Micturating Cysto-Urethrogram (MCU)
Introduction
MCU is defined as a study of the lower urinary tract in which contrast is injected into the urinary bladder with the help of a catheter (long, narrow plastic tube) on an x-ray unit or fluoroscopic unit.
Avoiding cystogram demonstrate the lower urinary tract and helps to detect the existence of any vesicoureteral reflux, urinary bladder pathology and congenital or acquired of the bladder outflow tract.
Indications
For children
- UTI (urinary tract infections)- commonly done after some weeks of acute UTI or can be done under antibiotic converge.
- Voiding difficulties such as
- Thin streaming dribbling
- Frequent urination
- Urgency
- Vesicoureteral reflux
- Dysfunctional voiding
- Dysuria
- Baseline study before the lower urinary tract surgery
For adults
- Trauma to urethra
- Urethral stricture
- Urethral diverticula
- Urinary tract infections (UTI)
- Reflux nephropathy of one or both kidneys before renal transplant.
Contrast Media
Urograffin 60% used which needs to be diluted with normal saline in the ratio of 1:3.
The estimated volume of the contrast media to be given to the patient during the procedure is determined by age of the child except for children less than 1 year in age, for them, it is determined by the body weight.
For children less than one year
Weight (Kg) x 7 = capacity (ml)
For children less than two year
[2 x age (in years) + 2] x 30 = capacity (ml)For children more than two year
[Age (in years)/2] x 30 = capacity (ml)Technique
- The bladder is filled with contrast media with the help of a Foley catheter.
- Take Anteroposterior (AP view) with a full bladder. It demonstrates the presence or absence of vesicoureteral reflux (VUR).
- When the bladder is filled to its capacity after that patient is asked for void (micturate).
- Bilateral oblique views are taken to demonstrate bilateral vesicoureteric junctions.
- Take a post-void film to check ureterocoele
Filming Technique
Scout film: The first image that is taken while performing the MCU and VCUG is the image of KUB that is called scout film. We evaluate the spine, pelvis, and soft tissues on the scout film.
After several seconds of the contrast media begins to flow, the image of minimally filled bladder is taken in Antero-posterior (AP) projection. During early filling a ureterocele or tumor can be detected and it may obscure as more contrast material enters into the bladder.
The bladder should appear smooth and regular in the last film, there should be no filling detects and the edges of the bladder image should be smooth.
Voiding phase
The image taken during voiding may demonstrate the urethral strictures or obstructions. They will also give the details of the presence or absence of vesicoureteral reflux. Voiding film necessary because gives the determination of reflux because reflux may only happen with the pressure generated by voiding.
Post-voiding film
A post-voiding film may demonstrate the reflux or extravasation of urine from the bladder or urethra. A normal post-void film has no reflux and no residual urine.
Films:
- Lateral bladder
- The lateral bladder, straining-catheter is then removed
- Lateral bladder during micturition.
Aftercare
No special aftercare is necessary for this procedure. However, patients should be warned that dysuria, may lead to retention urine, it is rarely experienced. In these types of cases, a simple analgesic may help and children can be helped by allowing them to micturate in a warm bath.
Complications
- Acute UTI
- Adverse reactions due to contrast media, result of contrast media absorption by bladder mucosa.
- Catheter trauma, it may cause dysuria, frequent hematuria, and urinary retention.
- The complication caused by filling bladder is the perforation from overdistension it can be prevented by using a non-retaining catheter.
- Retention of a Foley’s catheter
- Catheterization of the vagina or an ectopic urethral orifice
- Radiation effects: MCU is a diagnostic procedure that exposes gonads to some radiation inevitably. Radiation exposure should be kept at a minimum. Ensure that there are very short screening periods carefully. Collimate x-ray beam tightly.
Other Radiology Procedures
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