Cystography - The Window to Diagnosis

What Is Cystography?

Cystography is a diagnostic procedure or an imaging test done to diagnose the problems of the urinary bladder. This method mainly uses X-rays, and there may be X-ray pictures or fluoroscopy. In simple terms, this procedure is a type of X-ray movie. During cystography, the doctor inserts a thin tube known as the urinary catheter and injects a contrast dye into the urinary bladder. This dye will allow the doctor to visualize the urinary bladder. As the dye flows into the body, the doctor will take X-rays of the bladder. Cystography can be used alone or in combination with other procedures. For example, cystourethrography can be done to obtain images of the urinary bladder and the urethra. Sometimes, the doctor might also use fluoroscopy to visualize how the bladder empties when a person urinates. Cystography can also be done to check if the urine backs up in the kidneys instead of flowing outside the body. If a patient has got injured, the doctor might recommend computerized tomography (CT) cystography to visualize the cause of the problems.

What Is a Urinary Bladder?

The urinary system is a crucial organ system of the body. It comprises organs that form urine, filter the waste products from the body and maintain the fluid and electrolyte levels of the body. The urinary bladder is an integral part of the urinary system. It is a balloon-like structure that temporarily holds the urine and helps a person pass urine. The urinary bladder consists of muscles that contract and relax rhythmically to transport urine to the urethra. The urethra is a tube-like structure that connects the bladder to the outside and helps the person urinate.

Why Would a Patient Require Cystography?

The patient might need cystography to determine the exact cause of the following problems:

• Hematuria (blood in the urine).

• Recurrent urinary tract infections.

• Problems in emptying the bladder.

• Vesicoureteral reflux (the condition in which urine flows back to the bladder or the kidneys instead of flowing outside the body).

• Urinary incontinence (leakage of urine).

The other reasons for which the patient might need to undergo a cystography are listed below:

• Injuries to the bladder - This test allows the doctor to check for a tear in the bladder wall.

• Blockage in the ureters or the narrowing of the urethra or ureters.

• Spinal surgeries - Cystography allows the doctor to visualize the problems in the nerves connecting the urinary bladder and the spine.

How Does the Patient Prepare for Cystography?

The following things are to be kept in mind before the procedure:

• The doctor will explain everything about the procedure. The patient must carefully listen and sign a consent form.

• The patient must keep the doctor updated about the medications that the patient is taking.

• Sometimes, the doctor might administer a laxative before the procedure to stimulate bowel movements.

• The procedure is not performed under general anesthesia and takes time, so the patient will be unable to return to work the same day.

• Antimicrobial or antibiotic coverage is required before the procedure. The antibiotics most commonly administered before the surgery can be any one of these:

  • Cephalosporins (usually first or second generation).

  • Ampicillin and Gentamicin in combination.

  • Amoxicillin and Clavulanic acid.

What Happens During the Cystography Procedure?

The patient might have cystography as an outpatient procedure or stay in the hospital for some time. Therefore, the method by which the test is done depends upon the doctor’s practices:

• The patient must remove all objects, including clothes, jewelry, or other things that might interfere with the procedure.

• The doctor inserts a tube known as the catheter into the urinary bladder through the urethra.

• Next, the doctor will inject a dye into the body through this catheter.

• The doctor takes an X-ray of the kidneys, ureters, and urinary bladder to visualize the urinary system. For males, the doctor will cover the testicles with a lead shield to protect them from the X-rays.

• Next, the doctor injects a contrast dye into the urinary bladder through the catheter. The doctor will clamp the catheter to prevent the dye from draining out of the urinary bladder.

• The doctor might ask the patient to change positions and take several X-rays when the dye is injected.

• If cystography is accompanied by voiding cystography, the patient will be asked to urinate after the procedure. The doctor will take X-rays when the patient urinates.

• If the patient is not having a voiding cystography procedure, the doctor will remove the catheter after the X-rays have been taken.

What Happens After the Cystography Procedure?

The patient does not require any special care after the procedure and can continue to work and take a regular diet unless the doctor provides different instructions. The patient must avoid drinking additional fluids a day after the procedure. It will flush the contrast medium out of the body and prevent urinary bladder infection. The patient might have mild pain while urinating after the procedure. He might see blood in the normal urine, which might subside after a few days. The patient can consult the doctor under the following circumstances:

• If the pain persists for more than two days, the patient must report to the doctor immediately.

• Fever and chills.

• Abdominal pain.

• Blood in the urine.

• Reduced urine output.

What Are the Risks of the Procedure?

The patient might want to know the risks associated with the procedure. First, the patient must inform the doctor if the patient has undergone any previous radiologic procedures. Before the procedure, the patient must inform the doctor if the patient:

• Pregnant or planning to conceive because radiation exposure at the time of pregnancy can cause congenital defects.

• Allergic to certain medications, local anesthesia, or contrast dyes.

• Suffering from kidney failure or other medical conditions.

The following things affect the accuracy of the test results:

• The patient has gas or stools in the intestine.

• The patient has barium after the recent barium enema.

The patient cannot undergo cystography if he:

• Has urinary tract infections.

• Pregnant.

• Allergic to contrast dyes.

Conclusion

Cystography is an important diagnostic procedure that enables the doctor to visualize the urinary bladder and other organs of the urinary system. The main advantage is that it is a simple procedure and does not cause surgical trauma to the patient. However, the patient must inform the doctor of all the required things before the procedure to avoid complications. So, the patient should consult the doctor at the earliest to learn about the procedure and its associated risks.