A cystography is a specialized medical imaging test that provides detailed pictures of the bladder and, often, the urethra. This procedure uses X-ray technology, typically fluoroscopy, which captures real-time, moving images of the urinary tract. To make internal structures visible, a liquid contrast dye is introduced directly into the bladder. The goal is to evaluate the structure and function of the lower urinary system and identify abnormalities not visible on standard scans.
Why a Cystography is Necessary
Doctors recommend a cystography for persistent issues with urination or the urinary tract. A common indication is the investigation of vesicoureteral reflux (VUR), where urine flows backward from the bladder into the ureters and potentially the kidneys. Diagnosing VUR is important in children with recurrent urinary tract infections (UTIs) and fever, as the backward flow can lead to kidney damage over time.
The test determines the cause of other urinary symptoms, such as blood in the urine (hematuria) or difficulty fully emptying the bladder. A cystography can help locate blockages or narrowings, known as strictures, in the urethra or the tubes connecting the bladder to the kidneys. It is also performed to check for potential tears or ruptures in the bladder wall following suspected trauma to the lower abdomen or pelvis.
Depending on the diagnostic need, a doctor may order a standard cystography or a voiding cystourethrography (VCUG). A standard cystography focuses on the full bladder, primarily looking for structural abnormalities or leaks. A VCUG is a functional study that captures images while the patient actively voids, allowing physicians to assess urinary flow and check for reflux during the emptying process.
The Procedure: What to Expect During the Test
The procedure is performed in a hospital or outpatient center by a radiologist or urologist and an X-ray technologist. The patient lies on an X-ray table, and the genital area is cleaned with an antiseptic solution. A thin, flexible urinary catheter is then inserted through the urethra and into the bladder.
The provider slowly injects the contrast dye through the catheter until the bladder is full, which creates a feeling of pressure or a strong urge to urinate. Once the bladder is distended, the technologist takes a series of X-ray images, often using fluoroscopy to capture the process in motion. The patient may be asked to change positions, such as tilting to the side, to ensure a complete view of the bladder from all angles.
For a voiding cystourethrography, the catheter is removed after the bladder is full. The patient is then asked to urinate into a special receptacle while more images are captured. This voiding phase visualizes the urethra and detects any backward flow of urine. The entire procedure generally takes less than an hour.
Preparation, Recovery, and Potential Risks
Preparation for a cystography requires following the doctor’s specific instructions. Patients must sign a consent form and inform the medical team about any known allergies, especially to contrast dyes or iodine. If a sedative is used, the patient may be asked to refrain from eating or drinking for a few hours before the appointment.
Following the test, patients are encouraged to drink plenty of fluids for the next day or two. This helps flush the contrast dye out of the system and reduces the risk of developing a urinary tract infection. It is common to experience mild discomfort, a burning sensation during urination, or increased frequency of needing to use the restroom for up to 48 hours after catheter removal.
The procedure is generally considered safe, but minor risks exist. The most common risk is a urinary tract infection resulting from catheter insertion. There is also a small risk of a temporary allergic reaction to the contrast dye. Patients should contact their healthcare provider immediately if they develop a fever, experience worsening pain, or notice heavy bleeding in the urine.