Micturating Cystourethrography

• Micturating cystourethrography is an imaging technique.

Indications

• The procedure is indicated for vesicoureteric reflux.
• It helps in studying the urethra during micturition.
• It identifies bladder leaks post-surgery or trauma.
• It aids in urodynamic studies, like those for incontinence.

Contraindications

• An acute urinary tract infection will prevent the procedure from being performed.

Contrast Medium

• High osmolar contrast material (HOCM) or LOCM at a concentration of 150 mg I mL−1 is used.

Equipment

• A fluoroscopy unit with spot film device and tilting table is needed.
• A video recorder is required for urodynamics.
• A bladder catheter is essential.

Patient Preparation

• The patient should empty their bladder before the examination.

Preliminary Image

• A coned view of the bladder is taken.

Technique

• To demonstrate vesico-ureteric reflux, a condition almost exclusively confined to children, aseptic technique is used to catheterize the bladder, and residual urine is drained.
• Contrast medium (150 mg I mL-1) is slowly injected or dripped in with the patient supine.
• Bladder filling is observed by intermittent fluoroscopy.
• Early filling is monitored by fluoroscopy to detect catheter malposition in the distal ureter or vagina.
• Intermittent monitoring identifies transient reflux, which must be recorded.
• The catheter is not removed until the radiologist confirms the patient can micturate, tolerate further infusion, or until contrast medium stops dripping into the bladder.
• Older children and adults receive a urine receiver, while smaller children use absorbent pads.
• Children can lie on the table, while adults may micturate standing.
• Micturition may be achieved by suprapubic pressure in infants and children with a neuropathic bladder.
• Spot images are taken during micturition to record any reflux; video recording can be useful.
• The lower ureter is best seen in the anterior oblique position of the affected side.
• Boys should micturate in an oblique or lateral projection to capture images of the entire urethra.
• A full-length view of the abdomen demonstrates any undetected reflux of contrast medium into the kidneys and records postmicturition residue.
• Lateral views can help when fistulation into the rectum or vagina is suspected.
• Oblique views are needed when evaluating for leaks.
• Stress views are used for urodynamic studies.

Aftercare

• Although special aftercare is unnecessary, it's important to warn patients and their parents that dysuria and potential urinary retention may occur.
• A simple analgesic and warm baths may help.
• Most children receiving antibiotics for a recent urinary tract infection should have their dosage doubled for three days, starting the day before the procedure.
• Children not already on antibiotics typically receive a 3-day course.

Complications

• Urinary tract infection (UTI) is possible.
• Catheter trauma may cause dysuria, frequency, hematuria, and urinary retention.
• Complications from bladder filling can include perforation from overdistension.
• The use of a nonretaining catheter, such as Jacques catheter, may help prevent this.
• Catheterization can result in the catheterization of the vagina or an ectopic ureteral orifice.
• Retention of a Foley catheter may occur.