One of the hallmarks of urethral injury is blood and the meatus in males. The standard answer to the question “how do you evaluate for it?” is “retrograde urethrogram.” Unfortunately, too few people know how to perform this test, and not all radiologists are familiar. Many times it falls to the urologist, who may not be immediately available.
The technique is simple. The following items are needed:
- A urine specimen cup
- A tube of KY jelly (not the little unit dose packs)
- A bottle of renografin or ultravist contrast
- A 50-60 cc Toomey syringe (slip-tip)
- A fluoroscopy suite
Pour 25cc of contrast and 25cc of KY jelly in the specimen cup, cap it and shake well. Draw the contrast jelly up into the syringe. Under fluoro, insert the tip of the syringe into the penis and pull the penis toward yourself, pinching the meatus around the tip of the syringe. Slowly inject all the contrast, watching the contrast column on the fluoro screen. Once there is easy flow into the bladder, you can stop the study. If you see extravasation into the soft tissues, stop the study and call Urology.
The advantages to using this technique are:
- The contrast/jelly mix creates a contrast gel that is less likely to leak from the meatus when injected
- The jelly makes it easy to insert the catheter if no urethral injury is detected
Normal urethrogram:
Abnormal urethrogram:
