Synonym/Acronym
Voiding cystourethrography (VCU), voiding cystourethrogram (VCUG), micturating cystourethrogram (MCUG).
Rationale
To visualize and assess the bladder during voiding for evaluation of chronic urinary tract infections.
Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction. The patient may be instructed to increase fluid intake the day before the test and to have only clear fluids 8 hr before the test.
Regarding the patient’s risk for bleeding, the patient should be instructed to avoid taking natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Note the last time and dose of medication taken. Protocols may vary among facilities.
Normal Findings
- Normal bladder and urethra structure and function.
Study type: X-ray, special/contrast; related body system: Urinary system.
Voiding cystourethrography involves visualization of the bladder filled with contrast medium instilled through a catheter by use of a syringe or gravity, and, after the catheter is removed, the excretion of the contrast medium. Excretion or micturition is recorded and reviewed by the health-care provider (HCP) for confirmation or exclusion of ureteral reflux and evaluation of the urethra. Fluoroscopic or plain images may also be taken to record bladder filling and emptying. This procedure is often used to evaluate chronic urinary tract infections (UTIs).
Contraindications
Pregnancy is a general contraindication to procedures involving radiation.
Patients with conditions associated with adverse reactions to contrast medium (e.g., asthma, food allergies, or allergy to contrast medium). Patients with a known hypersensitivity to the medium may benefit from premedication with corticosteroids and diphenhydramine; the use of nonionic contrast or an alternative noncontrast imaging study, if available, may be considered for patients who have severe asthma or who have experienced moderate to severe reactions to ionic contrast medium.
Patients with bleeding disorders, because the puncture site may not stop bleeding.
Patients with an active UTI, obstruction, or injury.
Factors That May Alter the Results of the Study
- Gas or feces in the GI tract resulting from inadequate cleansing or failure to restrict food intake before the study.
- Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images.
- Inability of the patient to cooperate or remain still during the procedure, because movement can produce blurred or otherwise unclear images.
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
- Discuss how this procedure can assist in assessing the urinary tract.
- Inform the patient that the procedure takes about 30 to 60 min and is usually performed in the radiology department.
- Review the procedure with the patient.
- Explain that pregnancy testing may be required.
- Pediatric Considerations: There is no specific pediatric patient preparation for cystourethrography.
- Encourage being truthful about what the child may experience during the procedure (e.g., there may be a pinch or minor discomfort when the IV needle is inserted) and to use words that they know their child will understand.
- Note that toddlers and preschool-age children have a very short attention span, so the best time to talk about the test is right before the procedure.
- Allow the child to bring a favorite comfort item into the examination room, and if appropriate, that a parent will be with the child during the procedure.
- Consider using a blanket to wrap infants and small children to assist in keeping them still during the procedure.
- Provide older children with information about the test, and allow them to participate in as many decisions as possible (e.g., choice of clothes to wear to the appointment) in order to reduce anxiety and encourage cooperation.
- Encourage the child to practice the required position. If the child will be asked to maintain a certain position for the test, provide a type of visual media that demonstrates the procedure.
- Teach strategies to remain calm, such as deep breathing, humming, or counting to oneself.
Procedural Information
- The patient is asked/assisted to void before the procedure.
- Positioning is in either a supine or lithotomy position.
- A kidney, ureter, and bladder radiograph is taken to ensure that no barium or stool obscures visualization of the urinary system.
- Patients/parents are provided assurance that continuous monitoring for complications (e.g., allergic reaction, anaphylaxis, bronchospasm) occurs before, during, and after the procedure.
- A catheter is used to inject approximately 300 mL of contrast medium (air or iodinated contrast); the volume is adjusted lower for pediatric patients.
- When three-fourths of the contrast medium has been injected, an x-ray is taken as the remainder of the contrast medium is injected and the catheter is clamped.
- When the patient is able to void, the catheter is removed and the patient is asked to urinate while images of the bladder and urethra are recorded.
Potential Nursing Actions
Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
After the Study: Implementation & Evaluation Potential Nursing Actions
Avoiding Complications
- Monitor the patient for complications related to the procedure.
- Immediately report symptoms such as difficulty breathing, chest pain, fever, hyperpnea, hypertension, nausea, palpitations, pruritus, rash, tachycardia, urticaria, or vomiting to the appropriate HCP.
- Observe/assess the catheter insertion site for bleeding, inflammation, or hematoma formation.
- Administer ordered antihistamines or prophylactic steroids if the patient has an allergic reaction.
- Encourage the patient to increase fluid intake after the procedure to prevent stasis and bacterial buildup; increased fluids will help eliminate contrast medium.
Treatment Considerations
- Follow post-procedure vital sign and assessment protocol.
- Instruct the patient to resume usual diet, fluids, medications, or activity, as directed by the HCP.
Clinical Judgement
- Consider how to diminish the fears of the pediatric population and elicit cooperation during the procedure.
Follow-Up and Desired Outcomes
- Understands the importance of reporting to HCP symptoms such as persistent bladder spasms, fast heart rate, difficulty breathing, skin rash, itching, chest pain, or abdominal pain.
- Understands that the urine may be slightly pink (tinges of blood) and there may be some discomfort when urinating for 24 to 48 hr after the test related to irritation from the catheter. Prolonged pain, fever, or bright red urine should be immediately reported to the HCP.
- Agrees to increase oral fluid intake to eliminate any contrast medium or bacteria that may be present.