Posted , 4 users are following.
Hi,
Given an option, would you go for cystoscopy or retrograde urethrogram to check for strictures in a male? Which is less invasive? I am trying to reduce the risk of causing strictures as a result of a procedure.
Thanks
0 likes, 8 replies
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glenn77 Artemis272
Posted
If you are just checking for strictures, (plural) I would choose the retrograde urethrogram. (I've had both).With a cystoscopy, the instrument may get to the first stricture and be blocked from exploring farther up the urethra. With the urethrogram, a contrast liquid is forced up the urethra to the bladder. Images are made while the contrast is being injected, then during the stationary condition to get an image of the bladder, and finally, while you are "peeing" the contrast out. Doing the later can be a bit of a challenge, while lying on your back.
Artemis272 glenn77
Posted
How big is the balloon which is inflated in the urethra to keep the catheter in place and prevent the contrast running out the tip of the penis? Does is hurt when inflated?
Also, how large is the catheter which is inserted into the bladder? Is it smaller than the cystoscope?
victor37427 Artemis272
Posted
For retrograde urethrogram (RUG), there will be no balloon inflation to my knowledge. So it is just filling out your bladder with contrast from your tip of penis and taking images as mentioned by Glenn. However, for Void Cysto Urethrogram (VCUG), they might do balloon inflation if they encounter any stricture because they have to get the catheter into bladder to fill the bladder . Avoiding this balloon inflation is good to my knowledge as it may result in increase of stricture if you have any.
Coming back to your question, if you feel or know that you have a stricture then go for RUG and get as much clear image as possible, if not, go for cystoscopy.
glenn77 Artemis272
Posted
There is no balloon, just a flexible cup that is held tight to the penis by the radiologist while the liquid is gently forced up the urethra. It was not painful to me the two times I had this done, once at Wake Baptist hospital in Winston Salem, NC, and once by a specialist at UC Irvine.
Glenn
victor37427 Artemis272
Posted
Adding to my previous comment, assuming if there is a stricture then it is important to get actual location of the stricture through RUG test so that your next set of diagnosis will depend on this image entirely. If your image shows very minimal stricture (<1 cm long), doctors might opt for DVIU procedure and if your stricture is more in length then doctors might opt for Urethroplasty. However, avoiding dilatations in order to keep open the stricture is recommended to my knowledge for bigger strictures. Because there are high chances that it will come back and with increase length of stricture. So better go for urethroplasty for bigger strictures. Also for smaller strictures check out the Optilume procedure by Urotronic. Do some research and check doctors if they have done it before and about the outcomes.
Artemis272
Posted
From what I can find online, there are two parts to the Retrograde Urethrogram.
The first part involves inserting a catheter just into the end part of the penis and a small balloon is inflated to keep it in place. Then, a contrast is injected through the catheter to fill the urethra and images are taken. This part of the test only shows narrowings involving anterior urethra (middle and lower part of the urethra).
To check the narrowings in the urethra that extend to the bladder neck, voiding cystourethrogam is needed. This involves passing a catheter into the bladder and filling it with contrast. When the bladder is full, catheter is removed and you pass urine into a bottle. Images are taken while it is being done.
Are you saying that the first part can be avoided and it is enough to detect anterior and posterior strictures by simply inserting a catheter into the bladder, filling it with contrast and when peeing it out?
Generally, how big is the catheter? Is it smaller than the cystoscope?
glenn77 Artemis272
Posted
If a doctor uses a short catheter, it has to be large enough to give a seal with the urethra where it exits the penis at the meatus. It's no big deal compared to a cystoscopy, and it's nothing like giving birth. They can use a numbing gel if you're concerned about discomfort.
glenn77
Posted
Additionally, the catheter is not inserted into the bladder, just maybe an inch or so at the meatus of the penis. The contrast liquid then flows up the urethra through the prostate area and into the bladder.