(Cystourethrography, Voiding Cystography, Voiding Cystourethrography, VCUG)
What is cystography?
Cystography is a diagnostic procedure that uses x-rays to examine the urinary bladder. Still x-ray pictures or fluoroscopy (a study of moving body structures - similar to an x-ray "movie") may be used.
During cystography, contrast dye is injected into the bladder. Contrast refers to a substance taken into the body that causes the particular organ or tissue under study to be seen more clearly. X-rays are taken of the bladder, and fluoroscopy may be used to study the bladder emptying while a person urinates (voiding cystography). Cystography may indicate how well the bladder empties during urination and whether any urine backs up into the kidneys (vesicoureteral reflux).
What are x-rays?
X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially-treated plates (similar to camera film) and a "negative" type picture is made (the more solid a structure is, the whiter it appears on the film).
In fluoroscopy, a continuous x-ray beam is passed through the body part being examined, and is transmitted to a TV-like monitor so that the body part and its motion can be seen in detail.
Other related procedures that may be used to diagnose problems of the bladder include kidney, ureters, and bladder (KUB) x-rays, computed tomography (CT scan) of the kidneys, kidney scan, renal angiogram, renal ultrasound, retrograde cystography, pyelogram (intravenous, antegrade, and retrograde), cystoscopy, cystometry, and uroflowmetry. Please see these procedures for additional information.
How does the urinary system work?
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The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood.
The urinary system keeps chemicals, such as potassium and sodium, and water in balance,?and removes a type of waste, called urea, from the blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys.
Other important functions of the kidneys include blood pressure regulation, and the production of erythropoietin, which controls red blood cell production in the bone marrow.
Urinary system parts and their functions:
two kidneys - a pair of purplish-brown organs located below the ribs toward the middle of the back. Their function is to remove liquid waste from the blood in the form of urine, keep a stable balance of salts and other substances in the blood, and produce erythropoietin, a hormone that aids the formation of red blood cells.
The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.
two ureters - narrow tubes that carry urine from the kidneys to the bladder. Muscles in the ureter walls continually tighten and relax forcing urine downward, away from the kidneys. If urine backs up, or is allowed to stand still, a kidney infection can develop. About every 10 to 15 seconds, small amounts of urine are emptied into the bladder from the ureters.
bladder - a triangle-shaped, hollow organ located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and expand to store urine, and contract and flatten to empty urine through the urethra. The typical healthy adult bladder can store up to two cups of urine for two to five hours.
two sphincter muscles - circular muscles that help keep urine from leaking by closing tightly like a rubber band around the opening of the bladder.
nerves in the bladder - alert a person when it is time to urinate, or empty the bladder.
urethra - the tube that allows urine to pass outside the body.
Reasons for the Procedure
Cystography may be performed to assess the cause of hematuria (blood in the urine), recurring urinary tract infections (UTIs), or to assess the urinary system when there has been trauma to the bladder. Cystography may also be used to assess problems with bladder emptying and urinary incontinence.
Obstructions and strictures (narrowing) of the ureters or urethra may be evaluated by cystography. Cystography may be used to assess enlargement of the prostate gland.
Cystography may be performed before and/or after certain surgeries of the spine to assess possible problems with the nerves leading to the bladder from the spine.
There may be other reasons for your physician to recommend cystography.
Risks of the Procedure
You may want to ask your physician about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of x-rays, so that you can inform your physician. Risks associated with radiation exposure may be related to the cumulative number of x-ray examinations and/or treatments over a long period of time.
If you are pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure during pregnancy may lead to birth defects.
Patients who are allergic to or sensitive to medications, contrast dyes, local anesthesia, iodine, or latex should notify their physician.
Patients with kidney failure or other kidney problems should notify their physician.
Bladder infection may occur as a result of placing a catheter into the bladder for the procedure. Insertion of a catheter into the bladder may also cause bleeding or hematuria.
Situations in which cystography is contraindicated include, but are not limited to, the following:
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
Certain factors or conditions may interfere with the results of the test. These may include, but are not limited to, the following:
gas or stool in the intestines
inability to maintain a steady stream when urinating
barium in the intestines from a recent barium enema
Before the Procedure
Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
Your physician will give you specific instructions regarding withholding food and liquids prior to the test. Generally, you should not eat after midnight the night before the procedure and drink only clear liquids the day of the procedure. You may be instructed to drink additional clear liquids the day before and day of the procedure
If you are pregnant or suspect that you may be pregnant, you should notify your physician.
Notify your physician if you have ever had a reaction to any contrast dye, or if you are allergic to iodine.
Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
You may be instructed to take a laxative the night before the procedure. Alternatively, you may be given an enema or a cathartic (medication to induce bowel movements) medication the morning of the procedure.
Based upon your medical condition, your physician may request other specific preparation.
During the Procedure
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A cystography procedure may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.
Generally, a cystography follows this process:
You will be asked to remove any clothing, jewelry, or other objects that might interfere with the procedure.
If you are asked to remove clothing, you will be given a gown to wear.
You will be asked to empty your bladder prior to the procedure.
You will lie on your back on the x-ray table.
A catheter will be inserted into your bladder for injection of the contrast dye into the bladder.
A kidney, ureter, and bladder (KUB) x-ray will be taken to verify that the urinary system is visible. With male patients, a lead shield will be placed over the testes to protect the gonads from the x-rays.
The contrast dye will be injected into the bladder through the catheter. After the dye has been injected, the catheter tubing will be clamped to prevent drainage of the dye from the bladder.
X-rays will be taken while the dye is being injected and afterwards. You may be asked to change position for different x-ray views of the urinary system.
If a voiding cystography is requested, the catheter will be removed and you will be asked to urinate. X-ray or fluoroscopy films will be taken while you urinate. If you are unable to urinate while lying down, you may be allowed to sit or stand up.
If a voiding cystography is not performed, the catheter will be removed after all required x-ray views have been taken.
After the Procedure
There is no special type of care required after a cystography. You may resume your usual diet and activities, unless your physician advises you differently.
You should drink additional fluids for a day or so after the procedure to help eliminate the contrast dye from your system and to help prevent infection of the bladder.
You may experience some mild pain with urination or notice a pink tinge to your urine for a day or two after the procedure. This is to be expected after insertion of the catheter into your bladder. However, if the pain increases or persists longer than two days, notify your physician.
Also, notify your physician to report any of the following:
Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition.
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American Cancer Society
American Urological Association
National Cancer Institute
National Institutes of Diabetes and Digestive and Kidney Diseases
National Institutes of Health (NIH)
National Kidney Foundation
National Library of Medicine