Mcu

how we perform the RGU and MCU

1. MCU & RGU Shiva K umar Shrestha Radiography 3 rd Year Group:- MADHYAPUR

2. RETROGRADE URETHROGRAPHY (RGU) ASCENDING URETHROGRAM (ASU)

3. Definition A retrograde urethrogram  is a routine radiologic procedure (most typically in males) used to image the integrity of the urethra by using iodinated contrast media.

4. Indications Strictures Urethral tears Fistulae urethral diverticulam urethral obstruction

5. Contraindications Acute urinary tract infection

6. Contrast medium RGU HOCM or LOCM ; 20ml MCU HOCM or LOCM ; 150ml Amount 200 to 500ml (dilute with normal saline)

7. Equipment Fluoroscopy unit with spot film device and tilting table Video recorder Jaques or foley catheter In small infants a fine (5-7F) feeding tube is adequate Syringes Xylocaine jelly 1-2%

8. Patient preparation Patients micturates prior to the examination Informed consent should be taken.

9. Technique Patient lies supine on the x-ray table Retract the fore skin and clean the tip of penis with betadine or antiseptic solution. Inject a small amount of local anesthetic into the urethra with a 8-F Foley catheter or syringe and balloon is inflated with 1-3 ml of water. Local anesthesia helps to relax the sphincter as the patient may contract it during the procedure thus leading to a diagnosis of a stricture Contrast medium is injected under fluoroscopy control and films are taken  The male urethra is best seen in the oblique position. • Female urethra is best seen in lateral or anteroposterior position .

10. Imaging The view of films: 30 left anterior oblique with right leg abducted and knee flexed Supine PA 30 right anterior oblique with left leg abducted and knee flexed

11. MICTURATING CYSTOURETHROGRAPHY VOIDING CYSTOURETHROGRAM (VCUG) DESCENDING URETHROGRAM

12. MCU  is a fluoroscopic study of the lower urinary tract in which contrast is introduced into the bladder via a catheter Voiding cystourethrogram demonstrates the lower urinary tract and helps to detect the existence of any vesico -urethral reflux, bladder pathology and congenital or acquired of bladder outflow tract. MCU

13. Indications Vesicoureteric reflux dysfunctional voiding Dysuria Suspected urethral diverticulum

14. Vesicoureteric reflux

15. Technique The bladder is filled with the contrast media using foley catheter(5-7F) After the bladder is filled to its capacity; then the patient is asked to void( micturate ) AP with full bladder for demonstration of the presence or absence of VUR. both obliques to demonstrate bilateral vesicoureteric junctions. post void film to check for a ureterocoele .

16. UTI

17. Films taken Lateral bladder Lateral bladder, straining-catheter is then removed Lateral bladder during micturation

18. Aftercare No special aftercare is necessary, but patients and parents of children should be warned that dysuria , possibly leading to retention of urine, may rarely be experienced. In such cases a simple analgesic helpful and children may be helped by allowing them to micturate in a warm bath.

19. Complication  Contrast reaction (due to absorption through bladder mucosa) • UTI • Urethral trauma. • Intravasation of contrast – due to use of excessive pressure in stricture . Due to the contrast medium Adverse reactions may result from absorption of contrast medium by the bladder mucosa. The risk is small when compared with excretion urography . Contrast medium induced cystitis  

20. Due to the technique Acute urinary tract infection Catheter trauma- may produce dysuria , frequency haematuria and urinary retention Complications of bladder filling e.g , perforation from overdistension - prevented by using a non-retaining catheter, e.g. Jaques Catheterization of vagina or an etopic urethral orifice Retention of a foley catheter