Cystography

Cystography is a diagnostic procedure that uses x-rays to examine the bladder. Still x-ray pictures or fluoroscopy (a study of moving body structures - similar to an x-ray "movie") may be used.

During cystography, contrast dye is injected into the bladder. Contrast dye refers to a substance taken into the body that causes the particular organ or tissue under study to be seen more clearly. X-rays are taken of the bladder, and fluoroscopy may be used to study the bladder emptying while a person urinates (voiding cystography). Cystography may indicate how well the bladder empties during urination and whether any urine backs up into the kidneys (vesicoureteral reflux).

Reasons for the Procedure

Cystography may be performed to assess the cause of hematuria (blood in the urine), recurring urinary tract infections (UTI’s), or to assess the urinary system when there has been trauma to the bladder. Cystography may also be used to assess problems with bladder emptying and urinary incontinence.

Obstructions and strictures (narrowing) of the ureters or urethra may be evaluated by cystography. Cystography may be used to assess enlargement of the prostate gland.

Cystography may be performed before and/or after certain surgeries of the spine to assess possible problems with the nerves leading to the bladder from the spine.

There may be other reasons for your physician to recommend cystography.

Risks of the Procedure

The amount of radiation used during a cystography procedure is considered minimal. Therefore, risk for radiation exposure is very low.

If you are pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure during pregnancy may lead to birth defects.

Patients who are allergic to or sensitive to medications, contrast dyes, local anesthetic, iodine, shellfish, or latex should notify their physician.

Patients with kidney failure or other kidney problems should notify their physician.

Bladder infection may occur as a result of placing a catheter into the bladder for the procedure. Insertion of a catheter into the bladder may also cause bleeding or hematuria.

Situations in which cystography is contraindicated include, but are not limited to, the following:

• Recent bladder surgery
• Blockage of the urethra, or damage or tearing of the urethra
• Acute phase of urinary tract infection

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician before the procedure.

Certain factors or conditions may interfere with the results of the test. These may include, but are not limited to, the following:

• Gas or stool in the intestines
• Inability to maintain a steady stream when urinating
• Barium in the intestines from a recent barium enema

Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• Your physician will give you specific instructions regarding fasting from food and liquid before the test. Generally, you should not eat after midnight the night before the procedure and drink only clear liquids the day of the procedure. You may be instructed to drink additional clear liquids the day before and day of the procedure.
• If you are pregnant or suspect that you may be pregnant, you should notify your physician.
• Notify your physician if you have ever had a reaction to any contrast dye, or if you are allergic to iodine or seafood.
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications before the procedure.
• You may be instructed to take a laxative the night before the procedure. Alternatively, you may be given an enema or a cathartic medication (medication to induce bowel movements) the morning of the procedure.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

A cystography procedure may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

Generally, a cystography follows this process:

1. You will be asked to remove any clothing, jewelry, or other objects that might interfere with the procedure.
2. If you are asked to remove clothing, you will be given a gown to wear.
3. You will be asked to empty your bladder before the procedure.
4. You will lie on your back on the x-ray table.
5. A catheter will be inserted into your bladder for injection of the contrast dye into the bladder.
6. A kidney, ureter, and bladder (KUB) x-ray will be taken to verify that the urinary system is visible. With male patients, a lead shield will be placed over the testes to protect the gonads from the x-rays.
7. The contrast dye will be injected into the bladder through the catheter. After the dye has been injected, the catheter tubing will be clamped to prevent drainage of the dye from the bladder.
8. X-rays will be taken while the dye is being injected and afterwards. You may be asked to change position for different x-ray views of the urinary system.
9. If a voiding cystography is requested, the catheter will be removed and you will be asked to urinate. X-ray or fluoroscopy films will be taken while you urinate. If you are unable to urinate while lying down, you may be allowed to sit or stand up.
10. If a voiding cystography is not performed, the catheter will be removed after all required x-ray views have been taken.

After the Procedure

There is no special type of care required after a cystography. You may resume your usual diet and activities, unless your physician advises you differently.

You should drink additional fluids for a day or so after the procedure to help eliminate the contrast dye from your system and to help prevent infection of the bladder.

You may experience some mild pain with urination or notice a pink tinge to your urine for a day or two after the procedure. This is to be expected after insertion of the catheter into your bladder. However, if the pain increases or persists longer than two days, notify your physician.

Also, notify your physician to report any of the following:

• Fever and/or chills
• Abdominal pain
• Blood in the urine
• Urine output is less than usual amount

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.