Special Procedure: Cystourethrogram

Description :

Cystourethrography is a contrast study for the evaluation of the urinary bladder and urethra. With rare exception (e.g. the patient cannot have a urethral catheter passed), all of the phases will be performed :

• Pneumocystogram (negative contrast used).
• Double-Contrast Cystogram (both negative and positive contrast used).
• Cystogram (positive contrast used).
• Retrograde Urethrogram (contrast agent injected via catheter while exposing radiographs).
• Antegrade Urethrogram (radiolucent object used to compress urinary bladder to get patient to expel urine in a voiding manner).

Indications for this procedure :

• Evaluate for bladder and urethral masses, and other mural lesions such as urachal diverticuli that may be directly causative of lower urinary tract signs or contributing to recurrent infection.
• Assessment of location of a known mass to better estimate its relationship to the trigone and assess surgical resectability.
• Evaluate for bladder and urethral calculi.
• Evaluate some functional information in incontinent patients.
• Evaluate for anatomic abnormalities such as a pelvic bladder and urethro-rectal fistulae.
• Evaluate for bladder or urethral tears.

Contraindications and complications for this procedure :

• The bladder or urethra are at some risk for tear or rupture - this is generally only an issue if the tissue is already compromised by disease or previous surgery.
• Air embolism is a RARE and potentially fatal complication seen with pneumocystography and double-contrast cystography. It is more common in patients with gross hematuria. We use CO2 as our contrast gas to greatly decrease the already small risk.
• As with any procedure involving urinary catheterization, infection may occur.
• Urine culture should not be considered valid for 2 days after the study because of the anti-microbial effects of iodine contrast.