This document describes the cystourethrogram procedure. It begins by defining the cystourethrogram as an imaging test that uses contrast media to visualize the lower urinary tract and detect abnormalities. It then lists common indications for the test such as urinary tract infections, voiding difficulties, and congenital anomalies. The document goes on to describe the procedure, which involves catheterizing the bladder and instilling contrast media before taking x-ray images. Potential complications are also outlined.

2. Definition
The cysto urethrogram demonstrates the lower
urinary tract and help to detect an existence of
any vesicouretral reflux, bladder pathology and
congenital or acquired anomalies of bladder
outflow tract.

3. 1.UTI
2.Voiding difficulties likes: dysuria,
dribbling, frequency, urgency
3.Vesico ureteric reflux
4.Conginatal anomalies:
Meningomyelocele, Rectal anomalies.
5.Pelvic trauma
6.Boys with hematuria

4. INDICATION in
ADULT
1.Trauma to urethra
2.Urethral stricture
3.Suspected urethral diverticula

5. Contraindications
 Acute urinary tract infection.

6. CONTRAST MEDIA
 Water soluble contrast media like Conray 280,Trivideo
400 mg, Urograffin 60% are used which is diluted
with normal saline in 1:3 ratio.

7. PROCEDURE
Using sterile technique.
A catheter introduced into the bladder.
A polyethylene or soft rubber catheters
used.
A 5 F catheter is used in children and 8F
or 10F catheter is used in adult or older
children.

8. IN MALES
 In males, firstly retracted the foreskin of penis
 Then clean the glan penis,
 After that catheter introduced,

 The catheter is lubricated with an anesthetic jelly and
inserted slowly and gently into the urethra.
 And the urethra hold in vertical position.

9.  A normal bladder capacity in children is estimated in
ounces (1 ounce=29cc)
 In the bladder of newborn,30-50 cc can be instilled
with ease.
 3 year-12 year 200-250 cc
 Capacity in boys,5 year-6 year 100-150 cc
 In older boys 250 cc

10. Filming
In Children
 The bladder is filled by hand injection in 2 year children.
 In older children CM is instilled from a bottle placed one meter
above examination.
 During filling, fluoroscopy screening continusally
 For seeing the vesicouretral reflux, diverticuli or other
 abnormalities are present.
 Take oblique on both side to ensure that minimal reflux is not
overlooked.
 If reflux s appear then film are taken in oblique projection.
 If the bladder appears normal, one film are taken in frontal
projection at the end of filling.

11.  Catheter is removed and voiding starts in infants.
 At the end of voiding take a another film in frontal
projection.
 In the last take a another frontal film including the
kidney region .

12. In Adult male
 Bladder is filled in the usual way in older children.
 And voiding filming is done in both oblique
projection.
 Voiding study in male adult can be modified by getting
the patient to void against resistance, by using a penile
clamp. This is known as CHOKE
CYSTOURETHROGRAPHY which enhance the
visualization of urethra by artificial distension.

13. In Adult female
 The procedure is essentially the same as in girls.

14. Complications
 Infection due to catheterization of bladder.
 Adverse reaction
 Acute urinary tract infection.
 Catheter trauma causing dysuria, frequency,
hematuria and urinary retention.
 Perforation by catheter.
 Radiation effect.

16.  Hydro Cortisone