UNIT 2: CYSTOGRAPHY, CYSTOURETHROGRAPHY, & RETROGRADE UROGRAPHY

Question 1

What is Cystography and what is it done for?

Answer 1

• 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

Question 2

What contrast media is used for Cystography?

Answer 2

Low concentration (25-30%) ionic contrast media often used due to large volume of administration (more cost effective)

Question 3

T or F: Patient catheterized under sterile technique for Cystography

Answer 3

True

Question 4

Scout image for Cystography

Answer 4

• 10 X 12 LW
• centered to the MSP midway between the ASIS and the symphysis
• OR KUB with a 14X17

Question 5

How does Cystography contrast media work during this procedure?

Answer 5

• 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

Question 6

Cystography AP/ PA positioning

Answer 6

• Patient supine
• Legs should be straight
• 10 X 12 LW
• CR perpendicular to midway between ASIS and pubic symphysis at midline
• Suspend respiration

Question 7

Cystography AP Axial positioning and evaluation criteria

Answer 7

• 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.

Question 8

Cystography RPO/LPO positioning and evaluation criteria

Answer 8

• 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

Question 9

Cystography Lateral positioning and evaluation criteria

Answer 9

• 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

Question 10

Male Cystourethrography

Answer 10

• 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

Question 11

Cystourethrography tear image

Answer 11

• This patient has a third degree urethral tear noted by leakage of contrast into surrounding soft tissues.
• Tear is secondary to pelvic trauma

Question 12

Female Cystourethrography

Answer 12

• 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

Question 13

Voiding Cystourethrography or VCUG

Answer 13

• 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

Question 14

Retrograde Urography: what it’s for and positioning

Answer 14

• 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

Question 15

Retrograde Urography Image

Answer 15

Catheters placed in both ureters

Question 16

Retrograde Urography Procedure

Answer 16

• 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)

Question 17

What other interventional procedures can be done during Retrograde Urography?

Answer 17

• Many interventional procedures can be done during this exam as well.
• Stone retrieval
• Stone blasting/lithotripsy
• Biopsy
• Stent placement