Paediatrics 2, Ivo Dukic, 29th July 2013, North Western Deanery, Urology registrar teaching,
HOW DO YOU PERFOM A VOIDING CYSTOURETHROGRAM?
It is one of the most stressful urological investigations performed on children with 27% experiencing severe distress.
It is important to calm the parent as parental influence reduces the child’s anxiety.
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Issue verbal and written information regarding the procedure
Antibiotics are given one day prior to the procedure and continued for 3 days post procedure
Encourage parent assistance to encourage the child and distraction techniques
The procedure should be explained to parent and child using words and pictures
Use a low-osmolar contrast medium with 150 mg iodine /ml which should be warmed to body temperature
Estimate of bladder capacity
If > 1 year old, Estimated bladder capacity = (Age+2) x 30 (Koff et al, 1983)
If <1 year old, Estimated bladder capacity = Weight (kg) x 7 (Fairhurst et al, 1991)
This values are estimates and do not indicate that it is safe to infuse this amount in every patient.
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Strict aseptic non touch technique urethral catheterization using an 8Fr or 5Fr (for those <1 year) balloonless
catheter, usually a feeding tube
The catheter is taped into position to allow multiple bladder fills, as VUR can be intermittent
Contrast medium is given via a gravity based technique using a drip, typically 50 cm above the patients
bladder
The following images should be performed using the ALARA principle (As Low as Reasonable Achievable)
o Control film
o Early filling view (may show ureterocele)
o Full bladder view
o Voiding urethra view (in boys this is obtained by turning in the right or left anterior oblique psotion)
o Full length abdominal view to document reflux and to record the post void residual volume#
The last three images can be repeated as part of a cyclical voiding study, though more than two studies
are rarely necessary.
The catheter is removed for the 2nd cycle, this improves detection of VUR and PUV
COMPLICATIONS
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Catheter trauma related LUTS
Haematuria and urinary retention
UTI
Perforation of the bladder
Adverse reaction to contrast media
CONTRAINDICATIONS
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Active UTI
Fever
FURTHER READING
Agrawalla, S., Pearce, R. & Goodman, T.R., 2004. How to perform the perfect voiding cystourethrogram. Pediatric Radiology,
34(2), pp.114–119.
Koff, S.A., 1983. Estimating bladder capacity in children. Urology, 21(3), p.248.
Fairhurst, J.J. et al., 1991. Bladder capacity in infants. Journal of pediatric surgery, 26(1), pp.55–57.