Micturating Cystourethrogram(MCU) ppt.pptx

MCU RADIOLOGICAL PROCEDURE

1. Micturating Cystourethrogram(MCU) By Abhishek Singh BRIT 2 nd year

2. Definition The cysto urethrogram demonstrates the lower urinary tract and help to detect an existence of any vesicouretral reflux, bladder pathology and congenital or acquired anomalies of bladder outflow tract.

3. INDICATION in CHILDREN 1.UTI 2.Voiding difficulties likes: dysuria, dribbling, frequency, urgency 3.Vesico ureteric reflux 4.Conginatal anomalies: Meningomyelocele, Rectal anomalies. 5.Pelvic trauma 6.Boys with hematuria

4. INDICATION in ADULT 1.Trauma to urethra 2.Urethral stricture 3.Suspected urethral diverticula

5. C o n t r a i ndications A c u te u r i n a r y t r a ct infection .

6. CONTRAST MEDIA Water soluble contrast media like Conray 280,Trivideo 400 mg, Urograffin 60% are used which is diluted with normal saline in 1:3 ratio.

7. PROCEDURE Using sterile technique. A catheter introduced into the bladder. A polyethylene or soft rubber catheters used. A 5 F catheter is used in children and 8F or 10F catheter is used in adult or older children.

8. IN MALES In males, firstly retracted the foreskin of penis Then clean the glan penis, After that catheter introduced, The catheter is lubricated with an anesthetic jelly and inserted slowly and gently into the urethra. And the urethra hold in vertical position.

9. A normal bladder capacity in children is estimated in ounces (1 ounce=29cc) In the bladder of newborn,30-50 cc can be instilled with ease. 3 year-12 year 200-250 cc Capacity in boys,5 year-6 year 100-150 cc In older boys 250 cc

10. Filming In Children The bladder is filled by hand injection in 2 year children. In older children CM is instilled from a bottle placed one meter above examination. During filling, fluoroscopy screening continusally For seeing the vesicouretral reflux, diverticuli or other abnormalities are present. Take oblique on both side to ensure that minimal reflux is not overlooked. If reflux s appear then film are taken in oblique projection. If the bladder appears normal, one film are taken in frontal projection at the end of filling.

11. Catheter is removed and voiding starts in infants. At the end of voiding take a another film in frontal projection. In the last take a another frontal film including the kidney region .

12. In Adult male Bladder is filled in the usual way in older children. And voiding filming is done in both oblique projection. Voiding study in male adult can be 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 urethra by artificial distension.

13. In Adult female The procedure is essentially the same as in girls.

14. Complications Infection due to catheterization of bladder. Adverse reaction Acute urinary tract infection. Catheter trauma causing dysuria, frequency, hematuria and urinary retention. Perforation by catheter. Radiation effect.

15. Hydro Cort i s o n e