Babeh Edi

Micturating Cystourethrogram (MCUG)

Indications for imaging Vesicoureteric reflux in children - in recurrent UTI Stress incontinence Urethral stricture Bladder dysfunctions Contra Indications Current - urinary tract infection Contrast media allergies - cautions-   Anatomy  Demonstrated   Technique (typical for demonstration of reflux in a child) This is normally a paediatric procedure, therefore all normal paediatric imaging considerations are vitally important in this embarrassing and invasive procedure Some centres give prophylactic antibiotic cover. The patient lies supine on the examination table for catheterisation if not already catheterised outside the department, the patient is catheterised. Bladder catheterisation is an aseptic procedure undertaken by a suitable trained and qualified person. The contrast media warmed to body temperature is slowly infused through the catheter using a "giving set" into the bladder, intermittent pulsed fluoroscopy is used to check the filling and for reflux up the ureters. The contrast media reservoir should be no more than 1 metre above the table to limit the pressure. An alternative to spot films is to video tape the fluoroscopy. 1) Spot films are taken of the bladder, kidneys and ureters to record the normal or abnormal anatomy. 2) When the bladder is considered full or the contrast leaks round the catheter the balloon is deflated and the catheter withdrawn. depending on the age of the patient the patient is asked to micturate into a receiver either erect or supine, suitable privacy and sympathy may be required. 3) Spot films are taken during micturition and any reflux recorded, The patient is rotated into the 30 degree left and right anterior obliques to demonstrate the bladder ureteric junctions, to demonstrate the male urethra the left anterior oblique position is adopted with flexion of the right hip and knee to visualise the whole of the male urethra. 4) A final full length abdominal film is taken to visualise the kidneys. Variations For stress incontinence the film series is taken to include , at rest, straining and micturating in the lateral position, some centres have special sitting fluoro arrangements. For fistulae and bladder tract abnormalities a series of films in AP. lateral and oblique positions may be required. Contrast Media Low strength (approx 25% weight/volume) contrast agent i.e. Hypaque 25% urografin 150, suitable volume to fill the bladder, typical 20 ml in an infant to 500 ml in an adult, the contrast media should be warmed to body temperature.   Radiation protection General  fluoroscopic dose limiting precautions should be employed. Equipment Nursing- Catheterisation pack - and aseptic procedure pack.. Sterile towels Skin prep./ wash Sterile lubricant Giving set- Selection of Foley catheters 5 -7 gauge French in infants larger in adults. Drip stand Radiographic Fluoroscopy set with spot film or video recording devices. Complications Temporary Dysuria Transient Haematuria from catheterisation. CystitisAftercare Non specific, general patient post procedure care.   Evaluation of the Image ID and anatomical markers must be present and correct in the appropriate area of the film. Optimal exposure should penetrate all the bone structures and contrast should be low enough to visualise fully the bone and soft tissue structures. Images should be marked with contrast volume and indications of voiding or straining.  Radiographs Full length voiding film showing reflux into the right kidney Additional modalities Ultrasound is a useful adjunct RNI may be used to assess renal scarring in cases of proven reflux. Useful Text:  A Guide to Radiological Procedures, Chapman & Nakielny