Cystography is the radiological examination of the bladder and cystourethrography in the radiological evaluation of the bladder and urethra. The technique involves the introduction of contrast into the bladder through the urethra with the help of a catheter, helping the doctor visualize anatomic defects and other pathologies. Cystourethrography may be advised to any patient with any type of voiding (urinating) problems, even if the trauma is suspected, to help diagnose the cause, plan treatment, and/or surgical intervention. Cystourethrography can be done for all ages, including children.
Why is a cystography test done?
Cystography provides information on the bladder and detects any abnormalities such as diverticula, fistulas, or traumatic bladder rupture. In case of trauma, cystography is done in the presence of hematuria (blood in the urine) or hip fracture with microscopic hematuria (there is no visible blood in the urine, but red blood cells are seen in a microscopic examination of urine). Cystography may be indicated in the following conditions:
- Vesicocourethral reflux (VUR): It is indicated for the evaluation of VUR.
- Hydronephrosis: It is swelling of the kidney due to accumulation of urine, which occurs due to obstruction of the flow of urine out of the kidney.
- Enuresis: It is the inability to control urination despite being old enough to be able to exercise bladder control, resulting in involuntary urination. This is called urinary incontinence.
- Incontinence: It is a loss of bladder control.
- Voiding (urinating) dysfunction: The voiding dysfunction term is used to describe conditions associated with inconsistent coordination within the urinary tract between the muscles of the bladder and urethra, resulting in incomplete relaxation or overactivity of the pelvic floor muscles during urination.
- Congenital genitourinary malformations: These are present since birth.
How is a cystography test performed?
The procedure may be performed in a clinic or hospital set up under strict aseptic conditions. An image of the abdomen and pelvis (kidneys–ureters–bladder [KUB]) is first obtained. After this, the patient’s bladder is catheterized (a tube is inserted from the urinary opening), and the stored urine in the bladder is drained. The urine sample may be sent for analysis. The contrast agent that is non-reactive is then introduced through the catheter into the bladder. The amount of the contrast agent introduced into the bladder depends on the capacity of the patient’s bladder, which is usually 300-400 mL in adults and 30 mL in children. Once the contrast is introduced, radiological images of the bladder and urethra are obtained from all angles, after which the contrast is drained out. There is minimal discomfort during the procedure. Non-cooperative patients, especially children, may receive a short-acting sedative to reduce discomfort and anxiety. The patient can usually go home right after the procedure and resume all their regular activities.
What are the complications of a cystography test?
Cystography is a safe procedure, but rarely, complications may occur that include:
- Urinary tract infection, mainly due to the catheter being introduced
- Injury caused by the catheter being inserted, resulting in frank bleeding or blood-stained urging
- Discomfort during urination, which usually resolves in a few hours after the procedure
- Allergic reaction to the contrast agent
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