Gelman Adapter for Retrograde Urethrography
The Gelman adapter (CS Surgical) is a stainless-steel cone-shaped meatal-occlusion device for retrograde urethrography (RUG), developed by Joel Gelman to replace a discontinued commercial plastic adaptor; Gelman first used the cone-seal technique in 1997.[5] Seating the cone at the meatus permits contrast injection with penile stretch without an inflated Foley balloon in the fossa navicularis. Gelman's clinical-practice description favors this approach; comparative pain or diagnostic-accuracy superiority over other meatal-occlusion methods has not been established.[1][4]
Design
- Cone-shaped tip, sized to seat against the external meatus and fossa navicularis.
- Original plastic version has been replaced by reusable stainless-steel adult and pediatric models (CS17075 and CS17076); confirm the specific instrument's processing instructions rather than assuming a sterilization cycle.[1][4][5]
- Luer-compatible proximal connection for syringe-driven contrast injection.
- No inflated intra-urethral balloon. The cone seats at the meatal opening; it is not a catheter advanced into the urethra.
Why It Exists — The Foley-Balloon RUG Problem
One RUG technique uses a small Foley catheter with a balloon inflated within the fossa navicularis to seal the meatus. Gelman's practice description reports a 2 mL balloon measuring about 50 Fr against a typical approximately 24 Fr fossa[1]; a separate 2015 Gelman/Wisenbaugh article describes a Taylor adaptor and a different balloon example of approximately 59 Fr.[2] Balloon dimensions vary with the apparatus.[1][2] Potential limitations include:
- Fossa dilation, pain, urethral tearing and iatrogenic fossa stricture. Even 2 mL gives a balloon of about 50–59 Fr against a fossa of about 24 Fr, and Gelman reports new fossa navicularis strictures after balloon RUG in men referred with bulbar strictures.[1][2]
- Obscuration of distal urethral pathology under a catheter or balloon and altered appearance if excessive pressure is used.
- Dependence on technique: seal placement, adequate urethral distension and projection affect measured stricture location and length.
The Gelman adapter avoids a balloon in the fossa, but a poor meatal seal, injection pressure or positioning can still compromise the examination.
Reconstructive-Urology Uses
The Gelman adapter is one option for reconstructive imaging of anterior urethral strictures, selected recurrent strictures and postoperative assessment. Other meatal-seal methods may be appropriate when the cone does not seal or anatomy prevents its use.
- Anterior urethral stricture workup. Bulbar, penile, fossa navicularis and panurethral strictures. Avoiding a fossa balloon leaves distal anatomy unobscured, but adequate distension, penile stretch and projection are still needed to estimate length and location for BMG urethroplasty approach and stage selection.[1][3]
- Recurrent stricture evaluation post-urethroplasty.
- Post-DVIU or dilation surveillance.
- Pre-operative imaging for Optilume DCB candidacy. Accurate length measurement determines balloon length selection.
- Pelvic-fracture urethral-injury preoperative imaging with simultaneous antegrade cystogram through SPT (the up-and-down-o-gram).
- Post-prostatectomy bulbomembranous stricture / VUAS workup. Non-traumatic imaging is especially important in the irradiated post-prostatectomy urethra.
Technique
- Position. Oblique, tilted approximately 45° (right anterior oblique is standard).
- Penis on stretch toward the contralateral shoulder.
- Seat the Gelman adapter against the meatus, gentle pressure to form the friction seal.
- Inject contrast gently, titrating volume and pressure to a diagnostically distended urethra without forcing against resistance. Gelman obtains a scout film first and prefers flat-plate radiographs to fluoroscopy because of fluoroscopy's smaller field of view and lower resolution.[1][2] Gelman uses a 60 mL syringe of full-strength contrast and instills about 60 mL for the RUG, then more contrast slowly when a voiding film is needed.[1][2]
- Document proximal and distal stricture margins on appropriately distended views. A separate voiding cystourethrogram or antegrade study may be needed for the proximal urethra; RUG and voluntary sphincter relaxation do not guarantee bladder-neck filling, especially with an obliterated posterior segment.[2]
Gelman Adapter vs Alternative RUG Techniques
| Method | Mechanism | Strengths | Weaknesses |
|---|---|---|---|
| Gelman adapter | Cone-shaped meatal occlusion without an inflated intra-urethral balloon[1] | Avoids balloon distension and balloon-related distal obscuration; reusable | Seal depends on anatomy and handling; model-specific processing |
| Foley catheter balloon | Balloon inflation in fossa navicularis | Widely available | Overinflation may cause pain/injury and can obscure distal pathology[1][2] |
| Penile clamp | Padded ring at coronal sulcus | Simple, low-cost | Misses 2–4 cm of distal urethra inside the glans; cannot evaluate fossa / meatal disease[3] |
| Sponge-plug method (Li 2023) | Sterilized sponge with 7 Fr catheter inserted ~1.5 cm into anterior urethra | In an uncontrolled 40-person series: 72.5% reported no pain; all procedures yielded images | Intra-urethral component; study excluded relevant meatal stenosis and lacked direct comparison[3] |
Why the Gelman Technique Matters Reconstructively
An adequately distended, well-positioned RUG helps map stricture extent for reconstruction. Under-distension, obscured distal anatomy or an incomplete proximal study can mislead planning; no cited comparative study quantifies downstream wrong-incision or staging events attributable to an adapter choice.[1][2] For pelvic-fracture urethral injury, pair RUG with appropriate antegrade or voiding assessment; when the bladder neck does not open, additional antegrade endoscopic evaluation may be required.[2]
Historical Context — Joel Gelman
Gelman's center describes initial use of the adapter in 1997, the shift from a discontinued plastic design to a stainless-steel CS Surgical instrument, and his own account that he receives no royalties from the adapter. This is a practice-site disclosure, not a finding of the 2015 Gelman/Wisenbaugh paper, which illustrates a Taylor adaptor instead.[1][2][5]
See also: Gelman Visualizing Sound, Rigid Cystoscope, Flexible Cystoscope, Urethral Stricture.
References
1. Center for Reconstructive Urology (Gelman J). "Urethral stricture diagnostic evaluation — retrograde urethrogram and the Gelman adapter." Reference clinical-practice description; Gelman adapter pictured in Campbell-Walsh Urology. centerforreconstructiveurology.org/urethral-stricture/urethral-stricture-diagnostic-evaluation
2. Gelman J, Wisenbaugh ES. Posterior urethral strictures. Adv Urol. 2015;2015:628107. doi:10.1155/2015/628107. Describes a Taylor adaptor and combined posterior imaging, not a Gelman-branded adapter.
3. Li W, Man L, Huang G. An innovative method for occluding the urethral meatus and accessing urethra strictures in retrograde urethrography in males. BMC Urol. 2023;23:158. doi:10.1186/s12894-023-01328-0
4. CS Surgical. Urology instrument catalog, Gelman adapter adult CS17075 and pediatric CS17076, p. 9 of catalog; reusable stainless-steel specifications. Consult the supplied processing instructions.
5. Center for Reconstructive Urology (Gelman J). "Urethral stricture." Clinical-practice description of the cone-adaptor RUG technique and the stainless-steel Gelman adaptor. centerforreconstructiveurology.org/urethral-stricture. Accessed October 9, 2026.