Emergency 1 – March 2013 – Ivo Dukic, Arie Parnham, Mr DA Jones
HOW DO YOU DO URETHROGRAM +/- CYSTOGRAM?
Urethrogram
I would make sure any trauma patient had been stabilized and treated in accordance with ATLS
guidelines as the majority (86%) of urethral injuries secondary to trauma are associated with
additional injuries (Mundy & Andrich 2011)

I would explain the procedure to the patient and position them on an appropriate X-ray
table (A&E or X-ray Department).

I would position the patient in a 30° right lateral position with the right leg flexed at the
knee and hip if possible (alternatively the C-arm could be rotated to give a more lateral
view in trauma patients).

Using an ANTT, I would place a 12Fr. Foley catheter in the fossa navicularis and inflate
the balloon with 2mls of water. If a catheter was already in place a 6-8 Fr catheter could
be placed alongside and urethrogram performed if there was a possible urethral injury
and per urethral bleeding (Mundy & Andrich 2011).

I would take a scout/plain film.

I would slowly inject 20- 30mls of a non-ionic contrast agent (Omnipaque) and screen as
I was injecting and take at least 2 films to be archived.

I would perform a post drainage film to look for small tears.
Cystogram

70-97% of bladder injuries caused by blunt trauma are associated have associated pelvic
fractures. 90% are caused by motor vehicle accidents.

Insert catheter into bladder with ANTT

Fill with at least 350mls of diluted non-inonic contrast agent (Niopam / Omnipaque).

Oblique and post drainage films compulsory.
(10% of bladder perforations seen on post drainage films)