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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