Cystourethrogram

Definition:
A cystourethrogram is an X-ray test that takes pictures of your bladder and urethra while your bladder is full and while you are urinating. A thin flexible tube (urinary catheter) is inserted through your urethra into your bladder. A liquid material that shows up well on an X-ray picture (contrast material) is injected into your bladder through the catheter, then X-rays are taken with the contrast material in your bladder. More X-rays may be taken while urine flows out of your bladder, in which case the test is called a voiding cystourethrogram (VCUG).

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By filling your bladder with a liquid dye that shows up on x-rays, your doctor can watch the motion of your bladder as it fills and empties and can see if your urine splashes backwards toward your kidneys as the bladder muscle squeezes. This kind of test can help your doctor to better understand problems with repeated urinary-tract infections or problems involving damage to the kidneys. It can also be useful for evaluating urine leakage problems.

If X-rays are taken while contrast material is being injected into the urethra, the test is called a retrograde cystourethrogram because the contrast material flows into the bladder opposite the usual direction of urine flow.

Why It Is Done
A cystourethrogram is done to:

*Find the cause of repeated urinary tract infections.
*Look for injuries to the bladder or urethra.
*Find the cause of urinary incontinence.
*Check for structural problems of the bladder and urethra.
*Look for enlargement (hypertrophy) of the prostate or narrowing (stricture) of the urethra in men.
*Find out if urinary reflux is present. See a picture of abnormal backflow of urine.
*Look more carefully at abnormalities first found by intravenous pyelography.

How To Prepare
Tell your doctor before the test if:.

*You are or might be pregnant.
*You have symptoms of a urinary tract infection.
*You are allergic to the iodine dye used in the contrast material or any other substance that contains iodine. Also tell your doctor if you have asthma, are allergic to any medicines, or have ever had a serious allergic reaction (anaphylaxis), such as after being stung by a bee or from eating shellfish.

*Within the past 4 days, you have had an X-ray test using barium contrast material, such as a barium enema, or have taken a medicine (such as Pepto-Bismol) that contains bismuth. Barium and bismuth can interfere with test results.

*You have an intrauterine device (IUD) in place.

You may be asked to sign a consent form authorizing this procedure. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .

If you are breast-feeding, give your baby formula for 1 to 2 days after the test.

How It Is Done

A cystourethrogram is done by a urologist or a radiologist. The doctor may be assisted by an X-ray technologist. You usually will not have to be admitted to the hospital.

You will need to take off all or most of your clothes, and you will be given a cloth or paper covering to use during the test. You will be asked to urinate just before the test begins.
You will be asked to wear a hospital gown and  lie on your back on an X-ray table. Your genital area will be cleaned and draped with sterile towels. Men may be given a lead shield that covers their genitals to protect them from radiation. But women’s ovaries cannot be shielded without blocking the view of the bladder.

A part of your genital area is cleaned with soap on a cotton swab. Then a soft, bendable rubber tube called a urinary catheter is inserted into your bladder, usually by a nurse. The tube is first coated with a slippery jelly and then pushed gently through the opening of the urethra (at the end of the penis for men and near the opening of the vagina for women).

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A sterile flexible cystoscope in an operating theatre

A catheter will be placed through your urethra and into your bladder. Contrast material will then slowly be injected through the catheter until your bladder is full.

You will feel some pressure while the tube slides into the urethra. Once it is in place, a tiny balloon on the end of the tube is filled with air to hold it in position. The other end (about 6 inches of tubing) hangs outside of your vagina or penis. The doctor uses this tube to fill your bladder with fluid containing a dye that shows up on x-rays. You will feel pressure in your bladder as it begins to expand.

To create a clear picture, your bladder needs to be filled with as much fluid as it can hold. You will probably feel a very strong urge to urinate. A few pictures are taken with the bladder completely full, and then the balloon is emptied and the tube is pulled out. You are given a urinal container or a bedpan and asked to urinate while you are still on the table under the x-ray camera. Several pictures are taken while your bladder is emptying. Many patients find this part of the test embarrassing, but it is routine and the doctor thinks nothing of it.

X-rays will be taken when you are standing up and sitting and lying down. The catheter is removed and more X-rays will be taken while you are urinating. You may be asked to stop urinating, change positions, and begin urinating again. If you are unable to urinate in one position, you may be asked to try it from another position.

After the test is over, drink lots of fluids to help wash the contrast material out of your bladder and to reduce any burning on urination.

This test usually takes 30 to 45 minutes.

How It Feels
You will feel no discomfort from the X-rays. The X-ray table may feel hard and the room may be cool. You may find that the positions you need to hold are uncomfortable or painful.

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You will feel a strong urge to urinate at times during the test. You may also find it somewhat uncomfortable when the catheter is inserted and left in place. You will have a feeling of fullness in your bladder and an urge to urinate when the contrast material is injected. You may be sore afterward. If so, soaking in a warm tub bath may help.

You may feel embarrassed at having to urinate in front of other people. This procedure is quite routine for the X-ray staff. If you find yourself feeling embarrassed, take deep, slow breaths and try to relax.

During and after the test you may feel a burning sensation when you urinate. You may need to urinate frequently for several days after the test. You may also notice some burning during and after urination. Drink lots of fluids to help decrease the burning and to help prevent a urinary tract infection.

Risks Factors:
A cystourethrogram does not usually cause problems. Occasionally this test may lead to a urinary tract infection. If the contrast material is injected with too much pressure, there is some chance of damage to the bladder or urethra.

There is a small chance of having an allergic reaction to the x-ray dye used in the test. Some patients have some temporary irritation of their urethra after the tube has been in place, and this might result in some burning during urination for a few hours afterward. Let your doctor know if burning or pain with urinating lasts longer than a day; this could mean you have developed an infection.

As with all x-rays, there is a small exposure to radiation. In large amounts, exposure to radiation can cause cancers or (in pregnant women) birth defects. The amount of radiation from x-ray tests is very small-too small to be likely to cause any harm. X-rays such as this kind in the pelvic area should be avoided in pregnant women, because the developing fetus is more sensitive to the risks from radiation.

There is always a slight chance of damage to cells or tissue from radiation, including the low levels of radiation used for this test. However, the chance of damage from the X-rays is usually very low compared with the benefits of the test.

After the procedure
It is normal for your urine to have a pinkish tinge for 1 to 2 days after the test. Contact your doctor immediately if you have:

*Blood in your urine after 2 days.
*Lower belly pain.
*Signs of a urinary tract infection. These signs include:
*Pain or burning upon urination.
*An urge to urinate frequently, but usually passing only small amounts of urine.
*Dribbling or leaking of urine.
*Urine that is reddish or pinkish, foul-smelling, or cloudy.
*Pain in the back just below the rib cage on one side of the body (flank pain).
*Fever or chills.
*Nausea or vomiting.

Results
A cystourethrogram is an X-ray test that takes pictures of your bladder and urethra while you are urinating. Some results may be available immediately after the cystourethrogram. Final results are usually available within 1 to 2 days.

Cystourethrogram  Normal:

*The bladder appears normal.

*Urine flows normally from the bladder.

*The bladder empties all the way.

*The contrast material flows evenly out of the bladder through a smooth-walled urethra.

Cystourethrogram  Abnormal:

*Bladder stones,
*tumors,
*narrowing or pouches in the wall (diverticula) of the urethra or bladder are seen in the bladder.

*If the test was done because of possible injury to the bladder, a tear is found in the bladder wall or urethra.

*Urine flows backward from the bladder into the ureters (vesicoureteral reflux).

*Contrast material leaks from the bladder.

*The bladder does not empty all the way.

*The prostate gland is enlarged.

What Affects the Test
Reasons you may not be able to have the test or why the results may not be helpful include:
*Having barium (from a previous barium enema test), gas, or stool in the bowel.
*Being unable to urinate on command because of embarrassment at having to urinate in front of other people.
*Pain caused by having the catheter into the urethra. This may also cause problems with your urinary stream. You may have a muscle spasm or not be able to fully relax the muscles that control your bladder.
*A cystourethrogram is not usually done during pregnancy because the X-rays could harm an unborn baby.
Resources:
https://www.health.harvard.edu/fhg/diagnostics/cystourethrogram.shtml
http://www.webmd.com/a-to-z-guides/cystourethrogram-16691

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