Urology: Micturating Cystourethrography

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