MCUG Procedure PDF

MICTURATING CYSTOURETHROGRAPHY At the end of this lec the student should learn -indication of MCUG -the technique of MCUG Indications 1. Vesicoureteric reflux 2. Study of the urethra during micturition 3. Bladder leak post surgery or trauma 4. Urodynamic studies, e.g. fo...

MICTURATING CYSTOURETHROGRAPHY At the end of this lec the student should learn -indication of MCUG -the technique of MCUG Indications 1. Vesicoureteric reflux 2. Study of the urethra during micturition 3. Bladder leak post surgery or trauma 4. 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 1. Fluoroscopy unit with spot film device and tilting table 2. Video recorder (for urodynamics) 3. Bladder catheter Patient Preparation The patient empties their bladder prior to the examination. Preliminary Image Coned view of the bladder. Technique To demonstrate vesico-ureteric reflux (this indication is almost exclusively confined to children): 1. Using aseptic technique, the bladder is catheterized. Residual urine is drained. 2. Contrast medium (150 mg I mL−1) is slowly injected or dripped in with the patient supine, and bladder filling is observed by intermittent fluoroscopy. It is important that early filling is monitored by fluoroscopy in case the catheter is malpositioned, e.g. in the distal ureter or vagina. 3. Intermittent monitoring is also necessary to identify transient reflux. Any reflux should be recorded. 4. The catheter should not be removed until the radiologist is confident that the patient will be able to micturate, the patient does not tolerate further infusion or until no more contrast medium will drip into the bladder. 5. Older children and adults are given a urine receiver, but smaller children should be allowed to pass urine onto absorbent pads on which they can lie. Children can lie on the table, but adults will probably find it easier to micturate while standing erect. In infants and children with a neuropathic bladder, micturition may be accomplished by suprapubic pressure. 6. Spot images are taken during micturition, and any reflux is recorded. 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, so that spot films can be taken of the entire urethra. 7. Finally, a full-length view of the abdomen is taken to demonstrate any undetected reflux of contrast medium that might have occurred into the kidneys and to record the post-micturition residue. 8. Lateral views are helpful when fistulation into the rectum or vagina are suspected. 9. Oblique views are needed when evaluating for leaks. 10. Stress views are used for urodynamic studies. Aftercare 1. No special aftercare is necessary, but patients and parents of children should be warned that dysuria, possibly leading to retention of urine, may rarely be experienced. In such cases a simple analgesic is helpful, and children may be helped by allowing them to micturate in a warm bath. 2. Most children will already be receiving antibiotics for their recent urinary tract infection—the dose will usually be doubled for 3 days, starting on the day prior to the procedure. Children not already on antibiotics will also usually be prescribed a 3-day course (often trimethoprim). Complications 1. Urinary tract infection 2. Catheter trauma may lead to dysuria, frequency, haematuria and urinary retention. 3. Complications of bladder filling, e.g. perforation from overdistension; prevented by using a nonretaining catheter, e.g. Jacques 4. Catheterization of vagina or an ectopic ureteral orifice 5. Retention of a Foley catheter Thank you for listening