urology Urology (from Greek οὖρον ''ouron'' "urine" and ''-logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive orga ...

, voiding cystourethrography (VCUG) is a frequently performed technique for visualizing a person's

urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra ...

and

urinary bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine ent ...

while the person urinates (voids). It is used in the diagnosis of

vesicoureteral reflux Vesicoureteral reflux (VUR), also known as vesicoureteric reflux, is a condition in which urine flows retrograde, or backward, from the bladder into one or both ureters and then to the renal calyx or kidneys. Urine normally travels in one direct ...

(kidney reflux), among other disorders. The technique consists of

catheter In medicine, a catheter (/ˈkæθətər/) is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Cat ...

izing the person in order to fill the bladder with a

radiocontrast Radiocontrast agents are substances used to enhance the visibility of internal structures in X-ray-based imaging techniques such as computed tomography (contrast CT), projectional radiography, and fluoroscopy. Radiocontrast agents are typically i ...

agent, typically diatrizoic acid. Under

fluoroscopy Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and function ...

(real time x-rays) the

radiologist Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiatio ...

watches the contrast enter the bladder and looks at the anatomy of the patient. If the contrast moves into the

ureter The ureters are tubes made of smooth muscle that propel urine from the kidneys to the urinary bladder. In a human adult, the ureters are usually long and around in diameter. The ureter is lined by urothelial cells, a type of transitional ep ...

s and back into the

kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...

s, the

makes the diagnosis of

, and gives the degree of severity a score. The exam ends when the person voids while the radiologist is watching under fluoroscopy. Consumption of fluid promotes excretion of contrast media after the procedure. It is important to watch the contrast during voiding, because this is when the bladder has the most pressure, and it is most likely this is when reflux will occur. Despite this detailed description of the procedure, the technique had not been standardized across practices.

Uses

Some uses of this procedure are: to study the presence of vesicoureteric reflux, study of urethra during micturition, presence of bladder leak post surgery or trauma, and is used in urodynamic testing to assess

urinary incontinence Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in ger ...

. *All males with recurrent UTIs (

urinary tract infections A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...

) or abnormality on ultrasound if first UTI. *Females < 3 years of age with their first UTI. *Females < 5 years of age with febrile UTIs *Older females with

pyelonephritis Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Symptoms most often include fever and flank tenderness. Other symptoms may include nausea, burning with urination, and frequent urination. Complications may i ...

or recurrent UTIs *Suspected obstruction (e.g. bilateral

hydronephrosis Hydronephrosis describes hydrostatic dilation of the renal pelvis and calyces as a result of obstruction to urine flow downstream. Alternatively, hydroureter describes the dilation of the ureter, and hydronephroureter describes the dilation of th ...

) *Suspected bladder trauma or rupture * Vesico Vaginal/Vesico Colic fistula *

Cystocele A cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complica ...

Contraindications for voiding cystourethrogram is when the subject is having ongoing acute urinary tract infection. *Hypersensitivity to contrast media *Fever within the past 24 hours *Pregnancy

Procedure

Either high osmolar contrast agent such as diatrizoate or low osmolar contrast agent such as Iotalamic acid with concentration of 150 mg per ml can be used. The urinary bladder is catheterised under aseptic technique. The contrast medium is slowly injected or dripped in slowly. The level of bladder filling is observed by taking intermittent images using

. The early filling of the bladder should be monitored carefully to detect any accidental placement of the catheter in distal

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hy ...

and to detect any reflux of contrast into the ureters. The bladder should be filled up with as much contrast as possible until the subject is unable to tolerate it or when there is no more contrast going into the bladder. If the subject is able to pee himself, then catheter can be removed for the subject to pee. If there is no confidence that the subject is able to pee, then urinary catheter should remain in place. It is more convenient for adults to pee in erect position with a urine receiver. Meanwhile, children can pee while lie down on table with a urine receiver. Infants and smaller children can lie down on table and pee on absorbent pads. For those children or infants with neuropathic bladder, pressure on the suprabic region can help them to pee. Fluoroscopic spot images and videos are taken during micturition phase to detect any reflux. The lower ureter is best seen on anterior oblique position. In males, peeing should be done in oblique or lateral positions to visualise the whole of urethra. Finally, the whole abdomen is imaged to detect any undetected reflux in pervious images. Any urine left in the bladder after peeing is also recorded in this image. Lateral views is useful to evaluate any fistula from the bladder connecting into the rectum or vagina. Oblique views is used to evaluate any leaks from the bladder or urethra. Stress views are useful in urodynamic studies.

Verumontanum The seminal colliculus ( Latin ''colliculus seminalis''), or verumontanum, of the prostatic urethra is a landmark distal to the entrance of the ejaculatory ducts (on both sides, corresponding vas deferens and seminal vesicle feed into correspondi ...

appears elongated and proximal bulbal urethra has less conical appearance.

Complications

Children may have painful micturition after the procedure, which can lead to

urinary retention Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladd ...

(children afraid to pee due to pain). Some painkillers or peeing inside a warm bath may help. Those children who receive antibiotics before the procedure for urinary tract infection will double the dose for 3 days after the procedure. Those not already on antibiotics will be prescribed with 3 days of

trimethoprim Trimethoprim (TMP) is an antibiotic used mainly in the treatment of bladder infections. Other uses include for middle ear infections and travelers' diarrhea. With sulfamethoxazole or dapsone it may be used for ''Pneumocystis'' pneumonia in pe ...

. Haematuria (blood in urine) may also occur after the procedure. The procedure is invasive and uncomfortable, and carries a high potential for psychological trauma for both children and their parents. With respect to post-procedural urinary tract infection, the risk has been found to be sufficiently low, except in patients with a pre-existing urologic diagnosis, that pre-operative antibiotic use is not considered a necessary adjunct. Other complications is perforation of urinary bladder due to overdistension. This condition can be avoided by using non-retaining urinary catheter of Jacques. Accidental catherisation of vagina or unusual urethral opening and retention of urinary catheter are also possible. An increased risk of cancer, in particular genitourinary cancer, has been observed in one study arising from the radiation exposure inherent in the procedure.

References

External links

Voiding cystourethrogram
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National Library of Medicine The United States National Library of Medicine (NLM), operated by the United States federal government, is the world's largest medical library. Located in Bethesda, Maryland, the NLM is an institute within the National Institutes of Health. It ...

{{Urologic procedures Urologic imaging Radiography

Uses

Procedure

Complications

See also

References

External links