RGU/ASU (RetroGradeUrethrogram/ AScending Urethrography)

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RGU (Retrograde Urethrogram), also known as ASU (Ascending Urethrography), is a specialized X-ray procedure used to visualize the male urethra, especially to evaluate strictures, injuries, or abnormalities of the anterior urethra. This procedure is most commonly indicated in cases of trauma, difficulty in urination, urethral strictures, or congenital defects. During the test, the patient lies on an X-ray table, and a contrast medium (usually water-soluble iodine-based dye) is gently introduced into the external urethral opening (meatus) using a small catheter or syringe with a penile clamp to prevent leakage. As the contrast flows in a retrograde (upward) direction through the urethra, X-ray or fluoroscopic images are taken in real time to track the dye and assess the outline, patency, and caliber of the urethral canal. Any narrowing, blockage, false passages, or leakage of contrast can be clearly identified. RGU specifically evaluates the anterior urethra (penile and bulbar portions), while for the posterior urethra (membranous and prostatic parts), a voiding cystourethrogram (VCUG) or additional imaging may be used. The procedure is simple, quick, and minimally invasive but may cause slight discomfort during contrast administration. It is critical in preoperative planning for urethral stricture surgery, post-trauma assessment, or after catheter-related complications. After the procedure, patients can resume normal activities and are usually advised to drink fluids to help flush out the contrast. RGU/ASU remains a gold standard for evaluating male urethral pathology with excellent accuracy and diagnostic value.

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