MCU.pptx

MCU stands for Micturating Cystourethrogram.
it's a radiographic procedure used to visualize the urinary bladder and lower urinary tract.
MCU involves real-time imaging during urination (micturition).

1. Micturating Cystourethrogram Presenter: Dr. Dheeraj Kumar MRIT, Ph.D. (Radiology and Imaging) Assistant Professor Medical Radiology and Imaging Technology School of Health Sciences, CSJM University, Kanpur 18/09/2023 MCU By- Dr.Dheeraj Kumar 1

2. Micturating Cystourethrogram (MCU ) Define MCU clearly: MCU stands for Micturating Cystourethrogram. it's a radiographic procedure used to visualize the urinary bladder and lower urinary tract. MCU involves real-time imaging during urination (micturition). Distinguish MCU from other radiological techniques briefly. 18/09/2023 MCU By- Dr.Dheeraj Kumar 2

3. Indications for MCU Provide a comprehensive list of situations or conditions where MCU is commonly used: Evaluating vesicoureteral reflux (VUR) in children : Mention its significance in pediatric care. Assessing urinary incontinence and dysfunctional voiding in adults : Emphasize its relevance in adult urology. Detecting structural abnormalities : This includes strictures, diverticula, or any anatomical issues. Postoperative or post-injury bladder function evaluation : Highlight its role in post-surgical care. 18/09/2023 MCU By- Dr.Dheeraj Kumar 3

4. Urinary tract infection Dysuria Dysfunctional voiding Hydronephrosis and/or  hydroureter Bladder outlet obstruction Hematuria Trauma Urinary incontinence Neurogenic dysfunction of the bladder, e.g. Spinal dysraphism Congenital anomalies of the genitourinary tract Postoperative evaluation of the urinary tract 18/09/2023 MCU By- Dr.Dheeraj Kumar 4

5. Evaluating Vesicoureteral Reflux (VUR) in Children Significance in Pediatric Care: MCU is particularly vital in pediatric medicine, as it helps diagnose and assess vesicoureteral reflux (VUR) in children. VUR is the abnormal flow of urine from the bladder back into the ureters and kidneys. Left untreated, VUR can lead to urinary tract infections (UTIs) and potential kidney damage. MCU allows healthcare providers to visualize and grade the reflux, aiding in treatment decisions and follow-up care for young patients. 18/09/2023 MCU By- Dr.Dheeraj Kumar 5

6. Assessing Urinary Incontinence and Dysfunctional Voiding in Adults Relevance in Adult Urology: MCU isn't limited to pediatrics ; it plays a significant role in adult urology as well. For adults experiencing urinary incontinence or dysfunctional voiding, MCU helps identify underlying causes. Whether it's stress incontinence, urge incontinence, or other voiding disorders, MCU provides real-time imaging to evaluate bladder and urethral function, enabling tailored treatment plans for adult patients. 18/09/2023 MCU By- Dr.Dheeraj Kumar 6

7. Detecting Structural Abnormalities Strictures , Diverticula, and Anatomical Issues: MCU is a powerful diagnostic tool for detecting various structural abnormalities within the urinary tract. This includes conditions such as urethral strictures (narrowing of the urethra), bladder diverticula (pouch-like protrusions), or any anatomical anomalies. Accurate visualization and assessment of these issues are essential for determining appropriate treatment strategies. 18/09/2023 MCU By- Dr.Dheeraj Kumar 7

8. Postoperative or Post-Injury Bladder Function Evaluation Role in Post-Surgical Care: After surgical procedures involving the urinary tract or in cases of traumatic injury, MCU assists in evaluating bladder function. It helps healthcare providers assess whether the surgery was successful or if there are any complications. For post-injury scenarios, MCU aids in determining the extent of damage to the urinary system and guides treatment decisions. 18/09/2023 MCU By- Dr.Dheeraj Kumar 8

9. Procedure and Patient Preparation Micturating Cystourethrogram (MCU) is a procedure that requires careful planning and patient preparation to ensure its safety and effectiveness. Here's a breakdown of the steps involved in preparing for an MCU: 18/09/2023 MCU By- Dr.Dheeraj Kumar 9

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11. Informed Consent and Patient Education Crucial Importance: Obtaining informed consent from the patient or their legal guardian is a critical first step. It ensures that the patient fully understands the procedure, its purpose, potential risks, and benefits. Informed consent is essential both ethically and legally. Patient Education: Patient education is equally crucial. Explain the MCU procedure in clear and understandable terms, addressing any questions or concerns the patient may have. This not only fosters trust but also helps alleviate anxiety and apprehension. 18/09/2023 MCU By- Dr.Dheeraj Kumar 11

12. Maintaining Patient Privacy and Comfort Ensuring Comfort: Patient comfort is paramount for a successful MCU. Emphasize that a comfortable and relaxed patient is more likely to cooperate during the procedure, leading to better-quality images. Privacy: Ensure that the patient's privacy is respected throughout the process. Use appropriate draping and provide changing facilities when needed to maintain dignity and comfort. 18/09/2023 MCU By- Dr.Dheeraj Kumar 12

13. Allergies to Contrast Agents Highlight the Need: Stress the importance of checking for allergies to contrast agents before the procedure. Allergies can lead to adverse reactions, ranging from mild hives to severe anaphylactic reactions. Precautionary Measures: Explain that healthcare providers should ask the patient about any prior reactions to contrast agents. In cases of known allergies, alternative contrast agents or pre-medication may be necessary to prevent adverse reactions. 18/09/2023 MCU By- Dr.Dheeraj Kumar 13

14. Pre-Procedure Bladder Voiding Importance of an Empty Bladder: Make it clear why an empty bladder is necessary before conducting an MCU. A full bladder can interfere with the procedure by obstructing the view of the urinary tract. Instruct the patient to void their bladder completely before the MCU. Timing: Provide guidance on the timing of voiding; it should be done just before the procedure to ensure the bladder is as empty as possible. 18/09/2023 MCU By- Dr.Dheeraj Kumar 14

15. Patient Positioning on the Imaging Table Ideal Positioning: Describe the ideal positioning for the MCU procedure. Typically, the patient will be lying on their back on the imaging table with their legs spread apart. This positioning allows for clear visualization of the bladder and urethra. Comfort and Stability: Explain that the patient's comfort and stability are essential during positioning. Padding or cushions may be used to enhance comfort, and straps or supports may be employed to maintain the desired posture. 18/09/2023 MCU By- Dr.Dheeraj Kumar 15

16. Imaging Equipment and Contrast Agents The successful execution of a Micturating Cystourethrogram (MCU) relies on a combination of specialized imaging equipment and contrast agents. Let's delve into the details of these essential components: 18/09/2023 MCU By- Dr.Dheeraj Kumar 16

17. Fluoroscopy Equipment with a Digital Detector Role of Fluoroscopy: Fluoroscopy is a fundamental component of MCU, as it enables real-time imaging. Unlike traditional X-rays, which produce static images, fluoroscopy provides dynamic, continuous X-ray images. This dynamic visualization is crucial for capturing the filling, storage, and voiding phases of the bladder and urethra during micturition. Digital Detector: The use of a digital detector enhances image quality and efficiency. Digital detectors allow for immediate image capture and display, reducing the need for lengthy processing times. This aids in real-time assessment and expedites the procedure. 18/09/2023 MCU By- Dr.Dheeraj Kumar 17

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20. Types of Contrast Agents (Iodinated or Water-Soluble ) Choice of Contrast Agents: Two primary types of contrast agents are commonly used in MCU: Iodinated Contrast Agents: These contain iodine and are often used in MCU. They provide excellent radiopacity , enhancing the visibility of the urinary tract structures. However, some patients may have iodine allergies, necessitating precautions. Water-Soluble Contrast Agents: These agents are less likely to cause allergic reactions. While they may not offer the same level of radiopacity as iodinated agents, they are suitable for patients with known allergies or sensitivities. 18/09/2023 MCU By- Dr.Dheeraj Kumar 20

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22. Catheters and Tubing for Contrast Administration Role in Contrast Delivery: Catheters and tubing are instrumental in delivering the contrast agent into the patient's bladder. A catheter is introduced through the urethra into the bladder, allowing precise control over the contrast injection. Minimizing Patient Discomfort: Explain that healthcare providers take great care to minimize patient discomfort during catheter insertion. Lubrication and local anesthesia may be used as needed to ensure a smooth and pain-free procedure. 18/09/2023 MCU By- Dr.Dheeraj Kumar 22

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24. Radiation Protection Gear ( Lead Aprons and Shields ) Emphasis on Safety: Safety is a paramount concern in radiology, and MCU is no exception. Mention the use of lead aprons and shields, which are essential for minimizing radiation exposure to both patients and healthcare providers. Lead Aprons: Healthcare providers wear lead aprons to shield themselves from scattered radiation during the procedure. This protective gear helps reduce the risk of radiation exposure. Patient Protection: While lead aprons are not typically placed on patients during MCU, the procedure's design minimizes radiation exposure to the patient by focusing the X-ray beam only on the area of interest. 18/09/2023 MCU By- Dr.Dheeraj Kumar 24

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26. Image Acquisition Describe in detail how images are acquired during an MCU: Contrast agent introduction via catheter : the process of introducing the contrast agent into the patient's bladder. Real-time fluoroscopic imaging during micturition : images are captured while the patient is urinating. Sequential images capturing filling, storage, and voiding phases : the need for a comprehensive view of the bladder and urinary tract. Dynamic evaluation of bladder and urethral function : the dynamic nature of MCU, which allows for functional assessment. 18/09/2023 MCU By- Dr.Dheeraj Kumar 26

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28. Interpretation and Reporting on the interpretation process: Radiologist's role in analyzing images for abnormalities. Elements evaluated: bladder capacity, shape, compliance. Detection of reflux into the ureters (VUR). The significance of detailed reporting for clinical decision-making. 18/09/2023 MCU By- Dr.Dheeraj Kumar 28

29. Case Studies To better understand the clinical significance of Micturating Cystourethrogram (MCU), let's explore real-life case examples where MCU played a pivotal role in diagnosis and treatment planning: 18/09/2023 MCU By- Dr.Dheeraj Kumar 29

30. Case 1: Pediatric Patient with Suspected Vesicoureteral Reflux (VUR) Background : A 5-year-old male patient presented with a history of recurrent urinary tract infections (UTIs). Suspected vesicoureteral reflux (VUR), a condition where urine flows backward from the bladder into the ureters and potentially into the kidneys. 18/09/2023 MCU By- Dr.Dheeraj Kumar 30

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32. Role of MCU MCU was performed to confirm the presence and grade of VUR. During the procedure, contrast agent was introduced into the bladder, and real-time fluoroscopy captured the filling, storage, and voiding phases. The MCU images clearly showed the reflux of contrast into the ureters, confirming the diagnosis of VUR. 18/09/2023 MCU By- Dr.Dheeraj Kumar 32

33. Treatment Planning Based on the MCU findings, the healthcare team developed an appropriate treatment plan. The grade of VUR determined through MCU guided decisions regarding medical management or surgical intervention. Regular follow-up MCUs were scheduled to monitor treatment effectiveness and the resolution of VUR over time. 18/09/2023 MCU By- Dr.Dheeraj Kumar 33

34. Case 2: Adult with Urinary Incontinence Background : A 45-year-old female patient complained of urinary incontinence, particularly during activities that increased intra-abdominal pressure (stress incontinence). The patient also reported frequent urination and urgency. 18/09/2023 MCU By- Dr.Dheeraj Kumar 34

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37. Role of MCU: MCU was performed to assess bladder function and identify the cause of urinary incontinence. Dynamic imaging during micturition allowed visualization of bladder and urethral dynamics. The procedure revealed urinary leakage during increased intra-abdominal pressure, confirming stress incontinence. 18/09/2023 MCU By- Dr.Dheeraj Kumar 37

38. Treatment Planning: MCU findings played a crucial role in treatment planning. Non-invasive therapies, such as pelvic floor exercises or behavioral modifications, were recommended for mild stress incontinence. In more severe cases, surgical options like sling procedures were considered. 18/09/2023 MCU By- Dr.Dheeraj Kumar 38

39. Case 3: Postoperative Bladder Function Assessment Background : A 62-year-old male patient underwent surgery to address bladder outlet obstruction due to an enlarged prostate (benign prostatic hyperplasia, BPH). Following surgery, the patient experienced urinary retention and incomplete bladder emptying. 18/09/2023 MCU By- Dr.Dheeraj Kumar 39

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41. Role of MCU : MCU was conducted to evaluate postoperative bladder function. Real-time imaging assessed bladder capacity, contractility, and urethral patency. The procedure identified residual urine in the bladder, indicating incomplete voiding. 18/09/2023 MCU By- Dr.Dheeraj Kumar 41

42. Treatment Planning: Based on MCU findings, the healthcare team adjusted the patient's treatment plan. Catheterization and medication were prescribed to address the postoperative urinary retention. Subsequent MCUs were scheduled to monitor the effectiveness of treatment and ensure the restoration of normal bladder function. 18/09/2023 MCU By- Dr.Dheeraj Kumar 42

43. Benefits and Risks advantages of MCU: Accurate diagnosis of urinary tract conditions. Facilitates treatment planning and monitoring. Risks: risks or discomfort: Minimal radiation exposure. Rare allergic reactions to contrast agents. Patient discomfort during catheter insertion. 18/09/2023 MCU By- Dr.Dheeraj Kumar 43

44. References Smith, E. A., & Dillman , J. R. (2017). Vesicoureteral reflux. Radiologic Clinics, 55(5), 991-1006. Lebowitz , R. L., Olbing , H., & Parkkulainen , K. V. (1985). Imaging and radiologic management of urinary tract infection. The Pediatric Clinics of North America, 32(1), 205-226. Huang, L., Sant, G. R., & Tu , L. (2000). Vesicoureteral reflux in adults. Journal of Urology, 164(3), 722-725. Brenner, D. J., & Hall, E. J. (2007). Computed tomography—An increasing source of radiation exposure. New England Journal of Medicine, 357(22), 2277-2284. Kavanagh, E. C., & Ryan, S. (2010). Vesicoureteric reflux. Pediatric Radiology, 40(6), 956-965. 18/09/2023 MCU By- Dr.Dheeraj Kumar 44

45. Thank You 18/09/2023 MCU By- Dr.Dheeraj Kumar 45