Voiding cystourethrogram
A voiding cystourethrogram, abbreviated MZU or MCU, Eng. voiding cystourethrography ( VCUG ) is a medical examination method for detecting a reverse flow of urine through the ureter ( ureter ) into the renal pelvis ( vesico - uretero - renal reflux, VUR), as well as to assess anatomical or functional disorders of bladder emptying, and in particular to assess the posterior urethra. Here, a catheter is placed through the urethra ( urethra ) in the urinary bladder and the bladder is filled through this with an X-ray contrast agent. Since the catheterization in infants is difficult because of the very small urethra, the injection of the contrast agent can be in the bladder with a syringe through the abdominal wall. After moving the patient, the contrast- filled bladder is under fluoroscopy first bilddokumentiert targeted and befundet. Here, a descent of the bladder, bladder diverticulum, fistula or an irregularly configured bubble shadow can be displayed. Then explores urination, whether the contrast agent, contrary to the intended path, via one of the two ureters flows back to the respective kidney. Cause of the retrograde flow of contrast agent can be a primary refluxiver ureter, a subvesikale obstruction or a functional obstruction in dyssynergem sphincter.
Important is the final recording of the bladder, with the first, a Kontrastmittelextravasation is obvious to another can be residual urine or Pseudorestharn - by antegrade overrun of contrast agent from the refluxing ureters - are documented. In a neurogenic bladder reflex, the central controller is missing, the detrusor contractions no longer extend to coordinated contractions of the sphincter externus urethrae. ( [ Detrusor - sphincter dyssynergia ] ) *** Here please install the link, unfortunately, do not know how to do that ** * this shows the MZU typically the image of a so-called Christmas tree bubble with pseudodiverticula, trabeculae and reflux. During micturition may occur in this situation to a bulbous enlargement of the proximal urethra. Overall, here is one by the MZU (in combination with urodynamics ) detectable high-pressure system before that can guide you through the Reflux for permanent damage to the kidneys.
Indication
Invasive primary diagnostics for the detection of reflux -associated Harntransportstörungen at Nierenbeckenektasie, worsening of renal function ( here mainly in children), recurrent pyelonephritis in children and adults. Urethaldivertikel the woman. In pediatric urology diagnosis of congenital anomalies, such as ureterocele, bladder exstrophy, ectopic Harnleiterostien, prune belly syndrome, for further diagnostic evaluation in utero seen Harntransportstörungen with consecutive renal pelvis and Ureterektasie, the result of congenital subvesical obstructions are, for example, the urethral flap. Recurrent urinary tract infection in girls, one-time urinary tract infection in boys.
Risks
As it is in the method is an x-ray examination, there is always a certain amount of radiation. The dose, however, is such a low range that can be expected at best a so-called stochastic risk. As a foreign body is inserted through the urethra and, in addition, the bladder is filled with a liquid from the outside, there is also the danger that a urinary tract infection is caused by the investigation. At least in pediatrics, it is therefore usual to perform a preventive antibiotic treatment for three days.
Alternative test methods
Main article Miktionsurosonografie
If you want to demonstrate VUR and the consecutive Nierenbeckenkelchdilatation sonography, one must use an ultrasound contrast agent. This diagnostic method is not a radiation exposure for the patient is sensitive, however, is expensive and time consuming. Therefore, it is performed in routine care only in a few (mostly children radiological ) centers.