Voiding cystourethrography

Dr Aditya Shetty et al.

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 vesicoureteral reflux (VUR).

It is more commonly performed in the paediatric population than adults.

As per American College of Radiology (ACR) and Society for Paediatric Radiology (SPR) guidelines clinical indications for voiding cystourethrography include, but are not limited to:

Fever ≥39°C (102.2°F) and a pathogen other than E. coli after a first febrile urinary tract infection in a child is also considered a strong indication due to an increased risk of renal scarring in this population 2.

Technique
  • the bladder is filled with contrast using an infant feeding tube under aseptic precautions; a Foley catheter can be used for older children
  • intermittent screening of the patient on fluoroscopy, while distending the bladder with contrast, is necessary to check for a ureterocoele or VUR
  • after the bladder is filled to its capacity (which will vary as per age of patient) the patient is now asked to void

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

  1. AP with full bladder for demonstration of the presence or absence of VUR.
  2. both obliques to demonstrate bilateral vesicoureteric junctions.
  3. post void film to check for a ureterocoele.

While the urethra is well outlined in both procedures RUG/ASU is better to visualise anterior urethral abnormalities and VCUF is better for posterior urethral abnormalities. Additionally VCUG is carried for detection of bladder abnormalities and vesico-ureteric reflux (VUR). 

Share article

Article information

rID: 27057
Synonyms or Alternate Spellings:
  • Micturating cystourethrogram
  • VCUG
  • Micturating cystourethrography (MCU)
  • MCU
  • Micturating cystourethrography
  • Voiding cystourethrogram

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Full bladder
    Case 1: normal VCUG
    Drag here to reorder.
  • Drag
    Case 2: Normal voiding stack
    Drag here to reorder.
  • Drag
    Posterior urethra...
    Case 3: posterior uretrrhral valves
    Drag here to reorder.
  • Drag
    Case 4: neurogenic bladder
    Drag here to reorder.
  • Drag
    Case 5: neurogenic bladder
    Drag here to reorder.
  • Drag
    Case 6: Hutch diverticulum
    Drag here to reorder.
  • Drag
    Case 7: ureterocoele
    Drag here to reorder.
  • Drag
    Posterior urethra...
    Case 8: posterior urethral valves with pyonephrosis
    Drag here to reorder.
  • Drag
    Case 9: VUR
    Drag here to reorder.
  • Drag
    Case 10: neurogenic bladder with VUR
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.