Voiding cystourethrography

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.[1] 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, at least as of 2016 the technique had not been standardized across practices.[1]

Voiding cystourethrogram
MedlinePlus003784

Indications

Contraindications
  • Untreated urinary tract infection
  • Hypersensitivity to contrast media
  • Fever within the past 24 hours

Complications

The procedure is often, even usually, conducted on children and being an invasive and uncomfortable, albeit not outright painful, procedure it carries a high potential for psychological trauma for both children and their parents.[1][3] An increased risk of cancer, in particular genitourinary cancer, has been observed in one study arising from the radiation exposure inherent in the procedure.[4] With respect to post-procedural urinary track infection, the risk has been found to be sufficiently low, except in patients with a pre-existing urologic diagnosis, that pre-operative antibiotic use is not considered a necessary adjunct.[5]

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See also

References
  1. Frimberger D, Mercado-Deane MG (November 2016). "Establishing a Standard Protocol for the Voiding Cystourethrography". Pediatrics (Clinical Report). American Academy of Pediatrics. 138 (5): e20162590. doi:10.1542/peds.2016-2590.
  2. "Cystocele (Prolapsed Bladder) | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2017-12-17.
  3. Herd DW (2008). "Anxiety in Children Undergoing VCUG: Sedation or No Sedation?". Advances in Urology (Review article). Hindawi Publishing Corporation. 2008. doi:10.1155/2008/498614. Article ID 498614.
  4. Liao YH, Lin CL, Wei CC, Tsai PP, Shen WC, Sung FC, Li TC, Kao CH (30 December 2013). "Subsequent cancer risk of children receiving post voiding cystourethrography: A nationwide population-based retrospective cohort study". Pediatric Nephrology. 29 (5): 885–91. doi:10.1007/s00467-013-2703-5.(subscription required)
  5. Johnson EK, Malhotra NR, Shannon R, Jacobson DL, Green J, Rigsby CK, Holl JL, Cheng EY (August 2017). "Urinary tract infection after voiding cystourethrogram". Journal of Pediatric Urology. 13 (4): 384.e1-e7. doi:10.1016/j.jpurol.2017.04.018.(subscription required)
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