The inflated cuff may conceal an injury of the distal urethra at the fossa navicularis. There are some disadvantages to this method. This allows the excess pressure to be directed away from the distal cuff and not cause an iatrogenic urethral injury. The proximal cuff will expand when the pressure in the distal cuff exceeds the maximum safe pressure during cuff inflation. The newer types of catheters have two cuffs one at the tip and the other near the balloon inflation hub of the catheter. An advantage to using the Foley catheter is that it can subsequently be advanced into the bladder to perform the cystogram. There is no leakage of contrast from the urethra and onto the patient, which can cause artifacts on the radiographs and make interpretation difficult. The Foley catheter causes little or no discomfort, is flexible, and the patient may be able to move if necessary. The Foley catheter technique is the preferred method. Patients with previous reactions should receive nonionic agents and be premedicated with corticosteroids and antihistamines.
There is a small risk of allergic reactions to the contrast media. Do not try to advance a catheter against resistance as iatrogenic injury can result. Consult a Urologist if, in a patient with pelvic trauma, there is any difficulty in passing a urethral catheter into the bladder. A urethral injury identified on the retrograde urethrogram is the only absolute contraindication to transurethral bladder catheterization and retrograde cystography. Because septic shock and irreversible renal damage can occur, a relative contraindication in the setting of acute urethritis exists when the suspicion of genitourinary tract trauma is very low. The lifesaving procedures, such as securing an airway and stabilizing life- and limb-threatening injuries, must take precedence. However, the patient's overall condition must be taken into consideration. There are few contraindications to retrograde urethrography and cystography.
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