Urology: Micturating Cystourethrography
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Questions and Answers

What is a contraindication for micturating cystourethrography?

  • Study of the urethra during micturition
  • Bladder leak post-surgery or trauma
  • Acute urinary tract infection (correct)
  • Vesicoureteric reflux
  • What type of contrast material is used in micturating cystourethrography?

  • Non-ionic contrast material (NICM) 250 mg I mL−1
  • Low osmolar contrast material (LOCM) 300 mg I mL−1
  • Iso osmolar contrast material (IOCM) 200 mg I mL−1
  • High osmolar contrast material (HOCM) or LOCM 150 mg I mL−1 (correct)
  • What is the purpose of intermittent fluoroscopy during bladder filling?

  • To identify early filling and monitor for malpositioned catheter (correct)
  • To measure urinary flow rate
  • To monitor reflux
  • To monitor bladder capacity
  • How is micturition accomplished in infants and children with a neuropathic bladder?

    <p>By suprapubic pressure</p> Signup and view all the answers

    In which position is the lower ureter best seen?

    <p>Anterior oblique position of that side</p> Signup and view all the answers

    What is the purpose of taking a full-length view of the abdomen?

    <p>To demonstrate reflux of contrast medium into the kidneys</p> Signup and view all the answers

    Why are lateral views helpful in micturating cystourethrography?

    <p>To suspect fistulation into the rectum or vagina</p> Signup and view all the answers

    What is a potential complication of bladder filling during micturating cystourethrography?

    <p>Perforation from overdistension</p> Signup and view all the answers

    Why are antibiotics prescribed to children after the procedure?

    <p>To prevent urinary tract infections</p> Signup and view all the answers

    What is a common aftercare measure for children experiencing dysuria after the procedure?

    <p>Allowing them to micturate in a warm bath</p> Signup and view all the answers

    Study Notes

    Indications for Micturating Cystourethrography

    • 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

    Contrast Medium

    • High osmolar contrast material (HOCM) or LOCM 150 mg I mL−1

    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
    • Preliminary image: coned view of the bladder

    Technique for Demonstrating Vesicoureteric Reflux

    • Bladder catheterization using aseptic technique
    • Residual urine drainage
    • Slow injection or dripping of contrast medium (150 mg I mL−1) with patient supine
    • Intermittent fluoroscopy monitoring for early filling and reflux
    • Importance of not removing the catheter until confident of patient's ability to micturate
    • Use of urine receiver for older children and adults
    • Suprapubic pressure for micturition in infants and children with a neuropathic bladder
    • Spot images taken during micturition to record reflux
    • Video recording may be useful
    • Lower ureter best seen in the anterior oblique position of that side
    • Boys: micturition in an oblique or lateral projection for spot films of the entire urethra
    • Full-length view of the abdomen to demonstrate undetected reflux and post-micturition residue
    • Lateral views: helpful when fistulation into the rectum or vagina is suspected
    • Oblique views: needed when evaluating for leaks
    • Stress views: used for urodynamic studies

    Aftercare

    • No special aftercare necessary
    • Warning patients and parents of children about possible dysuria leading to retention of urine
    • Simple analgesic may be helpful
    • Allowing children to micturate in a warm bath may be helpful
    • Antibiotics: usually doubled for 3 days, starting on the day prior to the procedure

    Complications

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

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    Description

    Learn about the indications, contraindications, and equipment required for Micturating Cystourethrography, a diagnostic procedure used in urology.

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