OPPOSING URETHROGRAM (OUG)
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This document provides information about an opposing urethrogram procedure used to evaluate and document urethral strictures. It begins with an introduction to urethral anatomy and then describes the indications, contraindications, equipment, and technique for performing an opposing urethrogram. This involves inserting a suprapubic catheter and Foley catheter, filling the bladder with contrast medium under fluoroscopy, and obtaining images to assess any strictures present in the urethra. Potential complications are noted. The concluding sentences state that an opposing urethrogram is the only x-ray procedure that can accurately access the length of a urethral stricture.
OPPOSING URETHROGRAM (OUG)
- 1. GOOD MORNING TO ALL….
- 2. OPPOSING URETHROGRAM (OUG) MISS . SOWMIYA G, DRDT 2ND YEAR, GOVT.KMCH CHENNAI-10.
- 3. The opposing urethrogram is the radiographic study to evaluate and document the stricture and define the stricture recurrence. Combination of ascending urethrogram (AUG) and micturating cystourethrography (MCU) This procedure helps to access length of the stricture. INTRODUCTION
- 4. The adult male urethra is approximately 18 cm long, with the posterior urethra comprising the proximal 3 cm. The anterior urethra comprising the remaining 15 cm, with the division point between the two located at the perineal membrane. ANATOMY OF MALE URETHRA
- 5. Posterior urethra: 1) Prostatic urethra 2) Membranous urethra Anterior urethra: 1) Bulbous urethra 2) Pendulous urethra 3) Fossa naviculari THE URETHRA SUBDIVIDED INTO FIVE SEGMENTS
- 7. 1) Stricture 2) Urethral trauma 3) Fistulae or false passage 4) Vesico ureteric reflux 5) Study of the urethra during micturition 6) Bladder leak post surgery or trauma 7) Urodynamic studies,e.g.for incontinence. 8) Congenital abnormalities INDICATIONS
- 8. Acute urinary tract Infection Recent instrumentation CONTRAINDICATIONS
- 9. High osmolar contrast material or LOCM 300 mg/I 200-300 ml. LOCM 200–300mg/I 10-20ml. Pre-warming the contrast medium will help reduce the incidence of spasm of the external sphincter. CONTRAST MEDIUM
- 10. CONTRAST MEDIUM
- 11. Fluoroscopy unit with spot Film device and tilting table Video recorder (for urodynamics) Suprapubic catheter Foleys catheter 8-F EQUIPMENT
- 12. ALLENGERS 600mA FLUROSCOPY MACHINE
- 13. Suprapubic catheter Foleys catheter
- 14. Shave and clean lower abdomen and pelvis area. Take informed consent from patient or stander. The patient empties their bladder prior to the examination. Preliminary image Coned view of the bladder and Urethra PATIENT PREPARATION
- 15. Patient supine. It may be possible to fill the bladder via the suprapubic catheter. Using aseptic technique the bladder is catheterized. Residual urine is drained. To demonstrate Vesico-ureteric reflux (this indication is almost exclusively confined to children) TECHNIQUE
- 16. Contrast medium is slowly injected or dripped in with the patient supine and Bladder filling is observed by intermittent fluoroscopy. It is important that early filling is monitored by fluoroscopy. Intermittent monitoring is also necessary to identify transient reflux. Any reflux should be recorded.
- 17. Following of this procedure, then Using aseptic technique the tip of the catheter is inserted so that the balloon lies in the fossa navicularis. The catheter is connected to a 20 ml syringe containing contrast medium and flushed to eliminate air bubbles. And its balloon is inflated with 2–3 ml of water to anchor the catheter and occlude the meatus.
- 18. Gentle traction on the catheter is used to straighten the penis over the ipsilateral leg and prevent urethral overlap. Contrast medium is injected under fluoroscopic control and steep (30–45°) oblique films taken. And the patient is instructed to strain
- 19. Depending on the clinical indication, ascending urethrography (AUG) may be followed by descending micturating cystourethrography (MCU) to demonstrate the proximal urethra and bladder, assuming there is no contraindication to bladder catheterization. Examples : 1. False passage 2. Urethral stricture
- 21. Contrast reaction ( due to absorption through bladder mucosa) Urethral trauma or rupture. Extravasation of contrast – due to use of excessive pressure in stricture. COMPLICATIONS
- 22. AFTERCARE Warned - of rare dysuria , retention. Reflux - Antibiotics.
- 23. CONCLUSIONS Opposing Urethrogram (OUG) is the only procedure in x-ray to accesses the length of the Urethral stricture. And we can calculate and measures the abscesses in male urethra.
- 24. THANKING YOU……