Retrograde urethrography in boys

RETROGRADE

URETHROGRAPHY

JOHN F. REDMAN,

M.D.

NABIL K. BISSADA,

M.D.

IN BOYS

From the Division of Urology, University of Arkansas Medical Center, Little Rock, Arkansas

Retrograde urethrography is indicated in boys with hypospadiac meati, accessory urethral openings, urethral stricture disease, and suspected anterior urethral valves.le4 When the phallus or the meatus is small, retrograde urethrography may be difficult. The patient is placed in the conventional oblique position for retrograde urethrography. The penis is stretched. A 20- or 22-gauge polypropylene intravenous needle (Medicut) attached to a syringe filled with contrast medium is introduced into the opening to be injected (Fig. 1). A radiograph is made at the maximum force of injection (Fig. 2).

FIGURE 1. Ten-cc. syringe fitted with 22-gauge polypropylene needle ready fn- retrograde urethrography; arrow indicates tip of needle which has been removed.

Comment Retrograde urethrography in boys can be difficult, especially ifthe meatus is hypospadiac or stenotic. Small syringe tips, blunt metal needles, catheter adaptor tips, and small catheters are often ineffective. Reasons for failure include inability to introduce contrast media directly into the meatus and/or leakage around the device which precludes forceful injection. We have found the polypropylene intravenous needle to have decided advantages. It is ideal for injecting even the very small meatus. The flexible tip circumvents the technical problems of injecting a ventrally placed meatus without trauma while still occluding the meatus (Fig. 3A and B). It has been helpful to cut the needle short to allow the shoulder of the needle to come into apposition with the meatus. 4301 West Markham Street Little Rock, Arkansas 72201 (DR. REDMAN)

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FIGURE 2. Retrograde urethrogram in subject with intersex state following excision of vagina from posterior urethra.

UROLOGY

/ AUGUST1975

/ VOLUMEVI,

NUMBER2

FIGURE shoulder

3. (A) Technique of needle.

of injecting

ventrally

placed hypospadiac

meatus;

(B) detail of meatal occlusion

by

References 1. BUNGE, R. G.: Male intersexuality and damage to the upper urinary tract, J. Ural. 103: 232 (1970). 2. SCHMIDT,J. D. : Congenital urethral duplication, ibid. 105: 397 (1971).

3. DEVEREUX, M. H., and WILLIAMS, D. I.: The treatment of urethral stricture in boys, ibid. 108: 489 (1972).

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Diagnosis of an4. Scorn,, F. B., and CAFFARENA, E.: terior urethral valves, ibid. 110: 261 (1973).