II. Indications: Suspected Urethral Trauma (perform prior to Foley Catheter placement)
- Perineal or scrotal Hematoma
- Blood at uretheal meatus
- High riding Prostate
- Pelvic Fracture or Pubic Symphysis Diastasis suspected
- Inability to void
III. Contraindications
- Contrast allergy
IV. Preparations: Water Soluble Contrast
- Diatrizoate (no dilution needed)
- Iohexol (Omnipaque) diluted 50% with Normal Saline (1:1)
- Iodaxanol (Visipaque) diluted to 10% with Normal Saline
V. Technique: Bedside Emergency Department Procedure (where urology not available)
- Preparation
- Obtain consent
- Obtain Contrast Material and catheter set-up
- Operator should wear a lead apron, to remain in position for imaging during injection
- Sterilize the Urethral entry site and apply a drape
- Insert 8 Fr Foley Catheter until balloon is inside the distal Urethra (1 to 2 cm)
- Gently inflate balloon with 1 to 1.5 ml saline, air or contrast (just enough to secure in place)
- However, this risks Urethral injury, and some authors recommend against balloon inflation
- As alternative, pinch meatus closed to prevent leakage, or use Toomey Type syringe
- Catheter-tip syringe (Toomey-Type Syringe) may be used as an alternative to 8 Fr
- Secure by gently compressing glans (with hand) around catheter tip
- Gently inflate balloon with 1 to 1.5 ml saline, air or contrast (just enough to secure in place)
- Hold the penis gently outstretched
- Hold the Urethral meatus closed around the catheter
- Slowly inject contrast via catheter
- Use water-soluble contrast options (see list above)
- Inject slowly and gently
- Venous extravasation may occur with high pressure (appears similar to Urethral injury)
- Image with XRay or Fluoroscopy
- Perform imaging while injecting last 10 ml of contrast
- Obtain images in 2 opposing views (i.e. anteroposterior and lateral view)
- Consider repeat Imaging in 10 minutes
- Indicated in non-diagnostic imaging or venous plexus present
VI. Complications
- Genitourinary infection
-
Urethral injury (from catheter placement)
- May result in contrast extravasation with secondary inflammation
VII. References
- Herbert and Inaba in Herbert (2014) EM:Rap 14(3): 5-6
- Davis in Roberts (2014) Clinical Procedures in Emergency Medicine, 6th Ed, Saunders Elsevier, p. 1113-54
- Warrington (2016) Crit Dec Emerg Med 30(12): 12