micturating cystourethrogram

1. SHARDA UNIVERSITY
PREP BY : AASIF MAJEED LONE
email: fisaalone99@gmail.com
MCU
MICTURATING
CYSTOURETHROGRAM

2. MICTURATING
CYSTOURETHROGRAM
• Voiding cystourethrogram
demonstrates the
lower urinary tract & helps to detect
VUR ,
bladder pathology , congenital or
aquired
anamolies of bladder
• It is performed by passing a catheter
through
the urethra into the bladder, filling the
bladder with contrast material and then
taking
radiographs while the patient voids.

3. INDICATIONS
• CHILDREN:
• RECURRENT UTI
• VOIDING DIFFUCULTIES
• VUR
• MENINGOMYELOCELE, SACRAL
AGENESIS,
RECTAL ANAMOLIES
• BASELINE STUDY PRIOR TO
LOWER URINARY
TRACT SURGERY

4. • POST OP EVALUATION OF
URETERIC
ABNORMALITIES
• PELVIC TRAUMA
• IN RENAL FAILURE TO EXCLUDE
REFLUX
• POSTERIOR URETHRAL VALVE OR
POLYP
• CONGENITAL ANAMOLIES OF
BLADDER &
URETHRA.

5. ADULTS
• Trauma to urethra
• Urethral stricture
• Urethral diverticulum
• Recurrent UTI
• Reflux nephropathy prior to renal
transplant
• Follow up patients of spinal cord
injury
• Stress incontinience

6. Contrast media
• The estimated volume of contrast medium to be
given during the
examination is determined mainly by the age of the
child except for
children less than one year of age in whom it is
determined by
weight.
Less than one year,
Weight (kg) × 7 = capacity (ml)
Less than two years,
(2 × age in years + 2) × 30 = capacity (ml)
More than two years,
(Age in years/2 + 6) × 30 = capacity (ml)

7. • Contrast media: Water soluble
contrast media
like urograffin 60% is used which is
diluted
with normal saline in 1:3 ratio.
EQUIPMENT
- Preferably under fluroscopy.
- Foley`s catheter & syringe
- In infants – feeding tube no 5 – 7 F
• Preparation : none , rule out acute UTI.

8. Procedure
• Using a sterile technique , a catheter is
introduced into
the bladder.
• A 5f feeding tube with side holes are
used for children
and in older children or adults 8f r 10 f
catheters are
used .
• In girls after initial inspection of
perineum to identify
any local genitilia abnormalities
(cystoceles or labial
fusion ) the catheter is introduced..
• When it enters the bladder a varying
amount of urine
will flow through it .if no flow a catheter is
introduced

9. till urine is obtained.
Suprapubic pressure Is sometimes helpful.
In males , foreskin is retracted and
catheter is introduced .
The catheter should be lubricated with
anaesthetic jelly
and inserted slowly and gently into the
urthera holding the
penis is vertical position .
The normal bladder capacity in children is
estimated to be
1 ounce ie 29 cc .
For newborns -30 to 35 cc can be instilled.
• For upto 3 yrs – 200 to 250 cc
Adequate capacity is reached when the
child becomes
uncomfortable and begins voiding around the
catheter.
Bladder capacity (in milliliters) is variable
but can often be

10. predicted with the previous mentioned
formula
Filming
In children : upto 2 yrs of age bladder is
filled by hand
injection . For older children contrast medium is
instilled from
a bottle elevated one metre above the
examination table.
During filming , fluroscopic screening is
performed at short
intervals to see any vu reflux ,diverticuli .
The child is turned oblique on both sides to
ensure that
minimal reflux is not overlooked.
In infants : voiding starts the moment
catheter is removed. At
the end of voiding ,frontal film is taken which
includes entire

11. abdomen including the kidney region to
prevent overlooking
the vu reflux which is apparent only on
termination of voiding
and may reach upper collecting system.
In adult male : bladder is filled in
the usual
way as in older child and voiding
filming
done in both oblique projection
views.
The voiding study in male adults
can be
modified by getting the patient to
void
resistance i.e. by compression of
distal

12. penis thus enhancing the
visualization
urethra by artificial distention .

13. ALTERNATE
TECHNIQUES
1) SUPRAPUBIC BLADDER
PUNCTURE.
Sometimes in PUV & pelvic trauma –
not possible to catheterize.
2) URETHROCYSTOGRAPHY
Contrast medium introduced into the
bladder during RGU.
3) EXCRETION MCU ( MCU
followed by IVU )
Advantage – avoid catheterization and
related risk of infection.
Disadvantage - VUR can not be
visualized properly .
takes longer time.

14. Excretion MCU : (MCU
followed by
IVP)
• This method makes use of contrast
media accumulated
in the urinary bladdder during ivp
• Advantages : avoidance of physical and
psychological
trauma of catherization
• Avoidance of infection
• More physiological procedure hence
more reliable.
• Disadvatanges : visualization is not
usually adequate
• Takes longer time
• Vu reflux visualised poorly.

15. COMPICATIONS
Contrast reaction.
Contrast induced cystitis.
UTI.
Catheter trauma.
Bladder perforation –
overfilling.
Retention of a foley catheter.
Catheterisation of vagina /
ectopic ureter.
Radiation exposure
Autonomic dysreflexia- in
paraplegic patients due

16. to spinal cord injury at or above
t6 level, forceful
injection of contrast causes
severe headache
,sweating ,hypertension with
bradycardia due to
forceful opening of bladder
neck

17. • CONTRAINDICATIONS
Acute UTI.
• AFTERCARE
Warned – of rare dysuria ,
retention.
Reflux - Antibiotcs.

18. Posterior urethral
valves
Congenital thick folds of mucous
membrane located in the posterior
urethra
prostatic + membranous) distal to the
verumontanum.
Most common cause of severe
obstructive uropathy in children.
Almost exclusively in males.
Leading cause of end stage renal disease
in boys.
Now rare for them to present with severe
UTI and septicaemia -diagnosis is
generally made in early infancy and
antenatal period.

19. Micturiting cystourethrography
Procedure of choice for defining the
valves.
Indication -Thick walled bladder &
dilated ureters on USG.
Combination of ultrasound and MCU
allows both urologist and
nephrologist to plan immediate
management.
Repeated 3 months after ablation.

20. MCU – Lateral view.
Fusiform dilatation & elongation of
proximal posterior urethra
persisting throught voiding
Transverse/curvilinear filling defect in
posterior urethra

21. Posterior urethral valve in newborn .

22. Posterior urethral valve in a 7 yr. Old boy .

23. Posterior urethral valve -image shows a
dilated posterior urethra with an abrupt
transition to a normal-calibre anterior urethra
with bladder neck hypertrophy, the irregular
trabeculated bladder wall, and the left-sided
grade III vesicoureteric reflux.

24. Urachal diverticulum :
• persistence of a segment of the
urachus,
present as a protrusion at the
vertex of the
bladder. It may predispose to
urolith
formation.

25. Urachal diverticulum. Posteroanterior mcu
image shows a gross urachal diverticulum
bladder.

26. Prostatic utricle
• The prostatic utricle is a small,
blind-ending
midline pouch arising from the
prostatic
urethra at the level of the
verumontanum
• A large prostatic utricle may be
associated
with urinary retention, stasis, and
infection

27. MCU image shows a diverticulum resulting from spontaneous
opacification of a prostatic utricle

28. 