Normal retrograde urethrogram (RUG) and voiding cystourethrogram (VCUG)

Case contributed by Matt A. Morgan
Diagnosis certain


Scrotal pain and increased frequency. No other history provided.

Patient Data

Age: 40 years
Gender: Male

Normal retrograde urethrogram (RUG), followed by a normal voiding cystourethrogram (VCUG).

Retrograde urethrogram:

The penis is postioned at approximately the 10 o'clock position. The round opaque structure in the distal penis is the inflated Foley balloon. The Foley catheter tip is faintly radiopaque, but can be better seen as a filling defect after administration of contrast. 

There is no stricture or leak of the urethra. Contrast pauses at the external sphincter, with good opacification of the penile and bulbar urethra.

Voiding urethrogram:

The voiding urethrogram evaluates the posterior urethra. The Foley balloon is advanced into the bladder and contrast is instilled until the bladder is dilated. The bladder should be so dilated, that the patient "feels like he absolutely needs to pull off to the side of the road so he can urinate". The Foley is then removed and the patient is encourage to urinate.

Images are obtained of the open posterior urethra. As this is not a dedicated cystogram, imaging the bladder is a secondary concern. In this case, there is no stricture or leak.

Case Discussion

Retrograde urethrography (RUG) and voiding cystourethrography (VCUG) are complementary studies for evaluating the male urethra. The RUG evaluates the anterior urethra and the VCUG evaluates the posterior urethra.

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