An innovative method for occluding the urethral meatus and accessing urethra strictures in retrograde urethrography in males

Abstract

Objectives: To observe and evaluate the effectiveness and safety of using a sponge plug method to occlude the urethral meatus during retrograde urethrography (RUG) for accessing male urethral strictures.

Methods: 40 male patients with a mean age of 51.4 years and a history of urethral injury were primarily diagnosed with urethral stricture using a urethrocystoscope. RUG was performed using a ureteral catheter with a sponge plug inserted into the external meatus. Iodixanol, a contrast medium, was injected into the urethra or bladder for performing RUG and voiding cystourethrography (VCUG). The patients were positioned obliquely to obtain urethrograms.

Results: All X-ray radiologic procedures for performing urethrography were successful without any overflow of contrast liquid observed. In all cases, the sponge plugs became visible in the resulting images. The external meatuses were directly visualized in all cases on the obtained images, allowing identification of the number, location, and length of strictures as well as coexistent pathologies such as fistulas. In one case, the plug slipped off the meatus immediately after completing the procedure. The pain Visual Analogue Scale (VAS) was 0 to 2, mean 0.35. No instances of complication or adverse reactions was observed.

Conclusions: The sponge plug effectively occludes the external urethral meatus for retrograde urethrography, enabling visualization of the actual caliber of the entire urethra, including the strictures and external meatus, by filling it with contrast liquid. This technique is safe and well-tolerated by patients.

Keywords: Sponge plug; Urethra external meatus; Urethral stricture; Urethrography.

Fig. 1

The sponge plug was inserted into the urethral meatus (longitudinal section). (a) The ureteral catheter; (b) the sponge plug; (c) the lumen of the urethra

Fig. 2

The urethrograms were obtained through RUG and VCUG. The strictured segments were directly visualized due to the opacified urethral lumen at both ends of the strictures (black arrow). The opacified plugs clearly displayed the structures of the urethral meatus (white arrow). Each case had a specific history and location: (a) straddle injury involving the bulbar urethra, (b) pelvic fracture affecting the membranous urethra, (c) iatrogenic injury to the penile urethra. (d) exhibited a urethral fistula indicated by the curved arrow