Mcu
- 1. MICTURATING CYSTOUROGRAM (MCU) By – PRASHANT MISHRA B.Sc. M.T.R AIIMS BHUBANESWAR
- 2. URETHROGRAPHY ? • RADIOGRAPHIC EXAMINATION OF URETHRA, USING IODINATED CONTRAST MEDIA. Can be done by 2 types:- 1. Ascending – where contrast is injected to the urethra. use to visualize post. Urethra 2. Descending - similar to MCU Use to visualize ant. Urethra MCU is done to visualize the lower urinary tract and helps to detect the existence of any VUR, Bladder pathology, congenital anomalies.
- 3. OUTLINES • INDICATION • CONTRAST MEDIA • PROCEDURE • COMPLICATIONS • OTHER TECHINIQUES
- 4. M C U / VOIDING CYSTOURETHROGRAPHY • Fluoroscopic study of the lower urinary tract mainly to assess the - URINARY BLADDER - BLADDER PATHOLOGY - VESICO UTERAL REFLEX - CONGENITAL ANOMALIES - BLADDER OUTFLOW TRACT
- 5. INDICATIONS CHILDREN • UTI • VOIDING DIFFICULTIES – DYSURIA, THIN STREAM, DRIBBLING, URGENCY. • VESICO URETRIC REFLEX • CONGENITAL ANOMALIES LIKE , Meningomyelocele, Sacral agenesis, Rectal anomalies • Prior to lower Urinary Tract surgery • Pelvic trauma • P U VALVES • RENAL FAILURE TO EXCLUDE REFLUX • HAEMATURIA IN ADULTS 1. TRAUMA TO URETHRA 2. URETHRAL STRICTURE 3. URETHRAL DIVERTICULA OTHER CONDITIONS:- 1. UTI 2. REFLUX NEPHROPATHY PRIOR TO RENAL TRANSPLANT 3. FOLLOW UP OF PATIENTS WITH SPINAL CORD INJURY.
- 6. CONTRAST MEDIA • WATER SOLUBLE CONTRAST MEDIA IS USED LIKE Conray - 280 Trivideo 400 mg Urograffin 60% It is diluted with normal saline in 1:3 ratio.
- 7. Procedure :- • Catheter Bladder • Feeding tube of 5F with side holes for children & in older 8F OR 10F polyethylene or soft rubber catheters with end holes are suitable. • IN GIRLS - After an initial inspection of the perineum to identify any local genital abnormalieties like cystoceles or labial fusion, etc., the urethral catheter is inserted. When it enters, various amount of urine will flow through it. If there is no flow the catheter is advanced until urine is obtained. Suprapubic pressure is sometimes helpful in expressing a small amount of urine in the near empty bladder. If no urine is obtained the catheter may have been inserted into the vagina.
- 8. In Males - The foreskin is retracted and catheter is introduced. The catheter should be lubricated with an anaesthetic jelly and inserted slowly and gently into the urethra holding the penis is a vertical position. - The normal bladder capacity in children is estimated in ounces as age (in yrs) x 2. - In newborns, 30 – 50 cc can be instilled with ease. - From about 3 yrs., girls can hold upto 200 – 250 cc and from 12 yrs even more. - The capacity in boys is 100 – 150 cc upto 5-6 yr of age and 250 cc in older boys. - Adequate capacity is reached when the child become uncomfortable and begins voiding aroud the catheter.
- 9. Filming:- In Children- Children upto the age of 2 yrs is filled by hand injection. For older children contrast medium is instilled from a bottle elevated one metre about examination table. During filling, fluoroscopic screening is performed at short intervals to see if vesicouretral reflux, diverticuli or other abnormalities are present. The child is turned oblique on both sides to ensure that minimal reflux is not overlooked. If reflux appears, films are taken in the appropriate oblique projection. If the bladder appears normal, one film is taken in the frontal projection at the end of filling.
- 10. • voiding starts in infants the moment the cathether is removed. At the end of voiding, a frontal film is made of the entire abdomen including the kidney region in order to prevent overlooking the vesicouretral reflux which is apparent only on termination of voiding and may reach the upper collecting system. In Adult Male:- - Bladder is filled in the usual way as in a older child and voiding filming is done in both oblique position. Difference in adult voiding is that voiding is done against resistane i.e., either by compression of the distal part of penis or by using a penile clamp. also c/d CHOKE CYSTOURETHROGRAPHY. which enhances the visualization of urethra by the artificial distention. In Adult Female:- - procedure is same. in addition to standard exposures, a double exposed film taken at rest and during straining demonstrates the degree of bladder descent if any.
- 11. COMPLICATIONS :- 1. Danger of attendant infection due to catheterization of bladder. 2. Adverse reaction may result from absorption of contrast medium by mucosa of bladder. 3. Due to techinique: • acute uti • catheter trauma causing dysuria, frequency hematuria and urinary retention. • complication of bladder filling, e.g. perforation by the catheter or from over distention. • catheterization of vagina or ectopic ureteral orifice. • Radiation effect : VCU is a diagnostic procedure that inevitably exposes gonads to some radiation. It should be kept to a minm.
- 12. 4. Autonomic dysreflexia : In a paraplegic patients due to spinal cord injury at or above T6 level forceful injection of contrast causes severe headache, sweating and hypertension with bradycardia due to forceful opening of the bladder neck. Treatly by promptly relieving vesical distention or give diazoxide 3-5 mg/kg.
- 13. Other Techiniques :- • Excretion MCU (MCU followed by IVU) - This method makes use of conrast media accumulated in the urinary bladder during ivu. Advantages- • Avoidance of physical and psychological trauma of catheterization. • Avoidance of possible infection by urethral catheterization. • More physiological procedure hence can be more reliable Disadvantages:- • Visualization is not usually adequate. • Takes longer time • VRU cann't be visualized properly.
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