Indications, Contraindications, and Patient Preparation

Indications

• Trauma (bladder rupture, laceration, or fistulae)
• Incontinence (inability to control urination)
• Urinary retention (incomplete emptying of bladder)
• Recurrent urinary tract infections
• Post-surgical evaluation (bladder repairs, ureteral reimplantation).

Contraindications

• Relative: Known sensitivity to iodinated contrast (rare).
• No absolute contraindications beyond contrast precautions.

Patient Preparation

• No special prep required
• Patient should empty bladder before catheterization
• Explain procedure, reassure patient.

Projections

Clinical Note – Contrast Bag Height

For retrograde filling of the bladder, the contrast bag must not be placed more than 24 inches (61 cm) above the level of the bladder.

• Excessive pressure from a higher bag can overdistend or rupture the bladder.
• Gravity alone should control filling — never squeeze or manually force contrast.

AP Axial Cystogram (or PA Axial alternative)

CR Location & Positioning

• SID: 40 inches
• Patient Position: Supine on table for AP; prone may be used for PA. Arms at sides, legs extended.
• Adjustments: Align midsagittal plane to IR. Ensure shoulders and hips equidistant from IR. For AP, slight lordotic curve helps project symphysis below bladder neck. Trendelenburg (15–20°) may be used to show distal ureters and vesicoureteral junctions.
• CR:
  • AP: 10–15° caudad, entering 2 in. (5 cm) above pubic symphysis.
  • PA: 10–15° cephalad, entering ~1 in. distal to coccyx, exiting just above pubic symphysis.
• Pt. Instructions: Suspend respiration at end of expiration; remain still.
• Exposure: 10 × 12 in. (24 × 30 cm) lengthwise collimation.

Evaluation Criteria

• Bladder, distal ureters, and proximal urethra visualized.
• Pubic bones projected below bladder neck and proximal urethra.
• Adequate technique showing contrast within bladder and distal ureters.

AP Oblique Cystogram (RPO / LPO)

CR Location & Positioning

• SID: 40 inches
• Patient Position: Supine, rotated 40–60° into RPO or LPO.
• Adjustments: Flex knee of elevated side; abduct uppermost thigh to avoid superimposition. Arm of elevated side across chest. Pubic arch closest to table aligned over midline of grid.
• CR: Perpendicular, centered 2 in. above pubic symphysis and 2 in. medial to elevated ASIS. (For voiding studies: perpendicular at pubic symphysis).
• Pt. Instructions: Suspend respiration at end of expiration.
• Exposure: 10 × 12 in. (24 × 30 cm) lengthwise collimation.

Evaluation Criteria

• Bladder filled with contrast; distal ureters and proximal urethra demonstrated.
• Pubic bones projected below bladder neck and urethra.
• No superimposition from upper thigh.
• For voiding studies: entire urethra visualized, overlapping thigh for improved visibility.

Lateral Cystogram

CR Location & Positioning

• SID: 40 inches
• Patient Position: Lateral recumbent (right or left).
• Adjustments: Knees slightly flexed; midcoronal plane centered to midline of grid. Elbows flexed, arms raised or at right angle to clear pelvis. Hips and femurs superimposed.
• CR: Perpendicular to IR, centered 2 in. above pubic symphysis at midcoronal plane.
• Pt. Instructions: Suspend respiration at end of expiration.
• Exposure: 10 × 12 in. (24 × 30 cm) lengthwise collimation.

Evaluation Criteria

• Bladder in profile, anterior and posterior walls demonstrated.
• Bladder base and distal ureters clearly visualized.
• Hips and femurs superimposed.
• Useful for evaluating fistulae between bladder and rectum/uterus.

Procedure Adaptation

• Trauma patients: use sterile technique, avoid overfilling bladder.
• Post-surgical patients: reduce volume infused.
• Pediatric patients: smaller catheter, reduced contrast volume (50–300 mL).
• Patients with poor bladder capacity: fill slowly by gravity only.

Exposure Factors & Technical Considerations

• Contrast: Dilute iodinated contrast (150–500 mL).
• kVp: 75–85.
• SID: 40 inches.
• Infusion Technique: Contrast must flow into bladder by gravity only.
• Bag Height: Contrast bag should not be more than 24 inches above the patient’s bladder to prevent overfilling or rupture.
• Image Markers: R/L and post-void when applicable.
• Radiation Protection: Gonadal shielding should not be used as it will obscure anatomy.