MCUG is a radiographic procedure used to evaluate the urinary tract. Contrast medium is injected into the bladder under fluoroscopy and images are taken as the patient voids to check for any reflux of contrast into the ureters or kidneys. It is used to investigate conditions like urinary tract infections, vesicoureteral reflux, and incontinence. The procedure involves catheterizing the bladder, filling it with contrast, and taking spot images during voiding to check for reflux. Precautions like using low-dose techniques are important to reduce radiation exposure, especially in pediatric patients.

1. Radiographic round on
MCUG
By Sanju Timilsina
B.Sc,MIT 3rd year

2. What is MCUG?

3. Anatomy

5. Indications
Urinary tract infection Dysuria
Urethral Diverticulum Vesico uretric reflux
Stress Incontinence

6. Contrast Media
HOCM or LOCM 200 to 500 ml diluted with normal saline in ratio of 1:10/1:20

7. Equipments
 Fluoroscopy unit with spot film device and tilting table
 Video recorder
 Jaques or foleycatheter
 In small infants a fine (5-7F) feeding tube is adequate
 Syringes
 Xylocaine jelly 1-2%
 Aseptic tray

8. Procedure
• Under aseptic conditions, catheterize the urinary bladder with patient in
supine position.
• Push the diluted contrast medium slowly under fluoroscopic guidance
• Ask the patient to inform you when he has urge to micturate
• Ask the patient to micturate in a urine receiver in an erect oblique
position
• Spot images are taken during micturition in right and left oblique
projections and any reflux is recorded
• Finally,a full length view of abdomen is taken to demonstrate any
undetected reflux of the contrast medium that might have occurred in
kidneys and to record the post micturationresidue

9. Complications
• Contrast reaction
• Contrast induced cystitis
• UTI
• Catheter Trauma
• Bladder perforation-due to overfilling of contrast
• Retention of Foley’s catheter
After Care
• Patient should be warned of rare dysuria and retention of urine
• In case of reflux- antibiotics are to be prescribed

10. Normal MCU

11. Imaging in MCU
A case of urethral stricture
Full bladder in supine
position(Filling phase)
Left anterior oblique(voiding
phase)
Right anterior oblique
(voiding phase)

12. Thick walled trabeculated bladder
Bullet nosed dilation of posterior urethra

13. Vesico uretric reflux
• Refers to retrograde passage of urine from bladder into the ureter and
often into the cycles
• Most significant risk factor for childhood renal scarring and its sequalae
• VUR in most cases is the result of primary maturation abnormality of
the vesicoureteral junction resulting in short distal ureteric submucosal
tunnel
• Imaging of VUR
• MCUG
• Radionuclide cystography
• MR voiding cystography

14. Grading of VUR in radiographic image
Grade 1 Grade 2 Grade 3 Grade 4
Grade 5

15. Strenghts
• MCUG is superior method for demonstrating the anatomical detail of male
urethra,the bladder and vesicoureteric junction.Calyceal anatomy may be seen if
VUR is present; sometimes this is only opportunity to visualize calyces if child is
in renal failure
Weakness
• An MCUG requires bladder catheterization and entails high radiation burden to
gonads,especially in girls.with increasing availability of digital
equipment,particularly when combined with pulsed
fluoroscopy,however,absorbed doses from conventional MCUG can be reduced
provided screening times can be kept to minimum

16. MCUG in Br Hospital
• MCUG is done under fluoroscopy control
• Most of the cases visiting Bir hospital for MCUG + RGU is :
• Frequent Urination
• Dysuria
• Nocturia
• Stress incontinence
• Equipment's for and MCUG
• Dressing set
• Foley’s catheter
• Surgical gloves
• 10ml syringe,50ml irrigation syringe
• Normal saline
• Xylocaine Jelly
• Urograffin-20ml(1 amp for RGU and 4-5 amp for MCUG)
• Procedure
• Patient lie in supine position, examination area is cleaned using aseptic technique and catheterization is done bladder is
filled under fluoroscopy control after bladder is full the catheter is withdrawn and Patient is asked to micturate in
different position and films are taken. We assist radiologist in whole procedure.
• Films : Full Bladder,Straining,Right oblique micturating,Left oblique micturating,Ap micturating and post
void.

17. Radiation Protection
• The duration of fluoroscopy should be kept to minimum and low-dose
technique should be used whenever possible.
• The gonadal radiation dose received by children undergoing MCU can be
as high as 309 mRad in boys and 1,900 mRad in girls.
• With recent advances in fluoroscopy, dose reduction can be easily achieved
without any perceived loss of image quality.
• Radiation exposure in pediatric fluoroscopy can be reduced to values well
below the exposure settings that are typically found on un-optimized
fluoroscopes. Pulsed fluoroscopy is considered a requisite for optimal
pediatric fluoroscopy.

18. References
• Diagnostic radiology text book of medical imaging by Grainger &
Allison’s fourth edition volume 2
• A Guide to Radiological Procedures, Chapman & Nakielny - 4th
Edition.
• Clark’s Special Procedure.
• http://www.sjkdt.org/article.asp?issn=1319-
2442;year=2008;volume=19;issue=1;spage=20;epage=25;aulast=Al-
Imam
• https://www.slideshare.net/shubhamxsinghal/rgu-mcu?qid=27fbe1f9-
28de-4219-aa20-3e08ba555e61&v=&b=&from_search=1