Acrsar practice parameter for the performance of adult. Jun 25, 2019 ascending urethrogram procedure pdf aka. This is an xray test of the urethra, the tube that comes from the bladder through the penis from which you pass urine. I have seen where some coders automatically bill code 51610 with 74450 and some only code 51610 since the fluoroscopy would bundle into the code. It is a commonly used procedure in reconstructive urology for operative planning as well as a followup procedure. A retrograde urethrogram is an xray examination of the urethra for men, which cannot be seen on a normal xray. Nov 27, 2019 ascending urethrogram has been the gold standard investigation in the evaluation of stricture urethra. In this case there is persistent narrowing noted in membranous urethra stricture is likely. This leaflet is designed to give you some information about the procedure, to help you prepare for your examination and to give you some idea of what to expect when you attend. But it is associated with radiation exposure and underestimates the length of the stricture. A clear fluid or xray dye is used to outline the urethra so that it may be examined using xrays. This is followed by instillation of 30ml of watersoluble contrast and a plain radiograph is obtained. Indications for urethrography include, but are not limited to, evaluation of the following.
Retrograde pericatheter urethrography rpu technique and. If you have any questions about how to prepare for your study, please call md imaging at 5302431297. Code 51610 injection procedure for retrograde urethrocystography is the proper code for the surgical portion, which includes injection of contrast material into the urethral meatus in a retrograde fashion to delineate the. It is a commonly used procedure in reconstructive urology for operative planning as well as a followup procedure after urethral reconstruction. In the procedure a dye is injected into the urethral opening, and the movement. The indwelling catheter can be removed if the urethrogram appearances are acceptable. Pdf a perfected device for performing retrograde urethrography. The study commences with a scout film to assess bony structures as well as the presence of any calcified urinary tract pathology. Retrograde urethrography rug and voiding cystourethrography vcug are the modalities of choice for imaging the male urethra. This then allows the urologist to plan the best method to treat the problem, which will asscending on the location and length of the narrowing. If a urethrogram or voiding cysto urethrogram is required, you will then be asked to empty your bladder into a container.
It is used to diagnose urethral injury, or urethral narrowing. The urethrogram is the oldest radiographic test for assessing urethral stricture disease, and remains the gold standard for diagnosis and staging 1,2. Posttraumatic urethrography should include both an ascending and descending study. This teaching requires a retrograde urethrogram and cystogram to be performed to.
Antegrade urethrogram, although required rarely, is a very useful technique in such situations. A urethrogram can be done in conjunction with a cystogram or as a separate procedure. Jul 29, 2019 ascending urethrogram procedure pdf aka. Eventhough sono urethrogram is also associated with similar complications, the incidence is less compared to ascending urethrogram. This slide shows normal radiographic anatomy on a normal oblique ascending urethrogram. A retrograde urethrogram rug is a diagnostic procedure performed most commonly in male patients to diagnose urethral pathology such as trauma to the urethra or urethral stricture.
Hence to overcome these shortcomings of ascending urethrogram, ultrasound evaluation of stricture urethra called sono urethrogram has been tried. The procedure is simple and well tolerated by patients and represents an interesting alternative to the conventional rug technique. Typically the procedure is performed in men after they have been subjected to a blunt force trauma, but can also be done in women. Its an antegrade urethrogram, which youll know by now means a picture of the urethra when urine is flowing the normal way. A urethrogram is an investigation that allows us to visualise the urethra the water pipe that passes through the penis and leads to the bladder.
The examination is to look at the urethra and to find out if there is a narrowing within the tube. This anatomy is visualized with the use of contrast media xray dye. It is common in this situation to perform a urethrogram prior to catheter removal. The bladder should be so dilated, that the patient feels like he absolutely needs to pull off to the side of the road so he can urinate. Following open reconstructive urethral surgery it is standard urological procedure to leave a urethral catheter insitu for a number of weeks whilst the repair heals. Urethrogram medical definition merriamwebster medical. This is a diagnostic test for male patients with trauma injury to the urethra. Urethrography, retrograde definition of urethrography. The procedure involves the insertion of a foley catheter into the distal urethra and minimally inflating it. Common use to assess urethral patency in order to evaluate the success of surgical interventions on patients who have urethral structures or other anomalies that interfere with urination. Alternatively, for fistulae requiring staged procedures, a buccal mucosa graft is placed at the time of fistula excision figs. Apr 28, 2020 sono urethrogram was more sensitive and specific in diagnosing urethral stricture disease in our study as compared to ascending urethrogram.
Retrograde urethrogram, retrograde cystourethrogram catheter placement. Retrograde pericatheter urethrography rpu technique and its. Bedside emergency department procedure where urology not. Ascending urethrography catheter tip syringe sterile drape the urethrogram will show if there is a problem in the urethra that. Ascending urethrogram has been the gold standard investigation in the evaluation of stricture urethra. Hence a retrograde urethrogram is essential for diagnosis of urethral injury, or urethral stricture. Posttraumatic urethrography should include both an ascending. Aug 02, 2015 this slide shows normal radiographic anatomy on a normal oblique ascending urethrogram. With a sensitivity of 91% and a low specificity of 72% of the ascending urethrogram for diagnosing urethral stricture, it would be advisable to subject the patient to cystourethroscopy proceed.
The urethra is the tube that carries urine from the bladder and out the body. Pdf juan d bernamestre jr1, jd bernaserna21department of radiology, university hospital of. Overview a retrograde urethrogram rug is a diagnostic procedure performed most commonly in male patients to diagnose urethral pathology. Evidence of ongoing contrast leak, complete urethral transaction or an evolving stricture should undergo appropriate urological management. Introduction urethrography is most commonly performed via the retrograde injection of radiopaque contrast into the urethra to elucidate urethral pathol. If a urethrogram is not required, you will be free to use the washroom, get dressed and then leave the department. To compare the efficacy of sonourethrogram and ascending urethrogram in the evaluation of stricture urethra. A retrograde urethrogram is a routine radiologic procedure most typically in males used to. The urethra is the tube that runs from the bladder through the prostate and penis. A retrograde urethrogram allows us to evaluate any structural abnormalities in the urethra including narrowed areas strictures or contractures and outpouchings diverticulum. This diagnostic test is commonly performed in male patients when narrowing of the urethra is suspected.
When the urethra is studied with instillation of contrast into the distalanterior urethra it has been referred to as. A comparative study of ascending urethrogram and sono. Cystography can be used to evaluate bladder cancer, vesicoureteral reflux, bladder polyps, and hydronephrosis. These are the 3 projections that are taken during rgu procedure. Of course thats exactly what a voiding cystourethrogram is doing. Bladder prostate membranous urethra bulbar urethra penile urethra tip of penis these are the 3 projections that are taken during rgu procedure. Definition retrograde urethrography involves the use of xray pictures to provide visualization of structural problems or injuries to the urethra. When the posterior urethra is optimally opacified and the verumontanum visible, the bulbomembranous junction can be identified 11. Please arrive 15 min before your scheduled appointment time. Pdf on jan 10, 2017, v dola and others published ascending urethrogram and sonourethrogram in evaluation of male anterior urethra find, read and cite all the research you need on researchgate. A urethrogram is a special xray examination of the urethra pathway between the bladder and the opening where urine exits the body. A nuclear medicine thyroid scan uses a radioactive medication radiopharmaceutical to take pictures or images of the thyroid gland. It requires less radiation than pelvic ct, although it is less sensitive and specific than. Sono urethrogram was more proceure and specific in diagnosing urethral stricture disease in our study as compared to ascending urethrogram.
The voiding urethrogram evaluates the posterior urethra. Overview a retrograde urethrogram rug is a diagnostic procedure performed most commonly in male patients to diagnose urethral pathology such as trauma to the urethra or urethral stricture. Once you are happy to leave, you are free to do so. A urethrogram is performed 2 to 3 weeks later, and, if no abnormality is seen, and if the patient is able to void with minimal or no residual, the catheter is removed. Bladder prostate membranous urethra bulbar urethra penile urethra tip of penis. Any information contained in this pdf file is automatically generated from digital. The urethra is the tube which carries urine from the bladder to outside the body. Urethrography refers to the radiographic study of the urethra using iodinated contrast media and is generally carried out in males. A retrograde urethrogram is a routine radiologic procedure most typically in males used to image the integrity of the urethra. The procedure is as follows pain though is well tolerable, since proper preparation has preceded. First, rug is performed to visualize the adequately distended anterior urethra, and vcug is then performed to properly evaluate the posterior urethra, 1, 2.
Tie a tourniquet below corona so that you can hold the genital, retract genital parallel to femur. A urethrogam is a procedure which demonstrates the capacity of the bladder and its emptying ability and examines the urethra, the narrow tube which connects the bladder to the genitals through which urine passes before leaving the body. Urethrogram figures 1285 and 1286 is performed by placement of the tip of a foley catheter into the entrance of the urethra, followed by instillation of 50 ml of contrast under low pressure usually gentle hand injection or gravity. Oct 01, 2004 the identification of the bulbomembranous junction on a retrograde urethrogram is very important for assessing patients with urethral disease as well as for planning urologic procedures. Imaging of urethral stricture disease pubmed central pmc. Retrograde urethrogram procedure preparation md imaging. Definition a retrograde urethrogram is a routine radiologic procedure most typically in males used to image the integrity of the urethra by using iodinated contrast media. Apr 22, 2020 a retrograde urethrogram is a radiologic procedure performed to examine the integrity of the urethra, a part of the lower urinary tract. Apr 29, 20 but the name of the procedure is different. If there is a urethral stricture a block or closing, urine cannot flow out.
Pdf on jan 10, 2017, v dola and others published ascending urethrogram. The physician performed a retrograde urethrogram with fluoroscopic interpretation. This leaflet explains more about having a urethrogram examination, including the benefits. I have run into some notes that state that the physician performed a retrograde urethrogram with fluoroscopic interpretation. The foley balloon is advanced into the bladder and contrast is instilled until the bladder is dilated. Sep 24, 2018 a retrograde urethrogram rug is a diagnostic procedure performed most commonly in male patients to diagnose urethral pathology such as trauma to the urethra or urethral stricture. Sono urethrogram was more sensitive and specific in diagnosing urethral stricture disease in our study as compared to ascending urethrogram. There is no preparation needed prior to a urethrogram. The procedure involves the insertion of a foley catheter into the distal urethra and minimally. Patient should take nothing by mouth food or drink 4 hours prior to exam. Ascending urethrogram leads to radiation exposure of 12 msv, equivalent to 6 months of background radiation and 20 chest xrays 5, 6. It is not a good technique to visualize the prostatic urethra in cases of posterior urethral disruption as it is difficult to maintain the ureteric catheter in the posterior urethra and the contrast rapidly enters the bladder without properly filling. A urethrogram is a contrast study of the urethra under fluoroscopic control.
Eventhough sonourethrogram is also associated with similar complications, the incidence is less compared to ascending urethrogram. Most often, the urethrogram is performed in a retrograde fashion. A urethrogram is an examination of the urethra by xray imaging, almost always carried out on males. Starting with description of urethrography in brief. Is ascending urethrogram mandatory for all urethral. Ultrasonographic evaluation of urethral stricture disease. A urethrogram is usually carried out to show the cause of poor urinary flow thought.
Pdf ascending urethrogram and sonourethrogram in evaluation. With the patient in the lateral steep position, equal amounts of saline and contrast material 76% urograffin. Ask the patient to lie in supine position slightly tilted and legs position as shown in the video. This information sheet relates to the procedure being carried out on a male. Joshua broder md, facep, in diagnostic imaging for the emergency physician, 2011. Unexplained free intraperitoneal fluid following surgery or trauma 2. In radiology and urology, a cystography is a procedure used to visualise the urinary bladder using a urinary catheter, radiocontrast is instilled in the bladder, and xray imaging is performed. This is done by placing a catheter into the urethral meatus, expanding the balloon gently to form a seal and running a small volume of contrast into the urethra under image control. Rpu procedure rpu was performed under antibiotic coverage on the 21st postoperative day.
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