Mcu by armaan lone
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Micturating cystourethrogram (MCU) involves filling the bladder with contrast material and imaging the lower urinary tract during voiding. It can detect vesicoureteral reflux (VUR), bladder abnormalities, and congenital anomalies. The procedure involves catheterizing the bladder and instilling contrast based on the patient's age or weight. Imaging is done during filling and voiding to identify any reflux or blockages. Complications can include infection, contrast reaction, or trauma from catheterization. MCU is useful for evaluating VUR, recurrent urinary tract infections, genitourinary anomalies, and postoperative issues.
Mcu by armaan lone
- 1. SHARDA UNIVERSITY PREP BY : AASIF MAJEED LONE email: fisaalone99@gmail.com MCU MICTURATING CYSTOURETHROGRAM
- 2. MICTURATING CYSTOURETHROGRAM • Voiding cystourethrogram demonstrates the lower urinary tract & helps to detect VUR , bladder pathology , congenital or aquired anamolies of bladder • It is performed by passing a catheter through the urethra into the bladder, filling the bladder with contrast material and then taking radiographs while the patient voids.
- 3. INDICATIONS • CHILDREN: • RECURRENT UTI • VOIDING DIFFUCULTIES • VUR • MENINGOMYELOCELE, SACRAL AGENESIS, RECTAL ANAMOLIES • BASELINE STUDY PRIOR TO LOWER URINARY TRACT SURGERY
- 4. • POST OP EVALUATION OF URETERIC ABNORMALITIES • PELVIC TRAUMA • IN RENAL FAILURE TO EXCLUDE REFLUX • POSTERIOR URETHRAL VALVE OR POLYP • CONGENITAL ANAMOLIES OF BLADDER & URETHRA.
- 5. ADULTS • Trauma to urethra • Urethral stricture • Urethral diverticulum • Recurrent UTI • Reflux nephropathy prior to renal transplant • Follow up patients of spinal cord injury • Stress incontinience
- 6. Contrast media • The estimated volume of contrast medium to be given during the examination is determined mainly by the age of the child except for children less than one year of age in whom it is determined by weight. Less than one year, Weight (kg) × 7 = capacity (ml) Less than two years, (2 × age in years + 2) × 30 = capacity (ml) More than two years, (Age in years/2 + 6) × 30 = capacity (ml)
- 7. • Contrast media: Water soluble contrast media like urograffin 60% is used which is diluted with normal saline in 1:3 ratio. EQUIPMENT - Preferably under fluroscopy. - Foley`s catheter & syringe - In infants – feeding tube no 5 – 7 F • Preparation : none , rule out acute UTI.
- 8. Procedure • Using a sterile technique , a catheter is introduced into the bladder. • A 5f feeding tube with side holes are used for children and in older children or adults 8f r 10 f catheters are used . • In girls after initial inspection of perineum to identify any local genitilia abnormalities (cystoceles or labial fusion ) the catheter is introduced.. • When it enters the bladder a varying amount of urine will flow through it .if no flow a catheter is introduced
- 9. till urine is obtained. Suprapubic pressure Is sometimes helpful. In males , foreskin is retracted and catheter is introduced . The catheter should be lubricated with anaesthetic jelly and inserted slowly and gently into the urthera holding the penis is vertical position . The normal bladder capacity in children is estimated to be 1 ounce ie 29 cc . For newborns -30 to 35 cc can be instilled. • For upto 3 yrs – 200 to 250 cc Adequate capacity is reached when the child becomes uncomfortable and begins voiding around the catheter. Bladder capacity (in milliliters) is variable but can often be
- 10. predicted with the previous mentioned formula Filming In children : upto 2 yrs of age bladder is filled by hand injection . For older children contrast medium is instilled from a bottle elevated one metre above the examination table. During filming , fluroscopic screening is performed at short intervals to see any vu reflux ,diverticuli . The child is turned oblique on both sides to ensure that minimal reflux is not overlooked. In infants : voiding starts the moment catheter is removed. At the end of voiding ,frontal film is taken which includes entire
- 11. abdomen including the kidney region to prevent overlooking the vu reflux which is apparent only on termination of voiding and may reach upper collecting system. In adult male : bladder is filled in the usual way as in older child and voiding filming done in both oblique projection views. The voiding study in male adults can be modified by getting the patient to void resistance i.e. by compression of distal
- 12. penis thus enhancing the visualization urethra by artificial distention .
- 13. ALTERNATE TECHNIQUES 1) SUPRAPUBIC BLADDER PUNCTURE. Sometimes in PUV & pelvic trauma – not possible to catheterize. 2) URETHROCYSTOGRAPHY Contrast medium introduced into the bladder during RGU. 3) EXCRETION MCU ( MCU followed by IVU ) Advantage – avoid catheterization and related risk of infection. Disadvantage - VUR can not be visualized properly . takes longer time.
- 14. Excretion MCU : (MCU followed by IVP) • This method makes use of contrast media accumulated in the urinary bladdder during ivp • Advantages : avoidance of physical and psychological trauma of catherization • Avoidance of infection • More physiological procedure hence more reliable. • Disadvatanges : visualization is not usually adequate • Takes longer time • Vu reflux visualised poorly.
- 15. COMPICATIONS Contrast reaction. Contrast induced cystitis. UTI. Catheter trauma. Bladder perforation – overfilling. Retention of a foley catheter. Catheterisation of vagina / ectopic ureter. Radiation exposure Autonomic dysreflexia- in paraplegic patients due
- 16. to spinal cord injury at or above t6 level, forceful injection of contrast causes severe headache ,sweating ,hypertension with bradycardia due to forceful opening of bladder neck
- 17. • CONTRAINDICATIONS Acute UTI. • AFTERCARE Warned – of rare dysuria , retention. Reflux - Antibiotcs.
- 18. Posterior urethral valves Congenital thick folds of mucous membrane located in the posterior urethra prostatic + membranous) distal to the verumontanum. Most common cause of severe obstructive uropathy in children. Almost exclusively in males. Leading cause of end stage renal disease in boys. Now rare for them to present with severe UTI and septicaemia -diagnosis is generally made in early infancy and antenatal period.
- 19. Micturiting cystourethrography Procedure of choice for defining the valves. Indication -Thick walled bladder & dilated ureters on USG. Combination of ultrasound and MCU allows both urologist and nephrologist to plan immediate management. Repeated 3 months after ablation.
- 20. MCU – Lateral view. Fusiform dilatation & elongation of proximal posterior urethra persisting throught voiding Transverse/curvilinear filling defect in posterior urethra
- 21. Posterior urethral valve in newborn .
- 22. Posterior urethral valve in a 7 yr. Old boy .
- 23. Posterior urethral valve -image shows a dilated posterior urethra with an abrupt transition to a normal-calibre anterior urethra with bladder neck hypertrophy, the irregular trabeculated bladder wall, and the left-sided grade III vesicoureteric reflux.
- 24. Urachal diverticulum : • persistence of a segment of the urachus, present as a protrusion at the vertex of the bladder. It may predispose to urolith formation.
- 25. Urachal diverticulum. Posteroanterior mcu image shows a gross urachal diverticulum bladder.
- 26. Prostatic utricle • The prostatic utricle is a small, blind-ending midline pouch arising from the prostatic urethra at the level of the verumontanum • A large prostatic utricle may be associated with urinary retention, stasis, and infection
- 27. MCU image shows a diverticulum resulting from spontaneous opacification of a prostatic utricle
- 28.