MICTURATING_CYSTOURETHRORAPHY_ROOPA 30.pptx

MCU is a procedure used to diagnose structural and functional abnormalities of bladder and urethra.

1. MICTURATING CYSTOURETHRORAPHY ROOPA BISHT MRIT

2. CONTENT DEFINATION CLINICAL INDICATION CONTRAINDICATION Equipments Patient prepration and position CONTRAST MEDIA PROCEDURE Filming and parts visualisation COMPLICATIONS AFTERCARE

3. ANATOMY OF URETHRA

4. MICTURATING CYSTOURETHROGRAPHY (MCU ) DEFINATION Radiographic examination of urethra and the bladder. MCU is performed to diagnose structural and functional abnormalities of urethra and bladder while person urinates. Functional anatomy and pathology of urethra are asessd during micturition. MCU also known as VCUG (voiding cystourethrography). Lower urinary tract in which contrast is introduced into the urethra and bladder via a catheter. Whole procedure will take around 30 min. 4

5. CLINICAL INDICATION VOIDING DIFFICULTIES – dysuria, thin stream, dribbling, frequency, urgency. VESICOURETERIC REFLEX – abnormal flow of urine from bladder back up the ureters that connect kidneys to bladder. POSTOPERATIVE EVALUTION of ureteric abnormalities SUSPECTED URETHRAL STRICTURES , OBSTRUCTION and URETHERAL DIVERTICULA. CONGENITAL ANOMALIES in children like MENINGOMYELOOCELE , SACRAL AGENESIS. ENLARGEMENT OF PROSTATE URINARY TRACT INFECTION TRAUMA TO URETHRA 5

6. VESICOURETERIC REFLUX 6

7. DIVERTICULA STRICTURES

8. 8

9. CONGENITAL ABNORMALITIES NORMAL SACRAL AGENISIS

10. URETEROCELE

11. CONTRAINDICATION Severe UTI Suspected pregnancy Obstructive mass in the bladder 11

12. EQUIPMENT Fluroscopic unit with spot film device and tilting table Foley’s catheter – 5F for children - 8F or 10F for adults Clamp artery forceps Antiseptic solutions Local anesthesia Syringe – 20ml Gloves Sterile towel Gauze Saline Iodinated Contrast media 12

13. CONTRAST MEDIA Name of contrast media – water soluble iodinated contrast media l(low osmolar like Urograffin 60%) – 150ml Amount 200 - 500ml (dilute with normal saline) Concentration – 1:3 ratio ADMINISTRATION ROUTE – intraurethral The estimated volume of contrast media to be given during the examination is determined mainly by the age of the patient except for children less than one year of age in whom determined by weight. Less than one year weight(kg) x 7 = capacity(ml) Less than 2 year (2 x age in years + 2) x 30 = capacity (ml) More than two years (age in years / 2 + 6) x 30 = capacity (ml) 13

14. PATIENT PREPRATION AND POSITION No special preparation is required for the examination. Patient micturates prior to the procedure. Describe the whole procedure to the patient on the day of examination. Technologist should obtain consent from the patient for permission of procedure. Ask the patient to remove clothing and wear hospital gown. Patient in supine position on the fluoroscopic table. Then preliminary scout film is taken of bladder and urethra.

15. CATHERIZATION 15

16. PROCEDURE An IV line is inserted into the patient arm and sedative medication is given through line to make patient relax. The radiologist retract the foreskin of the urethra and clean the tip with antiseptic. Apply local anesthesia on urethral opening. The foley’s catheter should be lubricated with anesthetic gel and inserted into urethral orifice withholding the penis in vertical position. The floey catheter is advanced into the bladder under fluoroscopy guidance and the balloon is inflated with 1-2 ml of water then the diluated contrast is instilled in the bladder until the bladder is dilated. The radiologist monitors the reflux in bladder under fluoroscopy if he sees any reflux he will record on spot film. After filling the bladder with contrast media the catheter is removed and the Patient is placed in 30 degree posterior oblique position for urination, spot film is taken in voiding phase. 16

17. FILMING SCOUT FILM- Spot image taken for to visualize urethra and bladder. FILING PHASE - AP with full bladder for demonstration of the presence or absence of VUR. VOIDING PHASE- Lateral view is useful to determine delineate fistula formation into the rectum or vagina. Left and right oblique images to demonstrate bilateral vesicouretric junctions. POST VOID FILM- n o reflux and no residual bladder urine is seen in this normal post-void film. 17

18. Contrast reaction like absorption of contrast media by bladder mucosa. Catheter TRAUMA causing dysuria. Mild hematuria Burning while urinating UTI Pain in lower abdomen 19 COMPLICATION

19. AFTERCARE Drink lots of water Should also be given regular pain relief medicine. 20

20. REFRENCE Chapman Nakielnys Radiological procedures – Dr. Bhushan N Lakhkar