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Cystography Periprocedural Care

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

Equipment

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
  • Sterile gloves
  • 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 [16]
  • 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
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Patient Preparation

Anesthesia

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.[17]

Nonpharmacologic methods, including patient and parent education and preparation, can also be effectively used to reduce VCUG-associated distress.[18]

Positioning

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.[19] Urodynamic evaluation is usually performed with the patient in his or her usual voiding position.

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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.

References
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  17. Herd DW. Anxiety in children undergoing VCUG: sedation or no sedation?. Adv Urol. 2008. 498614. [Medline]. [Full Text].

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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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