A voiding cystourethrogram is performed by inserting a catheter into the urethra. Liquid contrast material is then instilled into the bladder through the catheter. X-rays are taken before, during and after filling of the bladder. When the bladder is full, the catheter is removed. While the patient voids, additional x-rays are taken.

Usefulness: A VCUG is helpful in detecting abnormalities of the bladder and urethra. Reflux is detected if contrast is seen to flow in retrograde fashion up the ureters from the bladder. If the bladder is ruptured, extravasation of contrast will be seen outside the bladder in the pelvis or abdomen. Obstructions or strictures of the urethra (such as posterior urethral valves) can be seen on the x-rays taken during voiding.

Limitations: Children and their parents almost uniformly dislike VCUG's because of the pain caused by insertion of the catheter. This can't be eliminated, but it can be made less terrifying if the test is explained to the child and parent and if the catheterization is performed quickly.

Indications: Children with urine infections. Children with suspected bladder obstruction or pelvic trauma where rupture of the bladder is suspected.

Examples: Normal VCUG. Reflux. Congenital urethral obstruction.

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©David A. Hatch, M.D., 1996