UNIT 2: CYSTOGRAPHY, CYSTOURETHROGRAPHY, & RETROGRADE UROGRAPHY Flashcards
What is Cystography and what is it done for?
• Radiographic examination of the bladder and lower urinary tract
• Procedure done for:
• Vesicoureteral reflux
• Recurrent UTI
• Neurogenic bladder (lacks bladder control due to a CNS issue)
• Bladder trauma
• Fistula (abnormal connection between an organ, vessel, or intestine and another
structure)
• Urethral stricture
What contrast media is used for Cystography?
Low concentration (25-30%) ionic contrast media often used due to large volume of administration (more cost effective)
T or F: Patient catheterized under sterile technique for Cystography
True
Scout image for Cystography
• 10 X 12 LW
• centered to the MSP midway between the ASIS and the symphysis
• OR KUB with a 14X17
How does Cystography contrast media work during this procedure?
• 300-500 ml Contrast drips into bladder via catheter by gravity
• NEVER INJECT CONTRAST FORCEFULLY AS THIS CAN DAMAGE THE BLADDER
• Fluoroscopic spot films may be taken during contrast infusion
• Once bladder is full, 4 common projections are taken:
• AP or AP Axial
• Bilateral Obliques
• Lateral
• If contrast refluxes into the ureter(s) during the exam, you may be asked to take KUB on 14 X 17
• Additional films are done as indicated such as a voiding film
Cystography AP/ PA positioning
• Patient supine
• Legs should be straight
• 10 X 12 LW
• CR perpendicular to midway between ASIS and pubic symphysis at midline
• Suspend respiration
Cystography AP Axial positioning and evaluation criteria
• Patient supine
• 10 X 12 LW
• CR angled 10-15 Degrees caudal
• Enters 2 inches Above pubic symphysis
• Suspend on exhalation
• If PA is performed, angle cephalad 10-15 degrees
• In this projection, bladder should be filled with contrast, and best demonstrates reflux.
Cystography RPO/LPO positioning and evaluation criteria
• 10X 12 LW
• Patient rotated 40 to 60* from supine
• CR perpendicular to 2 in above symphysis and 2 in medial to elevated ASIS.
• Suspend at end of expiration
• Demonstrates no superimposition of the bladder by the hips
• Bladder should be centered in your image
Cystography Lateral positioning and evaluation criteria
• 10 X 12 LW
• Patient in lateral recumbent position
• CR perpendicular to 2 in above pubic symphysis at the MCP
• Bladder filled with contrast
• Should demonstrate your hips and femur superimposed
Male Cystourethrography
• Procedure done to investigate the urethra for trauma or stricture
• Male patients placed in RPO 35 to 40 degrees with elevated leg extended
away from the ROI
• Radiologist inserts special catheter tip syringe filled with contrast into urethral orifice and injects
• Exposures are taken during injection
• Urethra and bladder should begin to get filled with contrast
Cystourethrography tear image
• This patient has a third degree urethral tear noted by leakage of contrast into surrounding soft tissues.
• Tear is secondary to pelvic trauma
Female Cystourethrography
• Procedure done to investigate the urethra for tumors, dilation, abscesses, or stricture
• Female patients placed supine with 5 degree caudal angle
• Radiologist inserts special catheter tip syringe filled with contrast into urethral orifice and injects
• Exposures are taken during injection
• Other positions include 35-40 degree Oblique and /or Lateral
Voiding Cystourethrography or VCUG
• An antegrade exam of the urethra normally done in conjunction with a cystogram
• This procedure is done to demonstrate
• Urethral stricture
• Recurrent UTI in children due to reflux
• Post operative bladder surgery
• Following the cystogram, the catheter is removed and male patients are
obliqued to 35 to 40*
• Men are usually given a urinal and women a bedpan
• Exposures are made as the patient urinates
Retrograde Urography: what it’s for and positioning
• Operative procedure performed by a urologist under light sedation
• Evaluates collecting system in patients with renal insufficiency or allergy to contrast
• Performed in a cystoscopic radiography suite OR in surgery with a C-arm
• Patient positioned in the modified lithotomy position
• Requires ureters to be catheterized in order to inject contrast agent directly into the renal pelvis
Retrograde Urography Image
Catheters placed in both ureters
Retrograde Urography Procedure
• Urologist will take urine samples from here for culture and microscopic examination
• Color dye injected IV to test kidney function
• Amount of time for dye to show up in urine
• Urologist will then inject 3 to 5 mL contrast into the renal pelvis via the catheters under imaging, either fluoroscopic or radiographic
** FIRST**
• Head of bed may be lowered 10 to 15 degree
• To prevent contrast from escaping into ureters
THEN
• Head of bed may be elevated to 35 to 40 for the ureterogram to show tortuous ureters and kidney mobility.
• Contrast is injected as the catheters are pulled back to the distal part of the ureters. (ureterogram)
What other interventional procedures can be done during Retrograde Urography?
• Many interventional procedures can be done during this exam as well.
• Stone retrieval
• Stone blasting/lithotripsy
• Biopsy
• Stent placement
