Urethrogram

Authors: Dr Alan List*
                            Prof Stacy Goergen *

What is a urethrogram?

A urethrogram is an examination of the urethra by X-ray imaging, almost always carried out on males. This information sheet relates to the procedure being carried out on a male.

The urethra is the tube that runs from the bladder through the prostate and penis.

A urethrogram is usually carried out to show the cause of poor urinary flow thought to be caused by narrowing (a stricture) of the urethra. The most common cause for narrowing of the urethra in men is benign (non-cancerous) enlargement of the prostate gland. A urethrogram is most often used to diagnose causes of narrowing of the urethra that are not caused by benign enlargement of the prostate gland.

Why would my doctor refer me to have this procedure?

Your doctor may refer you for this procedure if you have problems with poor urinary flow that the doctor thinks are not caused by the usual enlargement of the prostate that is commonly seen in older men. There might be a history of injury, surgery on the prostate, a bladder catheter or infection in the past, and any of these can result in narrowing of the urethra.

A urethrogram also can be carried out as an emergency procedure if injury to the urethra is suspected.

Urologists (specialist doctors) most commonly refer patients for a urethrogram. Your general practitioner might send you for this test before you see the urologist if you have problems passing your urine.

How do I prepare for a urethrogram?

There is generally no special preparation for a urethrogram. It is desirable that any urinary tract infection is treated before the procedure being carried out, but in some cases the procedure can be carried out if you are still receiving treatment.

The hospital radiology department or radiology practice where the procedure is being carried out will give you information about any preparation needed for the examination.

What happens during a urethrogram?

The procedure will be explained to you by the radiologist (specialist doctor) who will be carrying out the examination.

You will usually be asked to empty your bladder, and then to remove your clothing, put on a gown and lie down on an X-ray table called a fluoroscopy table. This will be located in the radiology or

X-ray department of the hospital or radiology practice. There will be a large camera over the table and a screen that the radiologist will use to look at your bladder and urethra during the procedure.

Sterile drapes will be placed over your lower body, and your penis and groin will be cleaned with antiseptic solution. The radiologist will wear sterile gloves to carry out the procedure.

Most radiologists will carry out the procedure by placing a narrow catheter (a thin plastic, silicone or rubber tube) just into the end part of the penis where the urine comes out. A small balloon will be inflated to keep the cathether in place and to stop contrast medium running out the end of the penis. Most people will experience some discomfort during passage of the catheter and inflation of the small balloon.

Contrast medium is gently injected through the catheter. Contrast medium, sometimes just called ‘contrast’ (or X-ray dye, even though it is a colourless fluid) is a fluid that makes a shadow on an X-ray image. This fluid is used to fill the urethra, and pictures or images are taken using an X-ray camera. These images will show if there is a narrowing in the urethra, where it is and how severe the narrowing is.

This part of the test only shows narrowings involving the middle and lower part of the urethra. Often this gives all the information required, but it can be necessary to obtain images of the upper urethra when voiding (while the urine and contrast is flowing through the urethra from the bladder). This usually involves removing the initial catheter and injecting local anaesthetic jelly into the urethra, which lubricates and anaesthetises the urethra, and assists passing a catheter into the bladder.

After the catheter has been passed into your bladder, your bladder will be filled with contrast. When it feels so full that you feel the need to pass urine, the catheter will be removed. During this filling stage, images of the bladder will be taken as necessary.

If you have a severe narrowing in the urethra, it may not be possible or safe to push the tube into your bladder. If this is the case, there is usually enough information on the initial study for the urologist.

The X-ray table will then be gradually tilted so that you are bought up to a standing position and you will be given a bottle to pass urine into. While you are doing this, more pictures of your bladder and urethra will be taken to see how well your bladder empties and to further show if there are any narrowings in the urethra.

Are there any after effects of a urethrogram?

After the urethrogram is over, you may notice some blood at the tip of your penis. The next few times you urinate, you can expect some mild discomfort or stinging at the end of the penis where the catheter was inserted and the balloon inflated. You may also pass a small amount of blood. This is normal after having a catheter inserted, will go away in a day or two and you do not need to worry.

How long does a urethrogram take?

Overall, the study will take between 30–60 minutes. The time taken will depend on:

• why you are having the procedure carried out;
• whether the radiologist has difficulty in trying to insert the catheter when the urethra is very narrow;
• if you have problems with being able to pass urine after the bladder has been filled.

What are the risks of a urethrogram?

Damage to the urethra. This is rare, but more common if the urethrogram is carried out as an emergency procedure. This is because the lining of the urethra is often torn before the procedure and the catheter can pass through the torn area outside of the urethra.

In the emergency situation, a urethrogram, with the catheter just into the end of the penis, should show urethral tears and then avoid further injury that could be caused by attempting to pass a catheter into the bladder. Attempting to insert a catheter into the bladder if there is already an injury to the urethra can cause the injury to be extended or the catheter to perforate the urethra through the tear. Injury can occur when there is a tight narrowing in the urethra and it is difficult to pass the catheter beyond the narrowing.

It is extremely rare for a urethrogram to injure the urethra if there is not already a tear in the urethra or a severe narrowing before the urethrogram begins.

Urine infection. This also is very rare, because sterile technique is used. Some initial discomfort or stinging is usual after the test. If you do have an infection, you will feel a burning sensation when you pass urine. If this goes on for more than 36 hours, you will need to see your doctor who may prescribe antibiotics. Other signs of an infection that you should see your doctor about include feeling the need to constantly go to the toilet and pass urine more than 36 hours after the procedure or a temperature or chills (shivering) at any time after the procedure. It is important if you do develop a fever (a temperature greater than 38°C) to see your general practitioner promptly and have your urine tested for infection.

Allergic reaction to contrast medium. This is rare, as the contrast is not injected directly into a blood vessel, but it can occur (see iodinated contrast). If you know you have had an allergic reaction to iodine containing contrast in the past, you must tell the radiologist before the procedure. You should also let the hospital or radiology practice know when you make your appointment. They may decide that you require medication with corticosteroids (steroids) for a day before the procedure or they may decide not to do the procedure at all if your previous reaction was a severe one.

What are the benefits of a urethrogram?

The urethrogram will show if there is a problem in the urethra that may be causing your symptoms. This then allows the urologist to plan the best method to treat the problem, which will depend on the location and length of the narrowing.

Who does the urethrogram?

The urethrogram will be carried out by a radiologist (specialist doctor), trained in carrying out radiology procedures and interpreting X-ray images. The radiologist will be assisted by the radiographer, who is the technician who operates the X-ray machine while the test is carried out and in some cases there may be a radiology nurse assisting.

Where is a urethrogram done?

A urethrogram is usually carried out in a hospital radiology department or radiology practice that has an X-ray room where there is fluoroscopy available. Fluoroscopy equipment is where the X-ray images can be watched on a TV screen as the examination is being carried out. It also stores the images as a record of the procedure.

When can I expect the results of my urethrogram?

The time it takes your doctor to receive a written report on the test or procedure will vary depending on:

• the urgency with which the results are required by your doctor;
• the complexity of the test or procedure;
• whether more information is needed from your doctor before the test or procedure can be interpreted by the radiologist;
• whether you have had previous X-rays or other medical imaging that need to be compared with this test or procedure (this is commonly the case if you have a disease or condition that is being assessed as to its progress);
• how the report is sent to your doctor (i.e. phone, email, fax or mail).

Please feel free to ask the private practice, clinic, or hospital when the written report will be provided to your doctor.

It is important that you discuss the results with your doctor, either in person or on the telephone, so that they can explain what the results mean for you.

*The author has no conflict of interest with this topic.

Page last modified on 26/7/2017.