Cystography Periprocedural Care
- Author: Wellman W Cheung, MD, FACS; Chief Editor: Edward David Kim, MD, FACS more...
Equipment used for cystography includes the following:
Sterile urethral catheterization kit with tubing
Urethral catheter – In children, a 5- or 8-French pediatric feeding tube may be used
Surgical tape (for securing catheter in position)
Intravenous (IV) pole
Fluoroscope or image recording setup
Contrast medium – For voiding cystourethrography (VCUG), this should ideally be warmed to body temperature; temperature receptors in the bladder mucosa can mediate an increase in detrusor tone in young children 
Protective shielding equipment (eg, lead aprons and thyroid shields) for staff and caregivers in the room
Additional equipment for urodynamics – This includes specialized urethral catheters with pressure transducers
VCUG can be a stressful and anxiety-producing experience in children. Whether a sedative should be given is determined on the basis of a careful risk-benefit analysis. A systematic review found that midazolam (0.5-0.6 mg/kg orally 30-45 minutes before the procedure or 0.2 mg/kg intranasally before the procedure) was safe and effective in reducing distress and did not interfere with voiding dynamics.
Nonpharmacologic methods, including patient and parent education and preparation, can also be effectively used to reduce VCUG-associated distress.
For catheterization, the patient is supine, with the lower extremities in the “frog-leg” position. With small children, VCUG is usually performed in the supine or supine oblique position, but the voiding phase may be performed with the patient upright and in the usual position assumed for voiding, depending on the radiologist’s preference. To obtain the necessary views, patients may have to be shifted to the lateral or oblique positions during the examination. Urodynamic evaluation is usually performed with the patient in his or her usual voiding position.
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