27.9: Imaging Studies VI: Voiding Cystourethrography and Cystography

Voiding Cystourethrography (VCUG) and Cystography are specialized radiographic procedures used to examine the structure and function of the bladder and urethra.

Voiding Cystourethrography (VCUG)

A Voiding Cystourethrogram (VCUG) is a diagnostic imaging procedure that assesses the anatomy and function of the lower urinary tract. It focuses on the bladder, bladder neck, and urethra, helping detect abnormalities such as vesicoureteral reflux (VUR)—the backward or reverse flow of urine into the ureters—and bladder neck obstruction, which can impede urine outflow. This procedure offers valuable insights into bladder filling and emptying, making it especially useful for patients with urinary disorders.

Cystography

Cystography is a radiographic procedure that assesses structural abnormalities of the bladder using static X-ray images. Unlike VCUG, which evaluates bladder function during urination, cystography captures images at specific stages—when the bladder is filled with contrast dye and after it empties. It often identifies bladder diverticula, tumors, trauma, or rupture. This procedure complements VCUG when dynamic functional assessments are not needed.

Procedural Guidelines

Pre-Procedure Preparation

Proper preparation ensures smooth execution and minimizes patient discomfort:

• Informed Consent: The healthcare provider explains the procedure, including potential risks and benefits, and obtains consent.
• Allergy Assessment: Patients are assessed for allergies, especially to contrast agents, iodine, or latex.
• Voiding Instructions: Patients are asked to empty their bladder before the procedure begins to ensure accurate imaging during filling and voiding.

During the VCUG Procedure

1. Catheter Insertion: The patient lies on an examination table, and a sterile catheter is gently inserted through the urethra into the bladder. Lubrication enhances comfort during this step.
2. Contrast Infusion: A radiopaque contrast agent is slowly introduced into the bladder through the catheter, allowing clear visualization of the bladder under fluoroscopy, a real-time X-ray imaging technique.
3. Bladder Filling Imaging: Fluoroscopic images are taken during bladder filling to evaluate its shape, capacity, and any abnormalities, such as diverticula or bladder wall defects.
4. Catheter Removal: Once the bladder is filled, the catheter is removed.
5. Voiding Imaging: The patient is asked to urinate while additional X-ray images are captured to assess urine flow through the bladder neck, and urethra.
6. Post-Voiding Imaging: After urination, further images are taken to check for residual urine in the bladder, which helps determine if it has emptied completely.

Cystography Procedure

Cystography focuses on detecting structural abnormalities in the bladder. During the procedure:

• Topical Anesthesia is applied to the urethra to minimize discomfort.
• A catheter is inserted into the bladder through the urethra.
• The contrast agent is injected into the bladder to provide clear X-ray images.
• X-ray images are taken when the bladder is full and again after the contrast agent has drained.
• The entire procedure usually takes 30 to 60 minutes.

Post-Procedure Care and Follow-Up

• After the procedure, patients may experience a burning sensation during urination, which usually resolves within a few hours.
• Drinking fluids is recommended to flush out the contrast dye and reduce irritation.
• Healthcare providers may schedule a follow-up appointment to review imaging results and plan the next steps in treatment.