CYSTOGRAMS, LOOPOGRAMS VCUGs & Urethrograms

Cystograms Purpose: evaluation of the anatomy and physiology to the urinary bladder Preparation: 1) explain the procedure to the patient 2) informed consent is required for catheterization of pediatric patients 3) have the patient empty his/her bladder

Supplies Sterile, disposable catheterization set Contrast media: ionic contrast Fluid administration set Variety of straight and Foley catheters in varying sizes (#14 adults, #8-10 child) (sometimes a small infant feeding tube for infants and toddlers)

Procedure Call nursing to perform catheterization Take preliminary KUB scout Set room up for fluoro Measure any residual urine once catheter has been placed Connect contrast media to catheter via catheter tubing set Radiologist will begin to fill bladder w/ gravity flow

Overhead images AP RPO LPO

AP

RPO/LPO

Cystograms vs. VCUG Cystogram: looking at the bladder only. The physician is not concerned about urethra, nor ureters! VCUG: looking at the bladder, urethra & ureters. This exam is an extension of a cystogram in that we take voiding imaging to see if the contrast is refluxing up into the ureters.

VCUG Same as the cystogram except overhead images will be taken on a 14x17 image size to include the kidneys, ureters & bladder. Usually done upright.

Procedure Preliminary KUB Inflate balloon on Foley and press against the stoma. Do not inflate the balloon in the stoma! Radiologist will inject contrast via the catheter into the stoma. Once the procedure is completed help patient replace his/her stoma pouch.

Overhead Images AP RPO LPO (Full 14x17 field size to include kidneys, ureters & bladder)

Retrograde Urethrograms Purpose: For evaluation of urethral patency Take preliminary image: RPO, center over the symphysis pubis and penis (70kVp), 10 x 12 F.S. Possible overheads: RPO

Overhead (male)

Overhead (female vcug)

Ileo Loopogram Purpose: Evaluation of the anatomy of the post ileo-loop (ileo conduit)

Supplies 14, 16, or 18 French Foley catheters— with large balloon 50cc Cath tip syringe for contrast media Hemostat Sterile gloves Sterile 4 x 4’s 20cc syringe to inflate the retention balloon on the Foley 50cc’s of contrast media Duraprep

Single-shot IVU Patient is pregnant Same setup and consent as the standard IVU Differences: No preliminary KUB 15 minute KUB & show to the radiologist No other images will be taken unless absolutely necessary and ordered by the radiologist!