HWN Suggests

The Importance of the RUG

As with any trauma, stabilizing life-threatening injuries takes priority. Following the stabilization of these injuries, attention should turn to the evaluation and management of conditions that have significant morbidity including urethral injury. A retrograde urethrogram (informally known as the “RUG” and also referred to as an ascending urethrogram) is a test ordered for suspected urethral injury and was first described in the literature in the early 1900s

read full article

Articles of Interest

A perfected device for performing retrograde urethrography

Retrograde urethrography (RUG) is considered to be the best initial study for urethral and periurethral imaging in men. Currently the most widely used RUG technique involves a Foley catheter (conventional technique). Fixation of the catheter is achieved by inflating a balloon in the fossa navicularis, which prevents extravasation on introduction of contrast material. No local anesthesia is used, nor is the use of lubrication recommended, such that the patient notes discomfort on introduction of the catheter and inflation of the balloon. Moreover, this technique cannot be performed in cases of stenosis, malformations or previous surgery in the urethromeatal area.

Genitourinary Trauma: Presentations, Evaluation, and Management Updates

A 16- or 18-French Foley catheter (some utilize 6- to 10-French catheters) is flushed with radiopaque contrast to remove any air bubbles. The penile glans and urethral meatus should be cleaned with antiseptic. The catheter is then placed with sterile technique just inside the urethral meatus so that the catheter balloon rests in the fossa navicularis. The catheter balloon in filled with 1-2 ml of radiopaque contrast, saline, or water. The balloon should not be overfilled, as this can cause distal urethral rupture. The operator then pulls the penis laterally to straighten the urethra, grasping the penis as distally as possible, and distal to the inflated balloon. A scout film is then obtained before 20-30 ml of radiopaque contrast is gently infused with a catheter tip syringe through the catheter and into the urethra while additional films are obtained. A normal study demonstrates retrograde flow of contrast from the catheter through the anterior and posterior urethra and into the bladder.

Podcast #375: Retrograde Urethrogram

Urethral injury is evaluated using a retrograde urethrogram (RUG), If urethra is confirmed to be intact, Foley catheter can be placed to allow additional tests.

Post-traumatic Retrograde Urethrography: A Review of Acute Findings and Chronic Complications

While injuries to the urethra are relatively rare compared to other segments of the genitourinary tract, urethral injury can be seen in 4-24% of male patients with pelvic fractures. Although rarely life-threatening, urethral injuries can lead to significant long-term morbidity. Retrograde urethrography (RUG) continues to be the best initial diagnostic study for evaluating acute male urethral trauma and post-traumatic complications.

Post-traumatic Retrograde Urethrography: A Review of Acute Findings and Chronic Complications

At our institution, we use a 14 French Foley catheter for most RUGs. Smaller catheters, ranging from 8 to 12 French, may be used with smaller urethras.

Retrograde Urethrogram (RUG)

Prime catheter with contrast. Secure catheter in distal penile urethra with any of the techniques. Use catheter tip syringe to occlude urethral lumen. Use gauze sling around distal penis to apply traction. Insert balloon catheter and gently inflate (max 3 cc) to occlude urethral lumen and apply traction. Use fingers to secure catheter, occlude urethral lumen, and apply traction.

Urethral trauma. Part I: introduction, history, anatomy, pathology, assessment and emergency management

RUG is the most accurate means of diagnosing and classifying urethral trauma currently available but is prone to overdiagnose complete injuries. If a radiological diagnosis is felt to be essential but to be used judiciously, a high index of suspicion is necessary in any patient with urethral bleeding; or with either a penile or perineal haematoma after a penile fracture or a straddle injury respectively; or with an unstable pelvic-ring disruption after a lateral compression injury of the pelvis.

Resources

Gold Diagnostics

A retrograde urethrogram (RUG) is a crucial diagnostic procedure in patient care, primarily employed to assess and diagnose various conditions affecting the urethra and urinary tract. It serves to pinpoint urethral strictures, evaluate urethral trauma, detect structural anomalies, and guide treatment strategies.

Radiology Key

The retrograde urethrogram—without voiding phase—is the preferred study to evaluate the anterior urethra, particularly in the male. For this study, a catheter is inserted into the fossa navicularis and the balloon partially inflated and placed on gentle traction to occlude the distal urethra. With the child in the lateral decubitus position, contrast is gently injected with slow steady pressure under fluoroscopy to overcome resistance of the external sphincter opacifying the posterior urethra as much as possible. In attempting to diagnose a suspected stricture to facilitate surgical planning, we try to opacify flanking aspects of the normal urethra by rotating the child or the fluoroscopy unit. To perform an adequate retrograde urethrogram in the shorter female urethra, a “double-balloon” catheter is sometimes used in adults to occlude both the meatus and bladder neck; this is not commonly used in children.

wradiology

Urethrogram is conducted by inserting the tip of a Foley catheter into the urethral opening, followed by the instillation of 50 milliliters of contrast under low pressure. A simple X-ray is then taken of the region. A healthy urethra should have a smooth linear shape and a full bladder. Meanwhile, a damaged urethra may have an uneven shape, cease abruptly without bladder filling, or have contrast extravasation into adjacent tissues.