Physics, Techniques and Procedures

Micturating cystourethrography

radiographic examination of the urinary bladder after filling with contrast medium and of the urethra during voiding. The bladder is filled via a catheter (alternatively via suprapubic bladder puncture) with a water-soluble contrast medium warmed to body temperature. Frontal, oblique and lateral radiographs of the bladder may be indicated if there is suspicion of fistulae, diverticula or rupture (cystography). The technique depends on the age of the patient. Sedation may be necessary in children. Hand injection of contrast medium may be adequate in children younger than 2 months of age, for older children the contrast medium is usually instillated from a bottle elevated approximately 1 metre above the table. The contrast medium filling is controlled with intermittent fluoroscopy and spot films are obtained during early bladder filling and of any vesicoureteric reflux observed. In small children, the bladder should be filled until micturition starts. The catheter is then quickly withdrawn and additional spot films are acquired, including oblique views of the ureters, bladder and urethra during voiding, and a post-micturition view of the kidneys.

In adults, the bladder is filled from a bottle elevated 1 metre above the examination table and the filling is continued until a strong voiding urge is felt by the patient. Spot films are obtained of any abnormalities observed at fluoroscopy, including vesicoureteric reflux (Fig. 1). When possible, voiding in male patients is most easily performed in the standing position. Female patients may be sitting. Radiographs during voiding include oblique views of the distal ureters, bladder and urethra (Fig. 2). A more detailed study of the bladder and bladder neck function may require videocystourethrography.

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Fig.1

Vesico-ureteric reflux occurring during filling of the bladder.
Micturating cystourethrography, Fig.1
Micturating cystourethrography, Fig.2