Micturating Cystourethrography

Indications of Micturating Cystourethrography (MCUG)

• Vesicoureteric reflux
• Study of the urethra during micturition
• Bladder leak post surgery or trauma
• Urodynamic studies, e.g. for incontinence

Contraindications

• Acute urinary tract infection

Equipment

• Fluoroscopy unit with spot film device and tilting table
• Video recorder (for urodynamics)
• Bladder catheter

Patient Preparation

• Patient empties their bladder prior to the examination
• Coned view of the bladder is taken as a preliminary image

Technique of MCUG

• Bladder catheterization using aseptic technique
• Contrast medium (150 mg I mL-1) is slowly injected or dripped in with the patient supine
• Bladder filling is observed by intermittent fluoroscopy to identify transient reflux
• Intermittent monitoring is necessary to ensure the catheter is not malpositioned
• Catheter removal is done when the patient can micturate, does not tolerate further infusion, or when no more contrast medium will drip into the bladder
• Spot images are taken during micturition to record any reflux
• A video recording may be useful
• The lower ureter is best seen in the anterior oblique position of that side
• Boys should micturate in an oblique or lateral projection to take spot films of the entire urethra
• A full-length view of the abdomen is taken to demonstrate any undetected reflux of contrast medium into the kidneys and to record the post-micturition residue
• Lateral views are helpful when fistulation into the rectum or vagina are suspected
• Oblique views are needed when evaluating for leaks
• Stress views are used for urodynamic studies

Aftercare

• No special aftercare is necessary
• Patients and parents of children should be warned about dysuria, possibly leading to retention of urine
• Simple analgesics may be helpful, and children may be helped by allowing them to micturate in a warm bath
• Antibiotics may be prescribed for 3 days to prevent urinary tract infection

Complications

• Urinary tract infection
• Catheter trauma may lead to dysuria, frequency, haematuria, and urinary retention
• Complications of bladder filling, e.g. perforation from overdistension
• Catheterization of vagina or an ectopic ureteral orifice
• Retention of a Foley catheter

Learn about the indications and technique of Micturating Cystourethrography (MCUG), a medical imaging procedure used to study the urethra and bladder. Understand the contraindications and equipment required for this procedure.