for completion of the procedure. Depending on the need to examine the anterior or posterior urethra, either of the two is done.

Retrograde Urethrogram (RUG): Ascending study to assess the anterior urethra which is composed of the penile and bulbar urethra.

Antegrade Urethrogram: Descending study to assess the posterior urethra which is composed of the membranous and prostatic urethra.

Why do Genital Urethrogram ?

Doctors recommend Genital Urethrogram when patients express problems with poor urinary flow or problems passing urine. In older men, the reason can be attributed to enlargement of the prostate. But in young and middle aged males and male children, it might be a history of injury, infection etc.

The procedure throws light on two major aspects of the urethra. Firstly, the capacity of the bladder and its emptying ability and secondly, examination of the urethra, the narrow tube which connects the bladder to the genitals through which urine passes before leaving the body.

Indications of Genital Urethrogram

Infection: Gonococcal Urethritis, non-gonoccocal urethritis

Inflammatory: Balanitis Xerotica obliterans

Trauma: Straddle injury, pelvic fractures

Iatrogenic: Instrumentation, prolonged catheterization, trans-urethral resection of the prostate, open radical prostatectormy, urethra reconstruction.

On the appointed day, the patient is admitted in the hospital radiology department or radiology practice where the procedure is to be done. The patient will be asked to empty the bladder and put on a hospital gown. He is made to lie on an x-ray table called a fluoroscopy table in a specific position. Sterile drapes are placed over the lower body. The penis and groin will be cleaned with an antiseptic solution. A narrow catheter or a thin plastic, silicone or rubber tube will be placed into the end part of the penis from where the urine exits. A small balloon will be inflated in order to keep the catheter in place and to stop contrast medium (special dye) running out of the end of the penis.

Contrast medium is gently injected into the urethra by placing a catheter at the top of the penis. As the bladder is filled with the contrast, the patient is likely to experience some discomfort. There can be an urgent need to pass urine. At this point, the catheter will be removed. The final images of the bladder will be taken.

The X-ray table will be tilted. The patient is now in a standing position. A bottle will be handed over to pass urine. When the patient is passing urine, x-ray pictures of the bladder and the urethra will be taken to understand how well the bladder empties. The images also pin-point if there is any narrowing in the urethra.

After completion of Genital Urethrogram, it is normal to notice some blood at the tip of the penis. The patient may experience some discomfort or stinging at the end of the penis where the catheter was inserted and the balloon was inflated. This will subside after passing urine few times on the same day or the next day. The urine can be with small amount of blood too.

Are there risks associated with Genital Urethrogram ?

Three potential risks have been identified but all the three are rare instances. Allergic reaction to the dye (contrast medium), urine infection and damage to the urethra are the three possible risks associated with Genital Urethrogram. Of the three, urine infection and allergic reaction are easily manageable.

Prior to the procedure, the patient must inform the medical team if he is allergic to iodine-containing contrast. With regard to urinary infection, if it does not subside even after 36 hours of the procedure, it is best to seek medical attention. Antibiotics will be prescribed. Damage to the urethra is also rare but might occur if Genital Urethrogram is performed as an emergency procedure. In some cases, emergency surgical repair is recommended. The surgery aims at restoring urethral function and near-perfect cosmetic appearance.

Incontinence

Loss of bladder control is referred to as urinary incontinence. Urinary incontinence occurs if the bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax. Women experience urinary incontinence twice as often as men. Various factors like pregnancy and childbirth, menopause and the structure of the female urinary tract account for this difference.

Causes of urinary incontinence

Drinking a lot of fluid or any other beverages in a short period of time increases the amount of urine in the bladder which results in urinary incontinence. Alcohol causes the bladder to fill quickly and triggers an urgent and uncontrollable urination. Alcohol also temporarily impairs the ability to recognize the need to urinate and act in a timely manner.

Sedatives such as sleeping pills can interfere with your ability to control bladder function. Water pills like diuretics, muscle relaxants and antidepressants can cause an increase in urinary incontinence. High blood pressure drugs, heart medications and cold medicines also affect the urinary bladder function.

Urinary tract infection can cause bladder irritation and even incontinence. Consuming foods and beverages that irritate your bladder like carbonated drinks, tea and coffee may cause episodes of urge incontinence.

Tackling urinary incontinence

Exercises help to strengthen pelvic floor muscles and sphincter muscles. Electrical stimulation is used to reduce stress incontinence and urge incontinence. Hormones such as estrogen cause muscles involves in urination to function normally. Surgery is suggested to alleviate incontinence only after other methods and treatments have failed.

Kegels Exercises

Kegels Exercises are pelvic floor exercises that attempt to strengthen the muscles of the pelvic floor (PC Muscle). These exercises improve the urethra and rectal sphincter functions. Dr. Arnold Kegel developed a set of exercises to aid women in strengthening their pelvic muscles, especially after childbirth. These exercises are now increasingly recommended for women who suffer from urinary incontinence.

Conditioned pelvic muscles can help in easier childbirth. The toned musculature of the pelvic region can make for an easier vaginal delivery. You can prevent prolapse of pelvic organs. A uterine prolapse can occur when the ligaments that hold the uterus to the wall of the pelvis become weak. This can lead to discomfort and incontinence. Kegel exercises strengthen the inner walls of the vagina and increase the blood flow to the genital area.