Micturating cystourethrography (MCU) is a radiographic examination that assesses the bladder and urethra during filling and voiding. It involves catheterization of the bladder followed by injection of contrast media and imaging under fluoroscopy during filling, voiding, and post-voiding. MCU is used to evaluate conditions like vesicoureteric reflux, posterior urethral valves, abnormalities of the bladder, and stress incontinence. Precautions must be taken to prevent complications from the contrast media or the catheterization procedure.
Micturating cystourethrography (MCU) is a radiographic examination that assesses the bladder and urethra during filling and voiding. It involves catheterization of the bladder followed by injection of contrast media and imaging under fluoroscopy during filling, voiding, and post-voiding. MCU is used to evaluate conditions like vesicoureteric reflux, posterior urethral valves, abnormalities of the bladder, and stress incontinence. Precautions must be taken to prevent complications from the contrast media or the catheterization procedure.
Original Description:
Micturating cysto urethrogram, a presentation by radiology and imaging resident.
Micturating cystourethrography (MCU) is a radiographic examination that assesses the bladder and urethra during filling and voiding. It involves catheterization of the bladder followed by injection of contrast media and imaging under fluoroscopy during filling, voiding, and post-voiding. MCU is used to evaluate conditions like vesicoureteric reflux, posterior urethral valves, abnormalities of the bladder, and stress incontinence. Precautions must be taken to prevent complications from the contrast media or the catheterization procedure.
Micturating cystourethrography (MCU) is a radiographic examination that assesses the bladder and urethra during filling and voiding. It involves catheterization of the bladder followed by injection of contrast media and imaging under fluoroscopy during filling, voiding, and post-voiding. MCU is used to evaluate conditions like vesicoureteric reflux, posterior urethral valves, abnormalities of the bladder, and stress incontinence. Precautions must be taken to prevent complications from the contrast media or the catheterization procedure.
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MICTURATING DR.
SABRINA BARI
CYSTOURETHROGRAP MD Resident (Phase-
A) HY Department of Radiology & Imaging, BIRDEM INTRODUCTION ◦ Urethrography: ◦ Urethrography refers to radiological study of urethra using iodinated contrast media. Types of Urethrography: ◦ Micturating Cystourethrography: Radiographic examination of urethra, bladder by injecting contrast media through catheter. ◦ Retrograde urethrography: Male urethra is studied using water soluble contrast agent through retrograde filling. ◦ For both studies static images of bladder is obtained, assessed dynamically under fluoroscopy. ◦ Some patient are assessed with both techniques, usually RGU first followed by MCU DEFINITION It is a Radiographic examination in which bladder is filled via suprapubic or retrograde catheterization and urethra is assessed during voiding.
Micturating Cystourethrography includes:
•Catheterization.
• Injection of CM retrograde.
Filling, voiding and post voiding situations evaluated under fluoroscopy.
Spot radiographs of bladder and urethra.
Anatomy Urinary system consists of: ◦ Kidneys ◦ Ureters ◦ Bladder ◦ Urethra Urinary Bladder ◦ The urinary bladder is a temporary reservior for urine. It is located in the Pelvic cavity, posterior to the symphysis Pubis and below the parietal peritoneum. The size and shape of it varies with the Amount of urine it contains. ◦ The inner lining of urinary bladder is a mucous membrane of transitional epithelium, that is continuous with that in the ureter. When the bladder is empty, the mucosa has numerous folds called rugae.
◦ The second layer is submucosa, composed of connective tissue with elastic
fibers.
◦ The next layer is the muscularies, composed of detrusor muscle. Contraction
of this muscle expels urine from bladder. Trigon ◦ It is a triangular area, formed by three openings in the floor of the urinary bladder,Two of the openings are from the ureters and form the base of the trigon. Small flaps of mucosa cover these openin gs and act as valves that allow urine to enter the bladder but prevents the backflow of urine. The third opening ,at the apex of the trigon, is the opening into the urethra. A band of detrusor muscle encircles this opening to form the internal urethral sphincter. :In females Length of 3-4 cm. In males: 20 cm in length. Anatomy It has four named regions: of Uretrha Prostatic urethra: Is approximately 3 cm in length. Passes through the prostate gland .Membranous urethra: Is approximately 1 cm in length. Passes through the urogenital diaphragm. • Bulbar urethra From inferior aspect of urogenital diaphragm to penoscrotal junction. .Spongy(penile) urethra
The interior of the prostatic urethra: On the posterior wall of the prostatic urethra there are: Urethral crest: A longitudinal ridge. Seminal colliculus/Verumontanum: An enlargement of the urethral crest. (act as a normal filling defect on RGU) Prostatic sinus: The groove on either side of the seminal colliculus. Prostatic utricle:A small opening on the midline of the seminal colliculus. Opening of the ejaculatory duct: One on either side of the prostatic utricle Sphincters of urethra ◦ Internal urethral sphincter ◦ External urethral sphincter ◦ Involuntary in nature ◦ Voluntary in nature. ◦ It controls the neck of the bladder ◦ Controls the membrenous urethra and prostatic urethra above the and is responsible for voluntary opening of the ejaculatory duct. holding of urine. INDICATIONS • Vesicoureteric reflux • Posterior urethral valve • Study of urethra during micturition • Abnormalities of urinary bladder. Eg: Diverticula, Fistula, Sinus, Cystitis. • Asses the integrity or ability of the urinary bladder to contract following trauma or surgery. • Stress incontinence in women. CONTRAINDICATIONS ◦ Acute UTI. Contrast media ◦ HOCM or LOCM, non irritant,non ionic ,water soluble contrast media like Iopamiro is used. ◦ Strength: 150 mg/ml ◦ Amount :150-200ml. 250 ml in patient with vesical fistula, 100-150 ml in post operative patient like radical prostectomy,cystectomy with preservation of sphincter or reconstruction of bladder. Equipments ◦ Fluroscopy unit with spot film device. ◦ 10 FR foleys catheter. In infant 5-7F feeding tube is edequate. ◦ Xylocain gel. Patient preparation ◦ Take written consent. ◦ Describe the procedure. ◦ Ask the patient to micturate prior to examination. Technique Patient lies supine on the x-ray table. With aseptic precaution, a catheter lubricates with xylocain gel ,then catheter introduced into the bladder. Residual urine is drained Diluted contrast media is slowly introduced and bladder filling is monitored by intermittent fluroscopy. Catheter is removed when patient desires to micturate. In children catheter remains in situ. When micturation commences ,it is quickly withdrawn. Older children and adult are given urine receiver, spontaneous micturation is viewed fluroscopically and films are taken in erect position.
Smaller children lie on table and is allowed to micturate on absorbent
pad.
In infant and children with neuropathic bladder ,micturation may be
accomplished by supra pubic pressure. Films Cystogram-supine Ap film of urinary bladder prior to micturation. During micturation- spot film In LAO position with right hip and knee flexed. In RAO position with left hip and knee flexed (entire urethra is visualised) Films Post voidal- supine PA film of urinary bladder.
In case og VVF/RVF- films are taken in lateral
position in VUR Full length view of abdomen (prior to post voidal ).to demonstrate any reflux of CM into the kidneys and to record the post micturation residue.
In this film, there is
VUR grade 5. In case of stress incontinence ◦ Position is same as for VUR , only the catheter left in situ until the patient is in erect position. ◦ Filming – in true lateral position to see the descent of the bladder base and urethral leak on straining. Parts of urethra Parts Of urethra Urethral stricture Christmas tree appearance of neurogenic bladder. Posterior urethral valve After care No special after care is necessary ,but warn about that patient may experience dysuria . In such case simple analgesic is sufficient.
Rarely patient may experience urinary retention. In that case patient is advised to micturate in warm bath.
If reflux is demonstrated and patient is not receiving any antibiotic ,then prescribe it. Complications 1. Due to contrast media: Adverse reaction may result from absorption of CM by the bladder mucosa. CM induced cystitis. 2. Due to technique: Acute UTI. Catheter trauma may produce dysuria, frequency,haematuria and retention of urine Perforation of urinary bladder from overdistension.
