Last revised by Ciléin Kearns on 3 May 2023
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Citation, DOI, disclosures and article data
Citation:
Shetty A, Kearns C, Chieng R, et al. Voiding cystourethrography. Reference article, Radiopaedia.org (Accessed on 20 Aug 2024) https://doi.org/10.53347/rID-27057
Permalink:
https://radiopaedia.org/articles/27057
rID:
27057
Article created:
Disclosures:
At the time the article was created Aditya Shetty had no recorded disclosures.
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Last revised:
3 May 2023, Ciléin Kearns ◉
Disclosures:
At the time the article was last revised Ciléin Kearns had no financial relationships to ineligible companies to disclose.
View Ciléin Kearns's current disclosures
Revisions:
26 times, by 17 contributors - see full revision history and disclosures
Systems:
Urogenital, Paediatrics
Sections:
Approach
Tags:
mcu, vcug, vur, aps, procedure, fluoroscopy
Synonyms:
- Micturating cystourethrogram
- VCUG
- Micturating cystourethrography (MCU)
- MCU
- Micturating cystourethrography
- Voiding cystourethrogram
Voiding cystourethrography (VCUG),also known as a micturating cystourethrography (MCU), is a fluoroscopic study of the lower urinary tract in which contrast is introduced into the bladder via a catheter. The purpose of the examination is to assess the bladder, urethra, postoperative anatomy and micturition in order to determine the presence or absence of bladder and urethral abnormalities, including vesicoureteric reflux (VUR).
It is more commonly performed in the pediatric population than adults.
On this page:
Article:
- Indications
- Procedure
- VCUG/MCU vs RUG/ASU
- References
Images:
- Cases and figures
Indications
As per American College of Radiology (ACR) and Society for Pediatric Radiology (SPR) guidelines clinical indications for voiding cystourethrography include, but are not limited to:
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
Previously history of urinary tract infection with fever ≥39°C (102.2°F) and infected by a pathogen other than E. coli is also considered a strong indication for voiding cystourethrogaphy to look for the presence of vescioureteric reflux and renal scarring so treatment be initiated early 2.
Procedure
The estimated age-adjusted bladder capacity can be calculated using 4,5:
linear equations:
<1 year
weight [kg] x 7 = capacity (mL)
2.5 × age [months]+ 38 = capacity (mL)
<2 years: (age (years) + 2) x 30 = capacity (mL) 6
>2 years: ((age [years]/2)+6) x 30 = capacity (mL)
non-linear equations:
(4.5 x age [years]0.40) x 30 = capacity [mL]
Technique
the patient empties their bladder before the examination 7
a urinary catheter is inserted into the bladder. An infant feeding tube can be inserted under aseptic precautions for infants or young children; a Foley catheter can be used for older children 7
contrast medium is slowly dripped or infused through the catheter into the bladder. The contrast is monitored initially confirm the position of the catheter 7
intermittent screening images can be taken while distending the bladder with contrast to check for a ureterocele or VUR 7
after the bladder is filled to its capacity (which will vary as per age of patient), the catheter is removed and the patient asked to void. Younger children can void on absorbant pads while older children can urinate into a urine receiver. Suprapubic pressure may be applied to increase the rate of voiding. The catheter should only be removed when it is confident that the patient is able to urinate, the patient unable to tolerate further infusion, or there is no more contrast medium for infusion 7
spot images are taken to look for VUJ obstruction 8. The lower ureter is best seen in the anterior oblique position. Oblique or lateral positions are also useful to visualize the whole of urethra 7
an abdominal view is taken to detect any reflux into the kidneys or record the postmicturition volume of the bladder 7
lateral view is useful to determine and delineate fistula formation into the rectum or vagin* 7
The following projections should be acquired keeping within the ALARA principle:
AP with full bladder for demonstration of the presence or absence of VUR
Left and right oblique images to demonstrate bilateral vesicoureteric junctions
Post-void film to check for a ureterocele
VCUG/MCU vs RUG/ASU
While the urethra is well outlined in both procedures,retrograde urethrogram (RUG)/ascending urethrography (ASU) is better to visualize anterior urethral abnormalities and VCUG is better for posterior urethral abnormalities. Additionally, VCUG is performed for detection of bladder abnormalities and vesicoureteric reflux (VUR). VCUG is the initial examination of choice after metoidioplasty or phalloplasty in transgender males (female to male) 3.
