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 as a CT cystogram.

Indications

  • dysfunctional voiding
  • bladder outlet obstruction
  • hematuria
  • 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 detrusor 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)
  • post-void 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

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