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Cystography Medication

  • Author: Wellman W Cheung, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Dec 30, 2014
 

Medication Summary

The goals of pharmacotherapy are to reduce anxiety, morbidity, and prevent complications.

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Anxiolytics, Benzodiazepines

Class Summary

Whether a sedative should be given is determined based on a careful risk-benefit analysis. By binding to specific receptor sites, these agents appear to potentiate the effects of gamma-aminobutyrate (GABA) and to facilitate inhibitory GABA neurotransmission, as well as other inhibitory transmitters.

Midazolam

 

Midazolam has been studied as an anxiolytic and amnestic agent that does not affect voiding dynamics. It is a shorter-acting benzodiazepine sedative-hypnotic that is useful in patients requiring acute or short-term sedation. It is also useful for its amnestic effects. A systematic review found that midazolam (0.5-0.6 mg/kg orally 30-45 min before the procedure or 0.2 mg/kg intranasally before the procedure) was safe and effective in reducing distress.

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Antihypertensives, Other

Class Summary

Autonomic dysreflexia is a potentially life-threatening complication. Once it is identified, immediately drain the bladder and remove the catheter and stop the study. Having an open urethral catheterization setup for immediate access would be helpful. If blood pressure remains elevated, an antihypertensive agent with quick onset and short duration of action (eg, nifedipine or a nitrate) may be given, and blood pressure is monitored.

Antihypertensives are used to reduce arterial pressure. For acute reduction of arterial pressure, the potent vasodilator sodium nitroprusside is effective. An intravenous beta-blocker may be administered in incremental doses until a heart rate of 60-80 beats/min is attained.

When beta-blockers are contraindicated, such as in second- or third-degree atrioventricular block, consider using calcium channel blockers. Sublingual nifedipine successfully treats refractory hypertension.

Esmolol (Brevibloc)

 

Esmolol is an ultra–short-acting beta2-blocker. It is particularly useful in patients with labile arterial pressure, especially if surgery is planned, because it can be discontinued abruptly if necessary. This agent is normally used in conjunction with nitroprusside. It may be useful as a means to test beta-blocker safety and tolerance in patients with a history of obstructive pulmonary disease who are at possible risk of bronchospasm from beta-blockade. The elimination half-life of esmolol is 9 minutes.

Labetalol (Trandate)

 

Labetalol blocks alpha-, beta1-, and beta2-adrenergic receptor sites, decreasing blood pressure.

Propranolol (Inderal LA, InnoPran XL)

 

Propranolol is a class II antiarrhythmic nonselective beta-adrenergic receptor blocker. It has membrane-stabilizing activity and decreases the automaticity of contractions. Propranolol is not suitable for emergency treatment of hypertension. Do not administer propranolol intravenously in hypertensive emergencies.

Metoprolol (Lopressor, Toprol XL)

 

Metoprolol is a selective beta1-adrenergic receptor blocker that decreases the automaticity of contractions. During IV administration, carefully monitor the blood pressure, heart rate, and electrocardiogram (ECG). When considering conversion from intravenous to oral dosage forms, use the ratio of 1 mg IV to 2.5 mg PO metoprolol.

Nitroprusside (Nitropress)

 

Nitroprusside causes peripheral vasodilation by direct action on venous and arteriolar smooth muscle, thus reducing peripheral resistance. It is commonly given intravenously because of its rapid onset and short duration of action. It is easily titratable to reach the desired effect.

Nitroprusside is light sensitive; both bottle and tubing should be wrapped in aluminum foil. Before initiating nitroprusside, administer a beta-blocker to counteract the physiologic response of reflex tachycardia that occurs when nitroprusside is used alone. This physiologic response increases shear forces against the aortic wall, thus increasing arterial pressure. The objective is to keep the heart rate at 60-80 bpm.

Nifedipine (Procardia)

 

Nifedipine is one of the more common channel blockers used for hypertension.

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Contributor Information and Disclosures
Author

Wellman W Cheung, MD, FACS Clinical Professor, Department of Urology and Department of Obstetrics and Gynecology, State University of New York Downstate Medical School

Wellman W Cheung, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Chinese American Medical Society, Endourological Society, American Urogynecologic Society, International Urogynaecology Association, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction

Disclosure: Received grant/research funds from Astallas for pi.

Coauthor(s)

Sophia Kawa Chiu, MD, MA, MSc Resident Physician, Department of Urology, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Acknowledgements

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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Ureterocele. Early anteroposterior voiding cystourethrography (VCUG) demonstrates small ureterocele (left). Ureterocele had been seen at prior ultrasonography of bladder. On VCUG obtained after bladder filling (right), ureterocele is obscured by contrast material. Image courtesy of Fernbach SK, Feinstein KA, Schmidt MB. Pediatric voiding cystourethrography: a pictorial guide. Radiographics. 2000;20:155-16.
Oblique voiding cystourethrogram obtained at left ureterovesical junction demonstrates primary vesicoureteral reflux (ie, reflux without underlying abnormality such as bladder diverticulum, neurogenic bladder, or bladder outlet obstruction). Image courtesy of Fernbach SK, Feinstein KA, Schmidt MB. Pediatric voiding cystourethrography: a pictorial guide. Radiographics. 2000;20:155-16.
Posterior urethral valves. Oblique voiding cystourethrogram shows filling defect in the urethra with marked change in urethral caliber at level of defect, which indicates obstruction. Although catheter has remained in place during voiding, secondary changes crucial to diagnosis—trabeculated bladder, abnormally prominent bladder neck, and dilated and elongated posterior urethra—are clearly depicted. Image courtesy of Fernbach SK, Feinstein KA, Schmidt MB. Pediatric voiding cystourethrography: a pictorial guide. Radiographics. 2000;20:155-16.
Voiding cystourethrogram (VCUG) in patient with bulbar urethral stricture. Graphics are superimposed on VCUG to show locations of prostate and external sphincter muscle (posterior urethra). Image courtesy of Joel Gelman, MD.
Voiding cystourethrogram in patient with detrusor sphincter dyssynergia shows trabeculated bladder wall and lack of cone-shaped bladder neck during voiding.
Postvoiding film shows no residual contrast material. Image courtesy of Radswiki.net.
Gross anatomy of the bladder.
 
 
 
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