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Principles of Voiding Cystourethrography (VCUG)

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Pediatric and Adolescent Urologic Imaging

Abstract

A voiding cystourethrogram (VCUG) is one of the most commonly performed studies in pediatrics. A VCUG is a fluoroscopic study that can assess the structure and function of the bladder and the structure of the urethra. It is frequently used in the evaluation of children with urinary tract infections to determine the presence of vesicoureteral reflux (VUR), bladder diverticula, complete bladder emptying, and assess for possible bladder sphincter dyssynergia. It is also used in the evaluation of hydronephrosis, congenital renal anomalies, imperforate anus, cloacal abnormalities, disorders of sexual differentiation, trauma, and screening siblings for VUR. In addition, it provides information regarding the urethra and is used in diagnosing posterior urethral valves, urethral strictures, or suspicion of a duplicated urethra or other anomalies.

The study is performed in a fluoroscopic suite. The urinary bladder is catheterized and filled with radiopaque contrast by gravity drip. At a minimum, images should include an early filling image, bilateral oblique images of the ureterovesical junction (UVJ) when the bladder is full, voiding images of the urethra, and post-void images of the kidneys and bladder. Depending on the child, this can be performed with or without sedation. Careful technique is required to provide adequate images without exposing the child to unnecessary radiation, applying the ALARA principle.

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References

  1. Belman BA. A perspective on vesicoureteral reflux. Urol Clin North Am. 1995;22(1):139–50.

    CAS  PubMed  Google Scholar 

  2. Berrocal T, Lopez-Pereira P, Arjonilla A, Gutierrez J. Anomalies of the distal ureter, bladder, and urethra in children: embryologic, radiologic, and pathologic features. Radiographics. 2002;22(5):1139–64.

    Article  PubMed  Google Scholar 

  3. Lee RS, Diamond DA, Chow JS. Applying the ALARA concept to the evaluation of vesicoureteral reflux. Pediatr Radiol. 2006;36 Suppl 2:185–91.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Schueler BA. The AAPM/RSNA physics tutorial for residents: general overview of fluoroscopic imaging. Radiographics. 2000;20(4):1115–26.

    Article  CAS  PubMed  Google Scholar 

  5. Goske MJ, Charkot E, Hermann T, John SD, Mills TT, Morrison G, Smith SN. Image gently: challenges for radiologic technologist when performing digital radiology in children. Pediatr Radiol. 2011;41:611–19.

    Article  PubMed  Google Scholar 

  6. Connolly B, Racadio J, Towbin R. Practice of ALARA in the pediatric interventional suite. Pediatr Radiol. 2006;36 Suppl 2:163–7.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Bevelacqua JJ. Practical and effective ALARA. Health Phys. 2010;98 Suppl 2:S39–47.

    Article  CAS  PubMed  Google Scholar 

  8. Moore QT, Don S, Goske MJ, Strauss KJ, Cohen M, Herrmann T, MacDougall R, Noble L, Morrison G, John SD, Lehman L. Image gently: using exposure indicators to improve pediatric digital radiology. Radiol Technol. 2012;84(1):93–9.

    PubMed  Google Scholar 

  9. Agrawalla S, Pearce R, Goodman TR. How to perform the perfect voiding cystourethrogram. Pediatr Radiol. 2004;34:114–19.

    Article  PubMed  Google Scholar 

  10. Bazopoulos EV, Prassopoulous PK, Damilakis JE, Raissaki MT, Megremis SD, Gourtsoyiannis NC. A comparison between digital fluoroscopic hard copies and 105-mm spot films in evaluating vesicoureteric reflux in children. Pediatr Radiol. 1998;28(3):162–6.

    Article  CAS  PubMed  Google Scholar 

  11. Racadio JM, Connolly B. Image gently, step lightly: practice of ALARA in pediatric interventional radiology. http://www.pedrad.org/associations/5364/ig/index.cfm?page=596

  12. Williams MB, Krupinski EA, Strauss KJ, Breeden 3rd WK, Rzeszotarski MS, Applegate K, Wyatt M, Bjork S, Seibert JA. Digital radiography image quality: image acquisition. J Am Coll Radiol. 2007;4(6):371–88.

    Article  PubMed  Google Scholar 

  13. Andrich MP, Majd M. Diagnostic imaging in the evaluation of the first urinary tract infection in infants and young children. Pediatrics. 1992;90(3):436–41.

    CAS  PubMed  Google Scholar 

  14. McDonald A, Scranton M, Gillespie R, Mahajan V, Edwards GA. Voiding cystourethrograms and urinary tract infections: how long to wait? Pediatrics. 2000;105(4):e50.

    Article  CAS  PubMed  Google Scholar 

  15. Spencer JD, Bates CM, Mahan JD, Niland ML, Staker SR, Hains DS, Schwaderer AL. The accuracy and health risks of a voiding cystourethrogram after a febrile urinary tract infection. J Pediatr Urol. 2012;8(1):72–6.

    Article  PubMed  Google Scholar 

  16. Phillips DA, Watson AR, MacKinlay D. Distress and the micturating cystourethrogram: does preparation help? Acta Paediatr. 1998;87:175–9.

    Article  CAS  PubMed  Google Scholar 

  17. Robinson M, Savage J, Steward M, Sweeney L. The diagnostic value, parental and patient acceptability of micturating cysto-urethrography in children. Ir Med J. 1999;92(5):366–8.

    CAS  PubMed  Google Scholar 

  18. Srivastava T, Betts G, Rosenberg AR, Kainer G. Perception of fear, distress, and pain by parents of children undergoing a micturating cystourethrogram: a prospective study. J Paediatr Child Health. 2001;37:271–3.

    Article  CAS  PubMed  Google Scholar 

  19. Zelikovsky N, Rodrigue JR, Gidcz CA, Davis MA. Cognitive behavioral and behavioral interventions help young children cope during a voiding cystourethrogram. J Pediatr Psychol. 2000;25(8):535–43.

    Article  CAS  PubMed  Google Scholar 

  20. Salmon K, Pereira JK. Predicting children’s response to an invasive medical investigation; the influence of effortful control and parent behavior. J Pediatr Psychol. 2002;27(3):227–33.

    Article  PubMed  Google Scholar 

  21. Herd DW. Anxiety in children undergoing VCUG: sedation or no sedation? Adv Urol. 2008; 498614.

    Google Scholar 

  22. Herd DW, McAnulty KA, Keene NA, Sommerville DE. Conscious sedation reduces distress in children undergoing voiding cystourethrography and does not interfere with the diagnosis of vesicoureteric reflux: a randomized controlled study. AJR Am J Roentgenol. 2006;187(6):1621–6.

    Article  PubMed  Google Scholar 

  23. Ferguson GG, Chen C, Yan Y, Royer ME, Campigotto M, Traxel EJ, Coplen DE, Austin PF. The efficacy of oral midazolam for decreasing anxiety in children undergoing voiding cystourethrogram: a randomized, double-blind, placebo controlled study. J Urol. 2011;185(6 Suppl):2542–6.

    Article  CAS  PubMed  Google Scholar 

  24. Merguerian PA, Corbett ST, Cravero J. Voiding ability using propofol sedation in children undergoing voiding cystourethrograms: a retrospective analysis. J Urol. 2006;176(1):299–302.

    Article  PubMed  Google Scholar 

  25. Ditchfield MR, Grattan-Smith JD, de Campo JF, Hutson JM. Voiding cystourethrography in boys: does the presence of the catheter obscure the diagnosis of posterior urethral valves? AJR Am J Roentgenol. 1995;164:1233–5.

    Article  CAS  PubMed  Google Scholar 

  26. Fernbach SK, Feinstein KA, Schmidt MB. Pediatric voiding cystourethrography: a pictorial guide. Radiographics. 2000;20(1):155–68.

    Article  CAS  PubMed  Google Scholar 

  27. Goodman TR, Kilborn T, Pearce R. Warm or cold contrast medium in the micturating cystourethrogram (MCUG): which is best? Clin Radiol. 2003;58:551–4.

    Article  CAS  PubMed  Google Scholar 

  28. Kogan BA, Giramonti K, Feustel PJ, Lin WY. Bladder volume on voiding cystourethrogram correlates with indications and results in male infants. Urology. 2011;77:458–62.

    Article  PubMed  Google Scholar 

  29. Palmer BW, Ramji FG, Snyder CT, et al. Voiding cystourethrogram – are our protocols the same? J Urol. 2011;186:1668.

    Article  PubMed  Google Scholar 

  30. Kanumakala S, Kalidasan V, Kenney I. Intra-renal reflux. Arch Dis Child. 2004;89:692.

    Article  CAS  PubMed  Google Scholar 

  31. Palmer LS. Pediatric urologic imaging. Urol Clin North Am. 2006;33:409–23.

    Article  PubMed  Google Scholar 

  32. Sillen U. Bladder function in healthy neonates and its development during infancy. J Urol. 2001;166:2376–81.

    Article  CAS  PubMed  Google Scholar 

  33. Papadopoulou F, Efremidis SC, Oiconomou A, Badouraki M, Panteleili M, Papachristou F, Soteriou I. Cyclic voiding cystourethrography: is vesicoureteral reflux missed with standard voiding cystourethrography? Eur Radiol. 2002;12(3):666–70.

    PubMed  Google Scholar 

  34. Canning DA, Lambert SM. Chapter 115. Evaluation of the pediatric urology patient voiding cystourethrography. In: Campbell-Walsh urology. 10th ed. Philadelphia: Elsevier Saunders; 2012. p. 3067–84.

    Chapter  Google Scholar 

  35. Rathaus V, Konen O, Shapiro M, Grunebaum M. Malposition of catheters during voiding cystourethrography. Eur Radiol. 2001;11(4):651–4.

    Article  CAS  PubMed  Google Scholar 

  36. McAlister WH, Cacciarelli A, Shackelford GD. Complications associated with cystourethrography in children. Radiology. 1974;111(1):167–72.

    CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Pediatric Urology, Department of Urology, University of Rochester School of Medicine and Dentistry/Strong Memorial Hospital/Golisano Children’s Hospital, 601 Elmwood Ave., 656, Rochester, NY, 14642, USA

    Jimena Cubillos MD

  2. Department of Imaging Sciences, Pediatric Imaging, University of Rochester School of Medicine and Dentistry/Strong Memorial Hospital/Golisano Children’s Hospital, 601 Elmwood Ave., 648, Rochester, NY, 14642, USA

    Nina Klionsky MD

Authors
  1. Jimena Cubillos MD
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  2. Nina Klionsky MD
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Correspondence to Jimena Cubillos MD .

Editor information

Editors and Affiliations

  1. Pediatric Urology Department, Cohen Children’s Medical Center of New York, Long Island, New York, USA

    Lane S. Palmer

  2. Pediatric and Adolescent Urology Institute, Cleveland, Ohio, USA

    Jeffrey S. Palmer

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Cubillos, J., Klionsky, N. (2014). Principles of Voiding Cystourethrography (VCUG). In: Palmer, L., Palmer, J. (eds) Pediatric and Adolescent Urologic Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8654-1_5

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  • DOI: https://doi.org/10.1007/978-1-4614-8654-1_5

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