Urethral Ultrasound: A Guide for Medical Professionals

Introduction

Urethral ultrasound or urethrogram is a diagnostic procedure often used to investigate conditions of the urethra, a tube that carries urine from the bladder to the outside of the body. This non-invasive test can provide important information about the structure and function of the urethra, aiding in the diagnosis and treatment of various urological issues.

During the procedure, the patient presents with a full bladder and voids urine into a receptacle. The patient then uses a simple technique to achieve urethral distension, which is essential for obtaining high-quality images. This article provides a comprehensive guide to performing and understanding the results of a urethral ultrasound.

Procedure Steps

Preparation

Patients scheduled for a urethral ultrasound should present with a full bladder. This ensures that the urethra is at its most distended state, providing the best possible imaging. Before the procedure, the patient may need to wait for the bladder to fill, which can take up to an hour or more, depending on individual bladder capacity and fluid intake.

Performing the Procedure

1. **Initial Positioning:** The patient is asked to empty their bladder into a receptacle. They then assume a sitting position, either upright or slightly leaning forward, depending on comfort and the operator's preference.

2. **Penile Retraction:** Using a gentle and controlled motion, the patient retracts their foreskin over the glans (head) of the penis. This is done to ensure a clear path for the urine and to prepare the urethra for distension.

3. **Urethral Distension:** The patient is instructed to direct the urine stream into a receptacle while clamping the penis between their thumb and forefinger. The clamping action is performed approximately 2 centimeters (cm) proximal to the tip of the penis, away from the foreskin. This maneuver blocks the flow of urine, allowing the urethra to become distended and filled with urine. This process can take several seconds, depending on the patient's coordination.

4. **Maintaining Distension:** Once the urethra is sufficiently distended, the patient is asked to maintain this position without clamping, allowing the bladder to fill back up with urine. The operator uses a transrectal or transvaginal probe to obtain clear imaging of the urethra.

Understanding the Results

Imaging Techniques

Urethral ultrasound can be performed using transrectal, transvaginal, or transperineal techniques. Each method has its advantages and is suitable for different patient populations and clinical scenarios.

Interpreting the Scan

The resulting scan can provide valuable information about the urethra, including its lumen, walls, and surrounding tissues. Abnormalities such as strictures, diverticula, or masses can be identified. The operator may also note any changes in the urethral lumen due to scarring or inflammation.

Follow-up Care

After the procedure, the patient may experience a feeling of fullness or mild discomfort, which typically resolves within a short period. Patients should be advised to drink fluids to help their bladder and urethra return to normal.

Conclusion

Urethral ultrasound, also known as a urethrogram, is a critical tool for diagnosing and evaluating conditions of the urethra. By providing detailed images of the urethral anatomy, this procedure helps urologists make informed decisions about patient care. Understanding the steps involved and knowing how to interpret the results are essential skills for medical professionals working in the field of urology.

Keywords

Urethral Ultrasound, Urethrogram, Bladder Scan