Cystography is an X-ray examination of the bladder, in which, as a result of contrast, its size, shape, and structure of the internal cavity are visualized. The method allows to determine the presence of concretions, neoplasms, diverticular and inflammatory changes in the walls, traumatic and congenital defects in the structure of the organ. Liquid and gaseous contrast agents are used for the procedure. Liquid preparations are administered in a descending and ascending manner.
In modern urology, the main indications for cystography are complaints related to bladder damage with unclear or unreliable ultrasound results. So, with various lesions of this part of the urinary system, frequent and painful urination, blood in the urine (hematuria), pain in the lower abdomen and perineum, urinary retention can be observed. Also, cystography is used if there are suspected abnormalities of development and defects of the bladder – diverticula, fistulas, doubling of the organ. In some cases, this diagnostic technique is used to detect neoplasms in the bladder wall, stones and inflammatory processes in the organ cavity, as well as to detect vesicoureteral reflux – in the latter case, the method of miction cystography is used.
Absolute contraindications to cystography are due to the use of contrast agents and the radiation load that the body experiences during this study. The procedure is not prescribed in the presence of acute inflammatory processes in the lower urinary system (urethritis, cystitis, prostatitis), intolerance to iodine-containing contrast agents, as well as during pregnancy. Varieties of the technique involving the introduction of gases into the bladder cavity (pneumocystography, sedimentary cystography) cannot be used if bleeding or rupture of the bladder wall is suspected due to the threat of gas embolism. Descending cystography is contraindicated in severe renal insufficiency and endocrine diseases (hyperthyroidism, diabetes mellitus).
As a rule, manipulation for various indications is almost always preceded by the appointment of a general urine analysis and ultrasound examination of the urinary system organs. If the data obtained during these diagnostic manipulations are insufficient for diagnosis or ambiguous, then resort to the method of cystography. This research method does not require special preparation, the only exception is its combination with urography, which is due to intravenous contrast injection. For this reason, on the eve of cystography, it is necessary to refrain from eating.
Methodology of conducting
Before the procedure, which is accompanied by catheterization of the urethra (ascending cystography or the use of double contrast), sedatives and painkillers are administered to the patient. In most clinics, before contrast is introduced, an overview X-ray of the abdominal area is taken to identify gas accumulations and other features. Then, in the supine position, a special catheter is inserted into the urethra, gently pushing it up to the bladder, then 150-300 ml of a contrast drug solution is injected through the tube using a special syringe.
After filling the bladder, they proceed to the actual cystography – they take several pictures in different projections (depending on the indications for the procedure). This determines the shape, size and position of the organ, the presence of filling defects in it corresponding to stones or tumors. For a more subtle study of the bladder, double contrast is used – after the introduction of a small amount of contrast solution, 100-150 ml of air is injected into the organ. This method of cystography can reveal even the smallest defects on the mucous membrane corresponding to tuberculosis, inflammation or erosion.
Descending cystography differs from the previous version in that the contrast is not administered through a catheter, but intravenously – jet or drip, depending on the functional activity of the kidneys. After that, they take pictures and wait until the necessary amount of urine containing contrast accumulates in the bladder – usually with normal kidney function, it takes about an hour. Then they take pictures in the desired projections. Descending cystography, according to most radiologists, is a much less reliable method of studying the bladder compared to ascending.
To perform miction cystography, the patient is asked to urinate after filling the bladder with contrast (ascending or descending), during the process of urination, sequential images or video are taken using an X-ray microscope. An important diagnostic sign in this case will be the detection of contrast from the bladder into the ureters – this indicates the presence of reflux in the urinary system.