Cystography

Cystography is a fluoroscopic study that images the bladder. It is similar to a voiding cystourethrogram (VCUG), and the difference between the studies is primarily one of emphasis; a cystogram focuses on the bladder and a VCUG focuses on the posterior urethra. The study has been adapted to CT with a CT cystogram.

Indications

  • dysfunctional voiding
  • bladder outlet obstruction
  • haematuria
  • trauma
    • fluoroscopic and CT cystography are considered equivalent in the emergent setting 3
  • congenital anomalies of the genitourinary tract
  • postoperative evaluation of the urinary tract

Procedure

Technique
  • insert Foley catheter in bladder, or use an indwelling Foley or suprapubic catheter

  • introduce water soluble contrast through the catheter (such as Isovue-300 or Cystografin)

  • if looking for a bladder leak after trauma, fill to detrusor contraction or to at least 300 ml

  • if looking for a postoperative injury, then fill to a smaller volume (~100-150 ml) or until resistance is felt

    • avoid overfilling, so as not to blow out an anastomotic suture

  • to try to ensure a destrusor contraction, try to have the patient void, if possible.

The following projections should be acquired keeping within the ALARA principle:

  1. AP scout image
  2. AP early filling images (if injury or postoperative evaluation, focus on those areas).
  3. AP and steep obliques of the bladder (try to include the area of where the UVJ would be).
  4. Postvoid radiograph

A double contrast cystography (pneumocystography) variation on the standard cystogram is possible, but is very uncommonly performed.

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Article Information

rID: 40678
System: Urogenital
Section: Approach
Synonyms or Alternate Spellings:
  • Cystogram
  • Cystograms
  • Fluoroscopic cystogram
  • Fluoroscopic cystography

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Cases and Figures

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    Case1: cystogram showing a psoas hitch repair
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    Case 2: bladder base injury with leak
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