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Concept
Voiding cystourethrography
Summary
In urology, voiding cystourethrography (VCUG) is a frequently performed technique for visualizing a person's urethra and urinary bladder while the person urinates (voids). It is used in the diagnosis of vesicoureteral reflux (kidney reflux), among other disorders. The technique consists of catheterizing the person in order to fill the bladder with a radiocontrast agent, typically diatrizoic acid. Under fluoroscopy (real time x-rays) the radiologist watches the contrast enter the bladder and looks at the anatomy of the patient. If the contrast moves into the ureters and back into the kidneys, the radiologist makes the diagnosis of vesicoureteral reflux, and gives the degree of severity a score. The exam ends when the person voids while the radiologist is watching under fluoroscopy. Consumption of fluid promotes excretion of contrast media after the procedure. It is important to watch the contrast during voiding, because this is when the bladder has the most pressure, and it is most likely this is when reflux will occur. Despite this detailed description of the procedure, the technique had not been standardized across practices.
Some uses of this procedure are: to study the presence of vesicoureteric reflux, study of urethra during micturition, presence of bladder leak post surgery or trauma, and is used in urodynamic testing to assess urinary incontinence.
Indications for performing VCUG:
All males with recurrent UTIs (urinary tract infections) or abnormality on ultrasound if first UTI.
Females < 3 years of age with their first UTI.
Females < 5 years of age with febrile UTIs
Older females with pyelonephritis or recurrent UTIs
Suspected obstruction (e.g. bilateral hydronephrosis)
Suspected bladder trauma or rupture
Vesico Vaginal/Vesico Colic fistula
Cystocele
Contraindications for voiding cystourethrogram is when the subject is having:
Ongoing acute urinary tract infection
Hypersensitivity to contrast media
Fever within the past 24 hours
Pregnancy
Either high osmolar contrast agent such as diatrizoate or low osmolar contrast agent such as Iotalamic acid with concentration of 150 mg per ml can be used.
Official source
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