Voiding cystourethrography

Medical imaging technique

In urology, voiding cystourethrography (VCUG) is a frequently performed technique for visualizing a person's urethra and urinary bladder while the person urinates (voids). It is used in the diagnosis of vesicoureteral reflux (kidney reflux), among other disorders. The technique consists of catheterizing the person in order to fill the bladder with a radiocontrast agent, typically diatrizoic acid. Under fluoroscopy (real time x rays) the radiologist watches the contrast enter the bladder and looks at the anatomy of the patient. If the contrast moves into the ureters and back into the kidneys, the radiologist makes the diagnosis of vesicoureteral reflux, and gives the degree of severity a score. The exam ends when the person voids while the radiologist is watching under fluoroscopy. Consumption of fluid promotes excretion of contrast media after the procedure. It is important to watch the contrast during voiding, because this is when the bladder has the most pressure, and it is most likely this is when reflux will occur. Despite this detailed description of the procedure, at least as of 2016 the technique had not been standardized across practices. Indications for performing VCUG:

All males with recurrent UTIs (urinary tract infections) or abnormality on ultrasound if first UTI. Females < 3 years of age with their first UTI. Females < 5 years of age with febrile UTIs
Older females with pyelonephritis or recurrent UTIs
Suspected obstruction (e. g. bilateral hydronephrosis)
Suspected bladder trauma or rupture
Vesico Vaginal/Vesico Colic fistula
Cystocele

Contraindications for voiding cystourethrogram is when the subject is having:

Ongoing acute urinary tract infection

Children may have painful micturition after the procedure, which can lead to urinary retention (children afraid to pee due to pain). Some painkillers or peeing inside a warm bath may help. Those children who receive antibiotics before the procedure for urinary tract infection will double the dose for 3 days after the procedure. Those not already on antibiotics will be prescribed with 3 days of trimethoprim. Haematuria (blood in urine) may also occur after the procedure. The procedure is invasive and uncomfortable, and it carries a high potential for psychological trauma for both children and parents. The long term psychological effects of VCUGs on children have been compared to that of childhood sexual abuse. Another complication is perforation of the bladder due to over distension. Accidental catherisation of vagina or unusual urethral opening and retention of urinary catheter are also possible.