10 Questions
What is a contraindication for micturating cystourethrography?
Acute urinary tract infection
What type of contrast material is used in micturating cystourethrography?
High osmolar contrast material (HOCM) or LOCM 150 mg I mL−1
What is the purpose of intermittent fluoroscopy during bladder filling?
To identify early filling and monitor for malpositioned catheter
How is micturition accomplished in infants and children with a neuropathic bladder?
By suprapubic pressure
In which position is the lower ureter best seen?
Anterior oblique position of that side
What is the purpose of taking a full-length view of the abdomen?
To demonstrate reflux of contrast medium into the kidneys
Why are lateral views helpful in micturating cystourethrography?
To suspect fistulation into the rectum or vagina
What is a potential complication of bladder filling during micturating cystourethrography?
Perforation from overdistension
Why are antibiotics prescribed to children after the procedure?
To prevent urinary tract infections
What is a common aftercare measure for children experiencing dysuria after the procedure?
Allowing them to micturate in a warm bath
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
Learn about the indications, contraindications, and equipment required for Micturating Cystourethrography, a diagnostic procedure used in urology.
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