MICTURATING CYSTOURETHROGRAM for university.pptx

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1. MICTURATING CYSTOURETHROGRAM MCUG VOIDING CYSTOURETHROGRAM ANTEGRADE URETHROGRAM LECTURER: MS. UROOJ FATIMA

2. WHAT IS MCUG? Micturating cystourethrogram is a radiologic procedure used to visualize urinary bladder and lower urinary tract MCUG involves real time imaging during micturation (urination). help to detect vesicouretral reflux, bladder patholgyand congenital or acquired anomalies of bladder outflow tract .

3. INDICATIONS CHILDREN: UTI Voiding difficulties such as dysuria, dribbling,urgency Vesico ureteric reflux conginatal anomalies Pelvic trauma Boys with haematuria

4. INDICATIONS ADULTS Trauma to urethra Urethral stricture suspected urethral diverticula Incontinence very common in female

5. CONTRAINDICATIONS Acute Urinary Tract infection (UTI) Allergic or sensitive to contrast medium.

6. PATIENT PREPARATION Patient will need to be prescribed a 3-day course of antibiotics to reduce the chance of infection; these should be prescribed by your GP shortly before the procedure date The antibiotics should be given the day before, the day of the MCUG, and the day after the procedure.

7. CONTRAST MEDIA Water soluble CM like CONRAY 280, TRIVIDEO 400mg, UROGRAFFIN 60% are used which is diluted with normal saline in ratio 1:3

8. PROCEDURE Using sterile technique A catheter is introduce into the bladder polyethene and soft rubber catheter are used A 5F catheter is used in children and 8F or10 F catheter is used in adults or older childern.

9. You will be asked to empty your bladder prior to the examination. You will then be brought into the examination room and asked to lie on the X-ray table. Your genital area will be cleaned and draped with sterile towels. Some local anaesthetic jelly will be inserted into the opening of your urethra using a small nozzle. The urethra is hold in vertical position. normal bladder capacity in children= 1ounce=29cc capacity in new borns=30-50cc capacity of 3-12 year child 200-250 cc capacity in boys 5-6 years 100-150cc in older boys 150 cc

10. FILMING The bladder is filled by hand injection in 2 year child. In older children CM is insillted from a bottled placed one meter above examination. During filming fluroscopy screening continuously For seeing vesicoureteric reflux, diverticula or other abnormalities are present Take oblique on both sides to ensure that minimal reflux is not overlooked. If reflux appear then film are taken in oblique positions. If the bladder is normal then one film is taken frontal at the end of filming Catheter is removed and voidong starts in infants. At the end of voiding the film is taken in frontal projection. In the last take another film including kidney region.

11. IN ADULT MALE Bladder is filled in the usual way as in older children and voiding filming is done in both oblique projections. Voiding study in male adult is modified by getting the patient to void against resistance, by using a penile clamp . This is known as CHOKE CYSTOURETHROGRAPHY which enhance the visualization of uretehra by artificial distension. IN ADULT FEMALE The procedure is same as in girls.

12. AFTER CARE Patient should drink plenty of water (or milk/sugar free squash if they prefer) that day and continues the course of antibiotics as prescribed.

13. CONTRAINDICATIONS UTI Infections due to catheterization Adverse reaction Catheter trauma causing dysuria, frequency haematuria, and urinary retention. Perforation by catheter. Radiation effect

14. The preliminary or 'scout' film (left image) shows normal bones and soft tissues. During the voiding phase (center image), the bladder wall appears to be smooth. The urethra is normal and there is no evidence of contrast material in the ureters (no reflux). The post void film shows that the bladder is empty and there is no extravasation of contrast outside the bladder. Unless an x-ray film is taken while the child is urinating, one cannot evaluate the urethra and one cannot say whether the child has reflux (abnormal retrograde flow of urine up the ureters).

15. VOIDING PHASE This film shows a normal male urethera , there is no obtruction.The variation seen in the diameter of urethera is normal.

16. GLOSSARY VESICOURETERAL REFLUX-- abnormal flow of urine from your bladder back up the tubes (ureters) that connect your kidneys to your bladder. DYSURIA--painful or uncomfortable urine. HAEMATURIA--blood in urine INCONTINENCE--uncontrolled leakage of urine. DIVERTICULA/DIVERTICULITIS--irregular bulging pouches or multiple pouches PERFORATION--a hole that develop in your body cavity.

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