The surgical procedure
The patient was anesthetized and positioned in lateral recumbency. The urinary catheter that had been placed in the emergency
room was removed. A 4-F angiographic marker catheter was placed within a 14-F red rubber catheter that was then advanced per
rectum into the descending colon (Photo 1). This marker catheter was used to calculate radiographic magnification.
Photo 1: A lateral caudal abdominal static fluoroscopic image demonstrating a marker catheter in the descending colon (black
block arrows) and a guidewire (white arrows) placed retrograde into the urethra and urinary bladder. (Photos courtesy of Drs.
Berent and Weisse)
Photo 2: A lateral caudal abdominal fluoroscopic image obtained during retrograde contrast urethrocystography demonstrating
a normal penile urethra but a narrowed prostatic urethra (white arrows) with contrast extravasation into prostatic tumor.
There’s also a filling defect in the dorsal bladder trigone (red arrows).
The prepuce was clipped, scrubbed and draped. All wire, catheter and stent manipulations were performed under fluoroscopic
guidance. A 0.035-in, angled hydrophilic guidewire was placed transurethrally and advanced into the urinary bladder. An 8-F
introducer sheath was advanced over the guidewire and secured to the prepuce with a single nylon suture.
A 4-F Berenstein catheter was advanced over the wire, through the introducer sheath and into the urinary bladder. The guidewire
was removed, a sample of urine was collected for culture and a 1:1 combination of iodinated contrast and sterile saline solution
was injected until the urinary bladder was full.
Photo 3: A lateral caudal abdominal static fluoroscopic image demonstrating the stent delivery system placed over the guidewire
and the compressed radiopaque stent (white arrows) placed across the malignant obstruction before stent deployment.
Photo 4: A lateral caudal abdominal fluoroscopic image obtained during repeat retrograde contrast urethrocystography demonstrating
the deployed stent (white arrows) and a patent urethra.
Urethrography was performed with the same contrast mixture through the introducer sheath to distend the urethra and define
the extent and location of the urethral obstruction (Photo 2). Maximal urethral diameter was determined, and an appropriately
sized, laser-cut, nickel-titanium alloy (Nitinol—NDC), self-expanding metallic stent was chosen. The Berenstein catheter was
removed over the guidewire, and the stent delivery system was advanced over the guidewire across the urethral obstruction
(Photo 3). The stent was deployed across the urethral obstruction, and repeat urethrography was performed through the introducer
sheath to confirm urethral patency (Photo 4). A final radiograph was obtained and the guide wire and introducer sheath were