Voiding Cystourethrogram (VCUG)
Voiding Cystourethrogram (VCUG)
Key Points
- Gold standard for diagnosing vesicoureteral reflux (VUR)
- Fluoroscopic examination of lower urinary tract
- Uses iodinated contrast medium
- Evaluates bladder and urethral anatomy
- Essential for surgical planning in urologic anomalies
VCUG is a dynamic fluoroscopic examination that provides detailed anatomical and functional information about the lower urinary tract, ureters, and kidneys during both filling and voiding phases.
Procedure Details
Pre-procedure Requirements
- No specific preparation needed
- Current urinalysis/culture (should be negative)
- Prophylactic antibiotics as per protocol
- Informed consent from parents/guardians
Technique Steps
- Patient Preparation
- Sterile catheterization
- 8-10 Fr feeding tube for infants
- 10-12 Fr Foley catheter for older children
- Positioning on fluoroscopy table
- Contrast Administration
- Gravity drip method preferred
- Warming contrast to body temperature
- Height of contrast bag 60-100 cm above table
- Use of water-soluble iodinated contrast
- Imaging Phases
- Early filling phase
- Continued filling phase
- Voiding phase
- Post-void residual assessment
Clinical Indications
Primary Indications
- Urinary Tract Infection (UTI)
- Febrile UTI in children
- Recurrent UTIs
- Breakthrough UTIs on prophylaxis
- Prenatal Hydronephrosis
- Moderate to severe cases
- Bilateral involvement
- Associated ureteral dilation
Other Indications
- Urinary tract anomalies evaluation
- Posterior urethral valves
- Complex genitourinary anomalies
- Pre/post-surgical assessment
- Voiding dysfunction assessment
Image Interpretation
Normal Findings
- Smooth bladder contour
- No reflux during filling/voiding
- Normal caliber urethra
- Complete bladder emptying
Pathological Findings
- Bladder Abnormalities
- Trabeculation
- Diverticula
- Irregular contour
- Mass effects
- Urethral Findings
- Posterior urethral valves
- Strictures
- Diverticula
- Anatomic variants
- Reflux Patterns
- Timing (filling vs. voiding)
- Unilateral vs. bilateral
- Grade assessment
- Associated findings
VUR Grading System
International Reflux Study Classification
- Grade I
- Reflux into non-dilated ureter only
- No pelvicalyceal involvement
- Grade II
- Reflux into non-dilated ureter and pelvicalyceal system
- No dilation of collecting system
- Grade III
- Mild to moderate dilation of ureter
- Mild to moderate dilation of pelvicalyceal system
- Normal or minimal blunting of fornices
- Grade IV
- Moderate ureteral tortuosity
- Moderate to severe pelvicalyceal dilation
- Obliteration of sharp fornices
- Grade V
- Gross dilation of ureter
- Extreme tortuosity
- Severe pelvicalyceal dilation
- Loss of papillary impressions
