A cystogram is a specialized medical imaging examination focused on visualizing the urinary bladder and the lower urinary tract. This test uses X-ray technology, often combined with fluoroscopy, which creates a continuous X-ray image, similar to a video. The procedure requires the introduction of a radiopaque contrast agent, or “dye,” directly into the bladder through a catheter. This contrast material fills the bladder, making its interior structure visible on the resulting images, helping diagnose structural and functional issues.
Diagnostic Applications
Physicians frequently order a cystogram to investigate recurrent urinary tract infections, persistent blood in the urine, or difficulties in emptying the bladder. It is commonly used to diagnose vesicoureteral reflux (VUR), a condition where urine abnormally flows backward from the bladder up toward the ureters and potentially the kidneys. This backward flow can lead to kidney damage and infection.
The imaging study also evaluates the integrity of the bladder wall, particularly following significant blunt trauma to the abdomen or pelvis. A cystogram can confirm or rule out a bladder rupture by showing whether the contrast material leaks outside the bladder boundary. Furthermore, it helps identify abnormal passages, known as fistulas, that may have formed between the bladder and nearby organs like the colon or vagina.
Specific conditions affecting bladder function and structure also necessitate this test. For example, it assesses bladder function in individuals with a neurogenic bladder, where nerve problems interfere with control. It can further help locate blockages or strictures, which are narrowings in the urethra, and identify bladder diverticula, small pouches that bulge out from the bladder wall.
Performing the Procedure
The cystogram is typically conducted in a hospital’s radiology department or an outpatient imaging center, usually by a radiologist and a technologist. You will be asked to change into a gown and lie on your back on the X-ray table, which is often connected to a fluoroscopy unit. Before the procedure begins, a preliminary X-ray of the abdomen is sometimes taken to serve as a baseline image.
The most sensitive part of the procedure involves the placement of a urinary catheter. This sterile process begins with thoroughly cleaning the genital area with an antiseptic solution. A small catheter is then gently inserted through the urethra and advanced into the bladder. A lubricating gel, sometimes containing a numbing agent, is used to minimize any discomfort during this step.
Once the catheter is positioned, the contrast dye is slowly introduced into the bladder, often delivered via gravity from a suspended bag. The bladder fills gradually until it reaches maximum capacity or until you feel a strong urge to urinate. As the bladder fills, the fluoroscope captures live, moving images and still X-rays from various angles to visualize the entire bladder structure.
In some cases, a voiding cystourethrogram (VCUG) is performed, which is a variation of the standard cystogram. For a VCUG, the catheter is removed after the bladder is full, and images are taken while you actively urinate. This specific timing allows the physician to examine the urethra and watch the flow of urine to check for VUR or obstructions during the actual voiding process.
Patient Preparation and Post-Procedure Expectations
A cystogram generally requires minimal preparation; you can usually eat and drink normally before the appointment. Inform the medical team about any possibility of pregnancy or allergies to contrast materials, though the dye used rarely causes a systemic allergic reaction since it does not enter the bloodstream. If you are taking medications, particularly antibiotics, your provider will give specific instructions on whether to continue or temporarily stop them.
After the catheter is removed, you are typically advised to resume your normal activities immediately. A common instruction is to drink plenty of fluids over the next few hours; this helps to flush the remaining contrast dye out of your system. It is normal to experience a mild burning sensation or some discomfort when you urinate for the first one to two days following the procedure.
Though the procedure carries a low risk, the most common complication is a urinary tract infection (UTI) resulting from the catheterization. Contact your physician immediately if you experience signs of a more significant problem, such as a fever, severe pain, or if you are unable to urinate.