Voiding Cystourethrography

In voiding cystourethrography, a contrast medium is instilled by gentle syringe pressure or gravity into the bladder through a urethral catheter. Fluoroscopic films or overhead radiographs ,demonstrate bladder filling, and then show excretion of the contrast medium as the patient voids.

Purpose

• To detect abnormalities of the bladder and urethra, such as vesicoureteral reflux, neurogenic bladder, prostatic hyperplasia, or diverticula
• To investigate possible causes of chronic urinary tract infection
• To investigate a suspected congenital anomaly of the lower urinary tract, abnormal bladder emptying, and incontinence
• To assess hypertrophy of the lobes of the prostate, urethral stricture, and the degree of compromise of a stenotic prostatic urethra (in men)

Patient Preparation

• Explain to the patient that this test permits assessment of the bladder and the urethra.
• Inform him that he needn't restrict food or fluids before the rest.
• Tell him who will perform the test and where and that it takes approximately 30 to 45 minutes.
• Inform the patient that a catheter will be inserted into his bladder and that a contrast medium will be instilled through the catheter.
• Tell him he may experience a feeling of fullness and an urge to void when the contrast medium is instilled. Explain that X-rays will be taken of his bladder and urethra and that he'll be asked to assume various positions.
• Make sure that the patient or a responsible family member has signed a consent form if required.
• Check the patient's history for hypersensitivity to contrast media or iodinecontaining foods, such as shellfish; note sensitivities on the chart.
• Just before the procedure, administer a sedative, if prescribed.

Equipment

Procedure And Posttest Care

• The patient is placed in a supine position, and an indwelling urinary catheter is inserted into the bladder.
• The contrast medium is instilled through the catheter until the bladder is full.
• The catheter is clamped, and X-ray films are exposed with the patient in supine, oblique, and lateral positions.
• The catheter is removed, and the patient assumes right oblique position (right leg flexed to 90 degrees, left leg extended, penis parallel to right leg) and begins to void.
• Four high-speed exposures of the bladder and urethra, coned down to reduce radiation exposure, are usually made on one film during voiding.
• If the right oblique view doesn't delineate both ureters, the patient is asked to stop urinating and to begin again in the left oblique position.
• The most reliable voiding cystourethrograms are obtained with the patient recumbent. Patients who can't void recumbent may do so standing (not sitting).
• Expression cystourethrography may have to be performed, under a general anesthetic, for young children who cannot void on command.
• Observe and record the time, color, and volume of the patient's voidings. Report hematuria if present after the third voiding.
• Encourage the patient to drink large quantities of fluids to reduce burning on urination and to flush out any residual contrast medium.
• Monitor for chills and fever related to extravasation of contrast material or urinary sepsis.

Precautions

• Voiding cystourethrography is contraindicated in patients with an acute or exacerbated urethral or bladder infection, or an acute urethral injury.
• Hypersensitivity to the contrast medium may also contraindicate this test.
• Male patients should wear a lead shield over their testes to prevent irradiation of the gonads; female patients' ovaries can't be shielded without blocking the urinary bladder.

Normal Findings

Delineation of the bladder and urethra shows normal structure and function, with no regurgitation of contrast medium into the ureters.

Abnormal Findings

Voiding cystourethrography may show urethral stricture, vesical or urethral diverticula, ureterocele, cystocele, prostate enlargement, vesicoureteral reflux, or neurogenic bladder. The severity and location of such abnormalities are then evaluated to determine whether surgical intervention is necessary.

Interfering Factors

• Embarrassment (inhibits patient from voiding on command)
• Interrupted or less vigorous voiding, muscle spasm or incomplete sphincter relaxation (due to urethral trauma during catheterization)
• Presence of contrast media from recent tests, stool, or gas in the bowel (possible poor imaging)