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Virtual Pediatric Hospital: Paediapaedia: Voiding Cystourethrogram (VCUG)

 

Paediapaedia: Genitourinary Procedure Descriptions

Voiding Cystourethrogram (VCUG)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Patient Preparation:
Explain the procedure to the patient and parents

Contrast:
Cystoconray

Technique:
The patient must be filled to their Estimated Bladder Capacity, to ensure they are assessed adequately for reflux, using the following formulas:
If less than 1 year old = 7 x weight in kg
If greater than 1 year old = (age in years +2) x 30

If the patient is less than 2 years old, a cyclic study should be done to increase your sensitivity to detecting reflux. This is done by putting the patient through 3 cycles of filling and voiding, before the catheter is finally removed during voiding and the final film of the urethra is obtained.

Have the patient empty the bladder before the exam
Place the patient in a frogleg position
Examine the patient to determine the position of the urethra. In the female, the urethra lies between the clitoris and the vagina and may be difficult to see.
Using sterile technique, drape and prep the patient first with 3 swabs of of an iodinated antibacterial cleansing solution, and then 2 swabs of water to clean off the iodinated antibacterial cleansing solution
If the patient is an older male, consider using viscous lidocaine to anesthesize the urethra. Fill the urethra with viscous lidocaine and give it 2-3 minutes to take affect before catheterizing the patient.
Place the end of the catheter in the specimen bottle and set the bottle on the table
Insert the 8 French feeding tube into the bladder through the urethra (use a 5 French feeding tube if the patient is a premature infant)
Tape the catheter to the leg in a female, or to the abdomen and penis in a male
Obtain a urine specimen and send it to the clinic with the patient.
Perform a Crudet manuver (gentle pressure on the lower abdomen) to empty the bladder of urine before starting.
Take a scout film of the abdomen, to make sure the catheter is in the bladder
Fill the bladder with contrast
AP film of abdomen with low volume filled bladder
Lateral urethra voiding shot in males, AP urethra voiding shot in females
Post void AP of bladder
Post void AP of the kidneys
Oblique and AP spot films of any reflux

Explain the results to the parents

Views to Take:
Scout with the catheter in the bladder
AP film of abdomen with low volume filled bladder
Lateral urethra voiding shot in males, AP urethra voiding shot in females
Post void AP of bladder
Post void AP of the kidneys
Oblique and AP spot films of any reflux

References:
See References Chapter.

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