Micturating Cystourethrogram (MCUG)

Indications for imaging Vesicoureteric reflux in children Stress incontinence Urethral stricture Bladder dysfunctions Contra Indications Current - urinary tract infection Contrast media allergies

Patient preparation
 The patient maturates prior the examination  Antibiotic cover on the day of the test and for up to 48 hours after.

Technique
 The patient lies supine on the examination table for catheterisation  Bladder catheterisation is an aseptic procedure undertaken by a suitable trained and qualified person.  The contrast media warmed to body temperature is slowly infused through the catheter  fluoroscopy is used to check the filling and for reflux up the ureters

When the bladder is considered full or the contrast leaks round the catheter, the balloon is deflated and the catheter withdrawn. the patient is asked to micturate into a receiver either erect or supine  Spot films are taken during micturition and any reflux recorded,

 The patient is rotated into the 30 degree left and right anterior obliques to demonstrate the bladder ureteric junctions,  to demonstrate the male urethra, the left anterior oblique position is adopted with flexion of the right hip and knee or RAO with the left hip and knee flexed to visualise the whole of the male urethra.  4) A final full length abdominal film is taken to visualise the kidneys.

 For stress incontinence the film series is taken to include , at rest, straining and micturating in lateral erect position  For vesico-vaginal or recto-vesical fistulae, a series of films in lateral position are taken

Contrast Media
 Hypaque ,urografin 150, suitable volume to fill the bladder  typical 20 ml in an infant to 500 ml in an adult, the contrast media should be warmed to body temperature  Selection of Foley catheters 5 -7 French in infants, larger in adults

Complications
 Temporary Dysuria  Transient Haematuria from catheterisation.  Cystitis

Full length voiding film showing reflux into the right kidney