Retrograde Urethrogram or a Venogram? Be Careful Next Time

Abstract

Retrograde urethrogram is employed for adequate demonstration of anterior urethral stricture and is commonly performed by trainee residents. Not uncommonly, contrast is injected under pressure to overcome the resistance of a stricture which can lead to extravasation or intravasation exposing the patient to risk of bacteremia, sepsis, contrast reactions, and worsening of stricture. We report two such cases of extensive intravasation delineating the "venogram" of peno-pelvic venous arcade. Such rare occurrences highlight the importance of eliciting history of various allergies and asthma, urethral instrumentation, obtaining sterile urine before the study, and performing the study under dynamic fluoroscopy.

Keywords: Intravasation; Stricture; Urethrogram.

Fig. 1

Retrograde urethrogram showing tight stricture at penobulbar junction and gross intravasation delineating dorsal vein of penis, circumflex veins, main trunks, and tributaries of internal pudendal, internal iliac and common iliac veins, and inferior vena cava (not shown)

Fig. 2

Retrograde urethrogram demonstrating stricture in midbulbar urethra along with dense intravasation with extensive visualization of corpus spongiosum, periurethral veins, dorsal vein of the penis, pudendal venous plexus and internal pudendal veins