Norm of Voiding Cystourethrography
Normal formation of bladder and urethra, normal elimination of contrast medium through the urethra, and absence of retrograde movement of contrast medium into the ureters.
Usage of Voiding Cystourethrography
Detection of urinary tract congenital anomalies, vesicoureteral reflux, neurogenic abnormalities, enlarged prostate gland, urethral strictures, and bladder diverticula or polyps.
Description of Voiding Cystourethrography
Using fluoroscopy or radiography, voiding cystourethrography demonstrates the bladder filling by contrast medium instillation through a catheter into the bladder and then shows exiting of the contrast medium during voiding after removal of the catheter.
Professional Considerations of Voiding Cystourethrography
Consent form IS required.
Bleeding, hematuria, and infection. Allergic reaction to contrast (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death) is a very rare possibility, since no contrast should be absorbed into the vascular tree with this procedure.
Previous allergy to radiographic dye, iodine, or shellfish; in the acute phase of a urinary tract infection; urinary tract obstruction; during pregnancy (if iodinated contrast material is used, because of radioactive iodine crossing the blood-placental barrier); recent bladder surgery; and urethral obstruction, evulsion, or transection. Sedatives are contraindicated in clients with central nervous system depression.
- See Client and Family Teaching.
- Obtain a balloon catheter, a contrast medium, and a syringe or tubing for instillation of the contrast medium.
- The client should disrobe below the waist.
- A sedative may be prescribed.
- Have emergency equipment readily available.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- After the client is positioned supine, a balloon catheter is inserted through the urethra into the bladder, and the balloon is inflated.
- The bladder is filled with contrast medium by gravity or syringe instillation, and the catheter is clamped.
- Radiographic or fluoroscopic films of the lower urinary tract are taken with the client in several positions.
- The catheter is then removed, and the client must void in a right-sided or left-sided position with the lower leg flexed at the hip. Male testes should be shielded by lead before voiding begins.
- Several more radiographic or fluoroscopic films of the lower urinary tract are taken during voiding.
- If the client is unable to void, the bladder area is gently pressed to stimulate voiding.
- Encourage oral intake of fluids, 125 mL/hour for 24 hours when this is not contraindicated.
- Monitor fluid intake and urine output for quantity, and monitor hematuria for 24 hours. Hematuria or dysuria that lasts more than 4–6 hours is abnormal.
- Observe for signs of allergic reaction to the contrast (listed above) for 24 hours.
- Observe for urinary retention or symptoms of urinary tract infection (fever, chills, pain [abdominal, suprapubic, or flank], tachypnea, tachycardia, hesitancy and frequency, dysuria, and hematuria). Notify physician for anuria present within 8 hours or for any of the above signs.
- Analgesics may be prescribed for bladder spasms, and sitz or tub baths may help decrease generalized genital area discomfort.
Client and Family Teaching
- A clear liquid diet and a cathartic may be prescribed the day before the exam.
- The urge to void during the procedure is normal.
- Drink 6–8 glasses of water or other fluids per day for 2 days (unless contraindicated). Watch for warning symptoms of complications (see above). Report chills, fever, dysuria, or frank blood in the urine.
- In women who are breast-feeding, formula should be substituted for breast milk for 1 or more days after the procedure.
Factors That Affect Results
- Although the clearest films result from the recumbent position, standing films are sometimes used for clients unable to void while lying down.
- Intestinal barium studies within 1 week before the test or the presence of a large amount of gas in the lower bowel may inhibit the clarity of the films.