•Micturating or voiding cystourethrogram demonstrate the lower urinary tract and helps to detect the existence of any vesico-urethral reflux, bladder pathology and congenital or acquired anomalies of bladder outflow tract.
•voiding difficulties like dysuria,dribbling, thin stream, frequency
•vesico ureteric reflux
•other congenital anomalies like meningiomyelocele,rectal anomalies
•pelvic trauma or post operative evaluation
•boys with heamaturia.
•Trauma to urethra.
• Urethral stricture.
•Suspected urethral diverticula.
•Reflux nephropathy prior to renal transplant of one/both kidneys.
•Follow up of patients with spinal cord injury
•Water soluble constrast media like Conray 280, Trivideo 400 mg, Urograffin 60% are used which is diluted with normal saline in 1:3 ratio.
•A catheter is introduced into the bladder by using sterile technique.
•A 5F feeding tube with side hole are used for children and 8F-10F Polyethylene or soft rubber catheters with end holes are used in adults.
•In males the foreskin is retracted and catheter is introduced.
•The catheter should be lubricated with an anaesthetic jelly and inserted slowly and gently into the urethra holding the penis in vertical position.
•In females after an initial inspection of the perinium to indentify any local genital abnormality. The urethral catheter is inserted.
•when it enters the bladder a varing amount of urine will flow through it. It indicates the right site of catheter insertion.
•bladder is filled by hand injection.
•Older children, contrast medium instilled from a bottle elevated one metre above examination table.
•during the filling a flouriscopic screening is done to see if vesico urethral reflux or any other abnormalities are present.
•If reflux appear films are taken in the appropriate oblique projection.
•If bladder appear one film is taken in the frontal projection at the end of filling.
•Voiding starts in infants the movement the catheter is removed. At the end of voiding a frontal film is taken in which entire abdomen including the kidney region in order to prevent overlooking the vesico urethral reflux
•bladder is filled in same way done in older Children and voiding filming is done in both oblique projection.
•The voiding study in male adults can be modified by getting the patient to void against resistance i.e. either by conpression by the distal part of penis or by penil clamp this is known as CHOKE CYSTOURETHROGRAPHY which enhances visualisation of urethra.
•The procedure is essentially the same as in girls.
• In addition to the standard exposures, a double exposed film taken at rest and during straining demonstrates the degree of bladder descent if any.
•SUPRAPUBIC BLADDER PUNCTURE.
•Sometimes in PUV & pelvic trauma – not possible to catheterize.
•Contrast medium introduced into the bladder during RGU.
•EXCRETION MCU ( MCU followed by IVU )
•Advantage – avoid catheterization and related risk of infection.
•Disadvantage – VUR can not be visualized properly .
•takes longer time.
GRADING OF VUR
Grade 1 : reflux limited to ureter
Grade 2 : reflux into renal pelvis
Grade 3 : mild dilatation of ureter and pelvicalyceal system.
Grade 4 : tortuous ureter with moderate dilatation, blunting of fornicies but preserved papillary impressions.
Grade 5 : tortuous ureter with severe dilatation of ureter and pelvicalyceal system, loss of fornicies and papillary impressions.
•Danger of infection due to catheterization of bladder.
•Adverse reaction to contrast medium.
•Complications of bladderfilling e.g. perforation by the catheter
•Radiation effect: VCU is a diagnostic procedure that inevitably
•exposes gonads to some radiation. It should be kept to a minimum. Careful attention to ensure very short screening periods. Tightly collimated X-ray beam.
•Autonomic dysreflexia: In paraplegic patients due to spinal cord injury at or above T6 level, forceful injection of contrast causes severe headache, sweating and hypertension with bradycardia due to forceful opening of the bladder neck. Treat by promptly relieving vesical distension sor give diazoxide 3-5 mg/kg.
•Prophylaxis antibiotic may be used