Retrograde Cystography Health Article

Definition

A retrograde cystogram provides x-ray visualization of the bladder with injection of sterile dye.

Purpose

A retrograde cystogram is performed to evaluate the structure of the bladder and identify bladder disorders, such as tumors, or recurrent urinary tract infections. The presence of urine reflux (backward flow) into the ureters may also be visualized with this x-ray study.

Precautions

The doctor should be made aware of any previous history of reactions to shellfish, iodine, or any iodine-containing foods or dyes. Allergic reactions during previous dye studies is not necessarily a contraindication, as dye is not infused into the bloodstream for this study. Other conditions to be considered by the physician prior to proceeding with the test include active urinary tract infection, pregnancy, recent bladder surgery, or presence of obstruction that interferes with passage of a urinary catheter.

Description

After administration of anesthesia, the doctor will insert a thin, tubelike instrument called a catheter through the patient's urethra and into the bladder. The contrast medium is then injected through the catheter into the bladder. X-ray pictures are taken at various stages of filling, from various angles, to visualize the bladder. Additional films are taken after drainage of the dye. The procedure takes approximately one to one and one-half hours and the patient may be asked to wait while films are developed.

Alternately, instead of a contrast dye and x-ray pictures, the test can be done with a radioactive tracer and a different camera. This is known as a "radionuclide" retrograde cystogram.

Preparation

The patient will be required to sign a consent form after the risks and benefits of the procedure have been explained. Laxatives or enemas may be necessary before the procedure, as the bowel must be relatively empty of stool and gas to provide visualization of the urinary tract. Immediately before the procedure, the patient should remove all clothing and jewelry, and put on a surgical gown.

Aftercare

Sometimes, pulse, blood pressure, breathing status, and temperature are checked at regular intervals after the procedure, until they are stable. The patient may have some burning on urination for a few hours after the test, due to the irritation of the urethra from the catheter. The discomfort can be reduced by liberal fluid intake, in order to dilute the urine. The appearance and amount of urine output should be noted, and the doctor should be notified if blood appears in the urine after three urinations. Also, patients should report any signs of urinary infection, including chills, fever, rapid pulse, and rapid breathing rate.

Normal results

A normal result would reveal no anatomical or functional abnormalities.

Abnormal results

Abnormal results may indicate:

• stones
• blood clots
• tumors
• reflex (urine passing backward from the bladder into the ureters)

BOOKS

Golomb, Gail. The Kidney Stones Handbook: A Patient's Guide to Hope, Cure, and Prevention. Winter Park, FL: Four G Press, 1994.

Lerner, Judith, and Zafar Khan. Mosby's Manual of Urologic Nursing. St. Louis: The C. V. Mosby Co., 1982.

Malarkey, Louise M., and Mary Ellen McMorrow. Nurse's Manual of Laboratory Tests and Diagnostic Procedures. Philadelphia: W. B. Saunders Co., 1996.

ORGANIZATIONS

American Kidney Fund. 6110 Executive Boulevard, Rockville, MD 20852. (800) 638-8299. <http://216.248.130.102/Default.htm>.

National Kidney Foundation. 30 East 33rd St., New York, NY 10016. (800) 622-9010. <http://www.kidney.org>.

National Kidney and Urologic Diseases Information Clearing-house (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5388. <http://www.niddk.nih.gov/health/urolog/pubs/kuorg/kuorg.htm>.

Kathleen D. Wright, RN

KEY TERMS

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Bladder—A balloon-like organ located in the lower abdomen that stores urine.

Catheter—A thin tube used to inject or withdraw fluids from the body.

Stones—Also known as calculi, stones result from an excessive build-up of mineral crystals in the kidney. Symptoms of stones include intense pain in the lower back or abdomen, urinary tract infection, fever, burning sensation on urination, and/or blood in the urine.

Ureter—Tube that carries urine from the kidney to the bladder.

Urethra—Tube that empties urine from the bladder to outside the body.