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.
- dysfunctional voiding
- bladder outlet obstruction
- fluoroscopic and CT cystography are considered equivalent in the emergent setting 3
- congenital anomalies of the genitourinary tract
- postoperative evaluation of the urinary tract
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:
- AP scout image
- AP early filling images (if injury or postoperative evaluation, focus on those areas).
- AP and steep obliques of the bladder (try to include the area of where the UVJ would be).
- Postvoid radiograph
A double contrast cystography (pneumocystography) variation on the standard cystogram is possible, but is very uncommonly performed.
- 1. Pollack HM, McClennan BL, Dyer RB et-al. Clinical urography. Saunders. ISBN:0721669352. Read it at Google Books - Find it at Amazon
- 2. Gross JA, Lehnert BE, Linnau KF et-al. Imaging of Urinary System Trauma. Radiol. Clin. North Am. 2015;53 (4): 773-88, ix. doi:10.1016/j.rcl.2015.02.005 - Pubmed citation
- 3. Morey AF, Brandes S, Dugi DD et-al. Urotrauma: AUA guideline. J. Urol. 2014;192 (2): 327-35. doi:10.1016/j.juro.2014.05.004 - Free text at pubmed - Pubmed citation