POINT OF TECHNIQUE
|Year : 2001 | Volume
| Issue : 1 | Page : 101-102
An indigenous economic technique of positive pressure retrograde urethrography in female patients
H Singh, LN Dorairajan, S Kumar
Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
L N Dorairajan
Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry-605006
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Usually double balloon catheter is required forpositive pressure retrograde urethrography in females. We describe a technique of positive pressure retrograde urethrography using Foley catheter and rubber stopper, inexpensive and could be adopted in any hospital or radiological suite.
Keywords: Urethral Diverticulum; Urethrography
|How to cite this article:|
Singh H, Dorairajan L N, Kumar S. An indigenous economic technique of positive pressure retrograde urethrography in female patients. Indian J Urol 2001;18:101-2
|How to cite this URL:|
Singh H, Dorairajan L N, Kumar S. An indigenous economic technique of positive pressure retrograde urethrography in female patients. Indian J Urol [serial online] 2001 [cited 2019 Nov 14];18:101-2. Available from: http://www.indianjurol.com/text.asp?2001/18/1/101/37475
| Introduction|| |
Female urethral diverticulum can be a challenge to diagnose especially if it has a narrow mouth. Owing to the short urethral length and the wide urethral meatus, it is difficult to generate sufficient pressure in the urethra by techniques applicable in males. Various radiological maneuvers have been described for the diagnosis of female urethral diverticulum. Voiding cystourethrography (VCUG), positive pressure retrograde urethrography and direct instillation of contrast into diverticula have all been used. Although properly performed. VCUG under fluoroscopic control usually delineates urethral diverticula but sometimes retrograde urethrography is required. Byrne showed that double balloon positive pressure retrograde urethrography is more sensitive than VCUG. In 1959, Lang and Davis introduced double balloon positive pressure urethrography. Later on single unit model double balloon catheters (Trattner and Davis Telinde catheter) were introduced. A few variants of this technique have been described. Steinhardt and Landles used rubber olive tip of Brodney clamp device and Allis forceps whereas Scaletscky et al applied a feeding bottle nipple, used as pacifier, for retrograde urethrography. As double balloon catheters are costly and not readily available, we used Foley catheter and rubber stopper for this investigation. It is easy to assemble and moreover rubber stopper snugly fits at urethral meatus preventing leak of contrast.
| Technique|| |
Preparation of catheter:
The tip of Foley catheter (14 or 16 Fr) is blocked by tying a sterile silk suture between the eye of the catheter and the balloon. A small hole is made opposite the balloon channel, 1 cm distal to the balloon. A hole of 4mm diameter is made at the centre of a sterile rubber stopper and the Foley catheter is passed through it. [Figure - 1]
Using aseptic precautions Foley catheter is passed into urinary bladder and balloon is inflated with 30m1 sterile distilled water. The stopper is pushed over the Foley catheter up to the external urethral meatus and held in place snugly with artery forceps to prevent leakage taking care not to close the jaws of the forceps over the catheter - that could block the lumen [Figure - 2] With the right hand 8-10ml contrast is pushed through the Foley catheter. Anteroposterior and oblique view X-rays are taken.
| Advantages|| |
Foley catheter, sterile silk suture, a rubber stopper and a sterile surgical blade are all that is required to make this catheter for positive pressure urethrography. These materials are inexpensive (cost of a Foley catheter is about Rs. 60) and are available even in the smallest of hospitals or radiological suites. The procedure is easy to learn and can therefore be performed by anyone with the minimum amount of training. We have successfully demonstrated a diverticulum in three consecutive cases and have not failed to show a diverticulum in any case so far. We have not encountered any significant complication while using this technique.
| References|| |
|1.||Zimmern P. The role of voiding cystourethrography in the evaluation of the female lower urinary tract. Prob Urol 1991; 5: 233. |
|2.||Byrne DJ. Double balloon positive pressure retrograde urethrography is more sensitive than voiding cystourethrography for diagnosis of urethral diverticula in females. J Urol 2000; 163: 1891. |
|3.||Long EK, Davis HJ. Positive pressure urethrography. Radiology 1959; 79:401. |
|4.||Steinhardt GF, Landes RR. Countertraction retrograde urethrography in women: an improved diagnostic technique. J Urol 1982; 128: 936-937. |
|5.||Scaletscky R, Castro MCR, Lima CLM. Use of pacifier in female urethral evaluation. Urology 1984: 24: 358. |
[Figure - 1], [Figure - 2]