Retrograde Urethrogram

What is a retrograde urethrogram?

A retrograde urethrogram (RUG) is a test healthcare providers use to see if your urethra (the tube you pee through) is damaged or if there’s scar tissue blocking your urine flow.

Retrograde urethrograms are most commonly used in men or people assigned male at birth (AMAB). You might need one if you have an injury to your pelvis or groin, or if your provider thinks you have scar tissue in your urethra.

When is a retrograde urethrogram performed?

A provider might perform a retrograde urethrogram during an emergency (for instance, after an accident or other traumatic injury) or if you have ongoing symptoms they want to check out. You might need a RUG if you’ve injured your pelvic or groin area and:

• There’s blood coming out of the opening of your penis.
• You can’t pee.

A provider may also perform a RUG if:

• They think your urethra has narrowing (stricture) due to an illness, blockage or injury.
• They’re having trouble inserting a catheter (a flexible tube that helps you pee).
• They need to insert a catheter that goes all the way to your bladder (transurethral bladder catheterization) but they think you might have an issue with your urethra. They’ll use a RUG to understand whether it’s safe to insert a transurethral catheter.

What does a retrograde urethrogram diagnose?

A retrograde urethrogram can help a provider diagnose:

• Urethral stricture.
• A blockage in your urethra.
• Damage to your urethra, such as a break (rupture), opening (fistula) or pocket (diverticula).

Is retrograde urethrogram painful?

No, a retrograde urethrogram shouldn’t be painful. It might be a little bit uncomfortable during the procedure or when you pee afterward. If you’re in pain, let your provider know.

How does a retrograde urethrogram work?

During a retrograde urethrogram, a provider will push fluid called contrast into your urethra. They’ll insert a tube or the end of a blunt syringe in the hole at the end of your penis (urethral meatus) where your pee comes out. While the fluid flows toward your bladder (the pouch inside your body that holds pee), the provider will take X-rays to detect any problems with your urethra.

How do I prepare for a retrograde urethrogram?

There’s nothing you need to do to prepare for a RUG.

What should I expect during a retrograde urethrogram?

During a retrograde urethrogram:

1. You’ll lie on your side on a table under an X-ray machine. You’ll bend one leg out to the side. A provider will move you or direct you into the right position.
2. A provider will clean around the opening of your penis and apply a sterile solution (like iodine) to it.
3. They might insert some topical numbing lubricant into your penis to numb your urethra. They’ll wait a few minutes to give it time to work.
4. Your provider will insert a small tube into the hole at the head of your penis. They’ll gently move the tubing a short way into your urethra. They may gently stretch or move your penis into position or have you tell them when you feel discomfort. It shouldn’t be painful — tell your provider if you’re in pain.
5. They’ll use a syringe (a tube with a nozzle and a plunger) to push fluid into the tube in your penis. This fluid makes your urethra stand out on the X-ray images, so your provider can see what might be causing issues.
6. Your provider will use the X-ray machine to get images as the contrast moves through the urethra toward your bladder.
7. They may give you a container to pee in while they take pictures of the contrast moving out of your body.

What should I expect after a retrograde urethrogram?

After the test, you may feel some discomfort when peeing. You may also see a little bit of blood come out when you pee. These side effects are normal and should only last about a day. Make sure you drink plenty of water so that you’ll pee out any leftover contrast.

What are the risks or side effects of a RUG?

Retrograde urethrograms are very low-risk procedures. Rare side effects include:

• Infection.
• Allergic reaction to the contrast dye.
• Damage to your urethra or bladder.

What type of results do you get from a retrograde urethrogram? What do the results mean?

If your test results are normal, it means fluid is flowing through your urethra as expected. Something else is probably causing your symptoms.

Other results could show that your urethra is damaged, narrowed or blocked.

If your urologist doesn’t get enough information from a RUG, they may need to perform a cystoscopy to look at your urethra directly.

When should I know the results of a retrograde urethrogram?

When you’ll know your results depends on why you’re having the test. If you’re injured or it’s a medical emergency, your provider will have test results right away so they can treat you. If it’s not an emergency, you may have results within a few days.

If the results are abnormal what are the next steps?

Next steps depend on what’s causing the issue. Your provider will talk to you about treatment options. These may include:

• Procedures to widen your urethra (like a urethral dilation).
• Surgery (like a urethroplasty).

When should I call my doctor?

Call your healthcare provider if:

• It’s painful to pee or you can’t pee.
• You have discomfort or are bleeding for longer than a day after the test.
• You have signs of an infection, like swelling around your penis or a fever.
• You have questions about your test results.

A note from Cleveland Clinic

A retrograde urethrogram is a simple and low-risk procedure. It only takes a few minutes and gives your provider important information about possible issues in your urethra. It can be used in an emergency or after an injury to let providers know if there’s damage they can’t see.