Urethrography in Men: Conventional Technique versus Clamp Method

Purpose: To compare examination adequacy and patient discomfort during retrograde urethrography (RUG) performed by using the conventional balloon method versus those of RUG and voiding cystourethrography (VCUG) performed with the clamp method of using drip infusion for the administration of contrast material. Materials and Methods: This prospective study was approved by the institutional review board; written informed consent was obtained from all patients. Eighty men (mean age, 64.3 years +/- 16 [standard deviation]; range, 18-85 years) suspected of having urethral stenosis were randomly distributed into two groups for urethrography: a control group (n = 36) and a clamp group (n = 44). In 11 of the 36 patients in the control group, the conventional balloon method could not be used, so these patients were transferred to the clamp group. Drip infusion was used to administer contrast material for RUG, and, except in cases where a suprapubic catheter was used (n = 8), for VCUG. The pain levels reported by patients were recorded by using a verbal descriptor scale (VDS) and a visual analogue scale (VAS). Results: In the control group, RUG was successfully performed in 69% of patients (25 of 36), and mean pain levels recorded on inflation of the balloon were distressing according to the VDS and 4.8 +/- 1.4 (range, 2.3-7.5) according to the VAS. In the clamp group, RUG was successfully performed in all cases; in 69% of patients in this group (38 of 55), the pain level recorded at external compression was no pain according to the VDS and 0 according to the VAS, while mean values in the remaining 31% of patients (17 of 55) were mild pain on the VDS and 0.6 +/- 0.3 (range, 0.3-1.2) on the VAS. Bladder filling for VCUG was achieved with drip infusion in 96% of patients (69 of 72) in an average time of 11 minutes. Conclusion: The conventional balloon method of performing RUG is painful and, in some cases, not effective. The clamp method is a simple, well-tolerated procedure that allowed diagnostic evaluation in all cases. Drip infusion enables RUG and VCUG to be performed without the need for syringes or bladder catheters, thus increasing patient comfort. (C) RSNA, 2009