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. Pdf juan d bernamestre jr1, jd bernaserna21department of radiology, university hospital of. Starting with description of urethrography in brief. This teaching requires a retrograde urethrogram and cystogram to be performed to. When the urethra is studied with instillation of contrast into the distalanterior urethra it has been referred to as. It is used to diagnose urethral injury, or urethral narrowing.
Retrograde urethrogram, retrograde cystourethrogram catheter placement. Aug 02, 2015 this slide shows normal radiographic anatomy on a normal oblique ascending urethrogram. But it is associated with radiation exposure and underestimates the length of the stricture. To compare the efficacy of sonourethrogram and ascending urethrogram in the evaluation of stricture urethra. 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. Introduction urethrography is most commonly performed via the retrograde injection of radiopaque contrast into the urethra to elucidate urethral pathol. This is an xray test of the urethra, the tube that comes from the bladder through the penis from which you pass urine. The physician performed a retrograde urethrogram with fluoroscopic interpretation. If you have any questions about how to prepare for your study, please call md imaging at 5302431297. Retrograde urethrography rug and voiding cystourethrography vcug are the modalities of choice for imaging the male urethra. Hence to overcome these shortcomings of ascending urethrogram, ultrasound evaluation of stricture urethra called sono urethrogram has been tried.
Evidence of ongoing contrast leak, complete urethral transaction or an evolving stricture should undergo appropriate urological management. Retrograde pericatheter urethrography rpu technique and its. Eventhough sonourethrogram is also associated with similar complications, the incidence is less compared to ascending urethrogram. Definition retrograde urethrography involves the use of xray pictures to provide visualization of structural problems or injuries to the urethra. This slide shows normal radiographic anatomy on a normal oblique ascending urethrogram. In this case there is persistent narrowing noted in membranous urethra stricture is likely. Its an antegrade urethrogram, which youll know by now means a picture of the urethra when urine is flowing the normal way. 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. With the patient in the lateral steep position, equal amounts of saline and contrast material 76% urograffin. 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. The procedure involves the insertion of a foley catheter into the distal urethra and minimally inflating it.
The urethra is the tube that carries urine from the bladder and out the body. A retrograde urethrogram is a routine radiologic procedure most typically in males used to. The procedure is simple and well tolerated by patients and represents an interesting alternative to the conventional rug technique. It is a commonly used procedure in reconstructive urology for operative planning as well as a followup procedure after urethral reconstruction. 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. Joshua broder md, facep, in diagnostic imaging for the emergency physician, 2011. Eventhough sono urethrogram is also associated with similar complications, the incidence is less compared to ascending urethrogram. A urethrogram is usually carried out to show the cause of poor urinary flow thought. 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. This anatomy is visualized with the use of contrast media xray dye. Purpose retrograde urethrography is used, in combination with a doctors observation and other tests, to establish a diagnosis for individuals, almost exclusively men, who.
Ascending urethrography catheter tip syringe sterile drape the urethrogram will show if there is a problem in the urethra that. When the posterior urethra is optimally opacified and the verumontanum visible, the bulbomembranous junction can be identified 11. The urethrogram is the oldest radiographic test for assessing urethral stricture disease, and remains the gold standard for diagnosis and staging 1,2. Most often, the urethrogram is performed in a retrograde fashion. This is a diagnostic test for male patients with trauma injury to the urethra. This information sheet relates to the procedure being carried out on a male. 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. Is ascending urethrogram mandatory for all urethral. 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. A retrograde urethrogram is an xray examination of the urethra for men, which cannot be seen on a normal xray. Rpu procedure rpu was performed under antibiotic coverage on the 21st postoperative day. The study commences with a scout film to assess bony structures as well as the presence of any calcified urinary tract pathology. A clear fluid or xray dye is used to outline the urethra so that it may be examined using xrays. Once you are happy to leave, you are free to do so.
Posttraumatic urethrography should include both an ascending and descending study. A comparative study of ascending urethrogram and sono. The procedure involves the insertion of a foley catheter into the distal urethra and minimally. The procedure is as follows pain though is well tolerable, since proper preparation has preceded. The voiding urethrogram evaluates the posterior urethra.
Jul 29, 2019 ascending urethrogram procedure pdf aka. Urethrography refers to the radiographic study of the urethra using iodinated contrast media and is generally carried out in males. A urethrogram can be done in conjunction with a cystogram or as a separate procedure. 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 a routine radiologic procedure most typically in males used to image the integrity of the urethra. Apr 28, 2020 sono urethrogram was more sensitive and specific in diagnosing urethral stricture disease in our study as compared to ascending urethrogram. In the procedure a dye is injected into the urethral opening, and the movement. Ascending urethrogram leads to radiation exposure of 12 msv, equivalent to 6 months of background radiation and 20 chest xrays 5, 6.
A urethrogram is a contrast study of the urethra under fluoroscopic control. 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. 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. If there is a urethral stricture a block or closing, urine cannot flow out. Pdf a perfected device for performing retrograde urethrography. 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. Of course thats exactly what a voiding cystourethrogram is doing. Tie a tourniquet below corona so that you can hold the genital, retract genital parallel to femur. 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. Unexplained free intraperitoneal fluid following surgery or trauma 2. Ultrasonographic evaluation of urethral stricture disease. Acrsar practice parameter for the performance of adult.
These are the 3 projections that are taken during rgu procedure. 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. The procedure uses a type of xray called fluoroscopic imaging to view images in real time. The urethra is the tube which carries urine from the bladder to outside the body. The urethra is the tube that runs from the bladder through the prostate and penis. Jun 25, 2019 ascending urethrogram procedure pdf aka. This is followed by instillation of 30ml of watersoluble contrast and a plain radiograph is obtained. 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. First, rug is performed to visualize the adequately distended anterior urethra, and vcug is then performed to properly evaluate the posterior urethra, 1, 2.
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. A retrograde urethrogram allows us to evaluate any structural abnormalities in the urethra including narrowed areas strictures or contractures and outpouchings diverticulum. This leaflet explains more about having a urethrogram examination, including the benefits. Patient should take nothing by mouth food or drink 4 hours prior to exam. Please arrive 15 min before your scheduled appointment time. The indwelling catheter can be removed if the urethrogram appearances are acceptable. Bladder prostate membranous urethra bulbar urethra penile urethra tip of penis.
I have run into some notes that state that the physician performed a retrograde urethrogram with fluoroscopic interpretation. Sono urethrogram was more proceure and specific in diagnosing urethral stricture disease in our study as compared to ascending urethrogram. Any information contained in this pdf file is automatically generated from digital. 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. Pdf on jan 10, 2017, v dola and others published ascending urethrogram. 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. Ascending urethrogram has been the gold standard investigation in the evaluation of stricture urethra. Urethrography, retrograde definition of urethrography.
Sono urethrogram was more sensitive and specific in diagnosing urethral stricture disease in our study as compared to ascending urethrogram. 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. It requires less radiation than pelvic ct, although it is less sensitive and specific than. Antegrade urethrogram, although required rarely, is a very useful technique in such situations. Imaging of urethral stricture disease pubmed central pmc. Overview a retrograde urethrogram rug is a diagnostic procedure performed most commonly in male patients to diagnose urethral pathology.
The foley balloon is advanced into the bladder and contrast is instilled until the bladder is dilated. Pdf ascending urethrogram and sonourethrogram in evaluation. There is no preparation needed prior to a urethrogram. Apr 29, 20 but the name of the procedure is different. Posttraumatic urethrography should include both an ascending. Bedside emergency department procedure where urology not. A urethrogram is an examination of the urethra by xray imaging, almost always carried out on males. Ask the patient to lie in supine position slightly tilted and legs position as shown in the video.
It is common in this situation to perform a urethrogram prior to catheter removal. Urethrogram medical definition merriamwebster medical. A urethrogram is a special xray examination of the urethra pathway between the bladder and the opening where urine exits the body. Retrograde pericatheter urethrography rpu technique and. 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. Cystography can be used to evaluate bladder cancer, vesicoureteral reflux, bladder polyps, and hydronephrosis. Alternatively, for fistulae requiring staged procedures, a buccal mucosa graft is placed at the time of fistula excision figs. If a urethrogram or voiding cysto urethrogram is required, you will then be asked to empty your bladder into a container. 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. 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. If a urethrogram is not required, you will be free to use the washroom, get dressed and then leave the department.
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