Retrograde Cystography

(Cystography - Retrograde)

Procedure Overview

What is retrograde cystography?

Retrograde cystography is a diagnostic procedure that uses x-rays to examine the urinary bladder. X-rays are made of the bladder after it has been filled with a contrast dye. Contrast refers to a substance taken into the body that causes the particular organ or tissue under study to be seen more clearly. This examination allows the physician to assess the bladder’s structure and integrity.

During retrograde cystography, contrast dye is injected into the bladder. X-rays are taken of the bladder while it is filled with contrast and after the contrast has drained out of the bladder. Retrograde cystography may show rupture of the bladder, as well as other bladder conditions such as tumors, blood clots, or diverticula (pouches in the wall of the bladder).

What are x-rays?

X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially-treated plates (similar to camera film) and a "negative" type picture is made (the more solid a structure is, the whiter it appears on the film).

Other related procedures that may be used to diagnose problems of the bladder include kidney, ureters, and bladder (KUB) x-rays, computed tomography (CT scan) of the kidneys, kidney scan, renal angiogram, renal ultrasound, cystography, pyelogram (intravenous, antegrade, and retrograde), cystoscopy, cystometry, and uroflowmetry. Please see these procedures for additional information.

How does the urinary system work?

Click Image to Enlarge

The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood.

The urinary system keeps the chemicals, such as potassium and sodium, and water in balance, and removes a type of waste, called urea, from the blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys.

Urinary system parts and their functions:

• two kidneys - a pair of purplish-brown organs located below the ribs toward the middle of the back. Their function is to remove liquid waste from the blood in the form of urine, keep a stable balance of salts and other substances in the blood, and produce erythropoietin, a hormone that aids the formation of red blood cells. The kidneys also help to regulate blood pressure.
  
  The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.
• two ureters - narrow tubes that carry urine from the kidneys to the bladder. Muscles in the ureter walls continually tighten and relax forcing urine downward, away from the kidneys. If urine backs up, or is allowed to stand still, a kidney infection can develop. About every 10 to 15 seconds, small amounts of urine are emptied into the bladder from the ureters.
• bladder - a triangle-shaped, hollow organ located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and expand to store urine, and contract and flatten to empty urine through the urethra. The typical healthy adult bladder can store up to two cups of urine for two to five hours.
• two sphincter muscles - circular muscles that help keep urine from leaking by closing tightly like a rubber band around the opening of the bladder.
• nerves in the bladder - alert a person when it is time to urinate, or empty the bladder.
• urethra - the tube that allows urine to pass outside the body.

Reasons for the Procedure

Retrograde cystography may be performed in cases of abdominal trauma to assess whether the urinary bladder has ruptured. Other conditions that may be evaluated by retrograde cystography include neurogenic bladder (a condition in which the nerve supply to the bladder is affected), tumors, vesicoureteric reflux (urine flows backwards from the bladder into the ureter), recurring urinary tract infections (UTIs), calculi (stones), and foreign bodies.

Retrograde cystography may also be used to detect urine leakage from the bladder after bladder surgery.

There may be other reasons for your physician to recommend retrograde cystography.

Risks of the Procedure

You may want to ask your physician about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of x-rays, so that you can inform your physician. Risks associated with radiation exposure may be related to the cumulative number of x-ray examinations and/or treatments over a long period of time.

If you are pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure during pregnancy may lead to birth defects.

Patients who are allergic to or sensitive to medications, contrast dyes, local anesthesia, iodine, shellfish, or latex should notify their physician.

Patients with kidney failure or other kidney problems should notify their physician.

Bladder infection may occur as a result of placing a catheter into the bladder for the procedure. Insertion of a catheter into the bladder may also cause bleeding or hematuria.

Situations in which retrograde cystography is contraindicated include, but are not limited to, the following:

• recent bladder surgery
• blockage of the urethra, or damage or tearing of the urethra
• acute phase of urinary tract infection

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Certain factors or conditions may interfere with the results of the test. These may include, but are not limited to, the following:

• gas or stool in the intestines
• barium in the intestines from a recent barium enema

Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• Your physician will give you specific instructions regarding withholding food and liquids prior to the test. You may be instructed to drink only clear liquids the day before and day of the procedure
• If you are pregnant or suspect that you may be pregnant, you should notify your physician.
• Notify your physician if you have ever had a reaction to any contrast dye, or if you are allergic to iodine or seafood.
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• You may be instructed to take a laxative the night before the procedure. Alternatively, you may be given an enema or a cathartic (purgative to induce bowel movements) medication the morning of the procedure.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

A retrograde cystography procedure may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

Generally, a retrograde cystography follows this process:

1. You will be asked to remove any clothing, jewelry, or other objects that might interfere with the procedure.
2. If you are asked to remove clothing, you will be given a gown to wear.
3. You will be asked to empty your bladder prior to the procedure.
   
   
   Click Image to Enlarge
4. You will lie on your back on the x-ray table.
5. A catheter will be inserted into your bladder for injection of the contrast dye into the bladder.
6. A kidney, ureters, and bladder (KUB) x-ray will be taken to verify that the urinary system is visible. With male patients, a lead shield will be placed over the testes to protect the gonads from the x-rays.
7. The contrast dye will be injected into the bladder through the catheter. After the dye has been injected, the catheter tubing will be clamped to prevent drainage of the dye from the bladder.
8. X-rays will be taken while the dye is being injected and afterwards. You may be asked to change position for different x-ray views of the urinary system.
9. The contrast dye will be drained from the bladder, and then one or more x-rays will be made. If required, air may be injected into the bladder prior to additional x-rays being taken.
10. After all required x-ray views have been taken, the catheter will be removed.

After the Procedure

There is no special type of care required after a retrograde cystography. You may resume your usual diet and activities, unless your physician advises you differently.

You should drink additional fluids for a day or so after the procedure to help eliminate the contrast dye from your system and to help prevent infection of the bladder.

You may experience some mild pain with urination or notice a pink tinge to your urine for a day or two after the procedure. This is to be expected after insertion of the catheter into your bladder. However, if the pain increases or persists longer than two days, notify your physician.

Notify your physician to report any of the following:

• fever and/or chills
• abdominal pain
• blood in the urine
• urine output is less than usual amount

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.