E1454. RUG: Resident Urethrography Gamesmanship 
  1. Laura Harper; Mayo Clinic
  2. Curtis Simmons; Mayo Clinic
  3. Boyd Viers; Mayo Clinic
  4. Lyndsay Viers; Mayo Clinic
Fluoroscopic urethrography, including retrograde urethrogram (RUG) and voiding cystourethrography (VCUG), provide excellent imaging of the urethra and are important modalities to assess urethral anatomy and injury. The urethra may be affected by trauma, inflammation, and stricture diseases and delineating the full extent of urethral pathology is crucial prior to surgical intervention. Radiologists, and especially radiology residents, may be unfamiliar with urethrography procedural techniques and how to recognize urethral pathology in real time during image acquisition. Even the experienced fluoroscopist may struggle to adapt standard technique for unique cases or recognize imaging mimics. Knowledge of crucial radiographic findings and how they relate to urologic management are often not well understood. This presentation will review urethrography indications and technique, urethral anatomy, patterns of urethral injury, and how to effectively communicate findings to guide management.

Educational Goals / Teaching Points
• Review indications, contraindications, and ACR appropriateness criteria for urethrography • Gain knowledge of proper patient positioning and various procedural techniques for performing urethrography • Identify urethral anatomy and key anatomic landmarks • Learn traumatic and non-traumatic mechanisms of urethral injury • Recognize patterns of urethral injury and stratify them into classification systems • Effectively communicate urethrography findings to the urologist • Understand the pitfalls and limitations urethrography

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
RUG and VCUG indications and technique will be reviewed in detail and will serve as a helpful reference for radiologists and residents prior to performing imaging. Procedural technique will include patient positioning, various supplies, tray set-up, contrast volume goals, voiding maneuvers, key images, image post processing. Urethral anatomy and common patterns of urethral injury, including pitfalls and mimics, will be presented to assist in real time assessment of imaging. Information regarding how to recognize and communicate important radiologic findings to the urologist will also be presented.

Fluoroscopic urethrography is challenging to perform and interpret, especially to the radiology resident who may be unfamiliar or intimidated by the procedure. Following review of this presentation, the reader will be more confident with the procedure, image interpretation and communication of findings to the urologist.