In cystography, the bladder is filled with a contrast dye to highlight the organ on x-rays or fluoroscopic films. In some cases, additional films are obtained as you urinate to reveal any abnormalities of the urethra or urinary dysfunction (a procedure called voiding cystourethrography, or VCUG). The recorded images are then examined for abnormalities.
A similar procedure, called urethrography, involves instilling contrast dye into the urethra but not as far as the bladder. Used almost exclusively in males, this test helps to diagnose structural problems in the urethra, such as obstructions.
Purpose of the Cystography
- Cystography is used to detect structural abnormalities of the bladder such as tumors; traumatic injury; or abnormal pouches or protrusions (diverticula).
- To assess the cause of hematuria (blood in the urine), recurring urinary tract infections (UTIs)
- VCUG can identify abnormalities of the bladder and urethra, as well as urinary dysfunction, such as backward flow (reflux) of urine from the bladder to the kidneys.
Who Performs Cystography
- A radiologist and a technician
Special Concerns about Cystography
- Pregnant women should not undergo this test because exposure to ionizing radiation may harm the fetus.
- This test is not appropriate in people with acute bladder or urethral infection.
- During this test, men will wear a lead shield over the testes to shield against excess radiation. However, in women it is not possible to shield the ovaries without blocking the view of the bladder.
- People with allergies to iodine or shellfish may experience an allergic reaction to iodine-based contrast dyes, but this is rare.
- Results may not be accurate if you have had other recent x-rays using a contrast dye or if there is feces or gas in the bowels.
- Embarrassment may prevent some individuals from urinating during VCUG.
Before the Cystography
- Tell your doctor if you have a known allergy or sensitivity to medications, contrast dyes, local anesthesia, latex, iodine or shellfish.
- Tell your doctor if you have a history of a bleeding disorder or if you are taking a blood thinner (anticoagulant), aspirin, or other medication that affects blood clotting.
- The morning of the test, you should drink only clear liquids for breakfast.
- At the testing facility, you will be asked to disrobe and put on a hospital gown.
What You Experience during Cystography
- You will lie on your back on an x-ray table. You may be given a sedative, if necessary.
- A thin, soft tube, called a Foley catheter, is inserted through the urethra and into the bladder. You may feel some discomfort during catheter insertion.
- The examiner instills a contrast dye solution through the catheter until your bladder feels full, and then clamps the catheter closed. You may experience a sensation of fullness and the urge to urinate.
- A series of x-rays or fluoroscopic films is obtained. You will be asked to assume a variety of positions as they are taken.
- If a VCUG is being done, the catheter is removed and you are asked to urinate (if you cannot do so while lying down, you may stand up). During urination, additional films are taken of the bladder and urethra.
- In rare cases, a small amount of air may be insufflated through the catheter into the bladder after the dye is eliminated, and more images are obtained (this is called the double-contrast technique).
- This test takes 30 to 45 minutes.
Risks and Complications of Cystography
- X-ray exams involve minimal exposure to radiation. Although radiation exposure is still small with fluoroscopy, you receive a higher dose than during standard x-ray procedures.
- Some patients may develop a bladder infection after this procedure.
- Rarely, some people may experience an allergic reaction to the iodine-based contrast dye, which can cause symptoms such as nausea, sneezing, vomiting, hives, and occasionally a life-threatening response called anaphylactic shock. Emergency medications and equipment are kept readily available.
After the Cystography
- You may experience some burning as you urinate the first few times after the test. Drink plenty of fluids to help flush the dye from your bladder and reduce this sensation, and to prevent any accumulation of bacteria.
- You may return home and resume your usual activities.
- Contact your doctor if you develop lower abdominal pain or fever, blood in the urine, or if urine output is less than normal.
Results of Cystography
- A radiologist (and possibly a urologist) will examine the images for evidence of any abnormality.
- If a definitive diagnosis can be made, appropriate treatment will be initiated.
- In some cases, additional urologic tests, such as cystoscopy or ultrasound of the kidneys, may be needed to establish a diagnosis and determine the extent of the problem.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media