Pediatric Voiding Cystourethrogram Exam (Fluoroscopy)

A voiding cystourethrogram (VCUG) is an x-ray exam of the kidneys, ureters, bladder, and urethra. This exam will help determine whether urine moves backward toward the kidney (reflux) and the bladder’s ability to hold and empty urine.

Click to enlarge. Urine is produced in the kidneys and transported to the bladder through tubes called ureters. Normally, a valve at the ureterovesical junction (where the ureters joins the bladder) prevents urine in the bladder from flowing back into the ureters and kidneys. Some children have an abnormality in the valves or ureters that allows urine to flow into the ureters and, in more severe cases, into the kidneys. This condition is often congenital, but has other causes such as a blockage, incomplete emptying of the bladder, and urinary tract infections.

Urinary tract infections in children are commonly caused by this backward flow, or reflux. By performing a VCUG after a urinary tract infection, a radiologist can determine if reflux is the cause and your primary care physician can begin appropriate treatment to prevent future complications.

This page contains the following information about voiding cystourethrogram exams:

Reasons for Having a Voiding Cystourethrogram

A voiding cystourethrogram is used to check for reflux after a child has had a bladder, kidney, or urinary tract infection. If it is determined that your child has reflux, it can be treated, often with medication, before kidney damage occurs.

Since reflux runs in families, siblings of patients may need to undergo a VCUG as well. This exam may be needed for an infant or child who has dilated kidneys that were noticed on a pre- or post-natal ultrasound.  Additionally, a VCUG may be ordered as a follow up test after surgery.

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Risks Involved in a Voiding Cystourethrogram

There is the risk of radiation exposure; however, modern equipment uses very low doses and exposure is limited to the area being examined. For a 5-10 year old child, the effective radiation dose received during this procedure is similar to what the average person receives from natural background radiation over 6 months.

A VCUG cannot assess an obstruction in the flow of urine from the kidneys. If an obstruction is suspected, your child may need additional tests.

Your child may experience some discomfort during catheter insertion.

Conditions to Let Our Doctor Know About

In advance of your exam, let your INVISION radiologist or technologist know if your child has a current kidney, bladder, or urinary tract infection. Also let the radiologist or technologist know if you are or may be pregnant.

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Insurance Coverage

Voiding cystourethrograms are usually covered by insurance when ordered by a physician. Check with your insurance carrier to be sure. Please bring your insurance card with you to your exam.

Exam Locations

Pediatric voiding cystourethrograms may be performed at the following INVISION partner hospitals in the Denver, Colorado area. Exam results are evaluated by INVISION radiologists.

Please note:

INVISION is partially owned by Radiology Imaging Associates (RIA); consequently, your radiologist’s lab coat and your bill, if you receive one, may say RIA rather than INVISION.

Scheduling this Exam

To schedule a voiding cystourethrogram, please call the hospital where the exam will be performed.

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Preparation Guidelines

There is no special preparation for this exam.

It is important, however, that you provide emotional support for your child before and during the procedure. If your child is younger than four, it may be easier to not talk about the exam until the day it is scheduled to prevent him or her from becoming anxious or worrying. For older children, explaining the procedure using age-appropriate tools (i.e. book or doll) may help them be more relaxed.

Please arrive 30 minutes prior to your appointment time to complete paperwork.

Support for Your Child during the Exam

A parent may be in the room during the exam, but must wear a lead apron. Pregnant mothers are not allowed in the room during the exam. You may be asked to assist during the exam. If you will be uncomfortable helping, please let the technologist know before the exam begins.

What to Expect During the Exam

Upon arriving in the radiology department for your appointment, you will be given paperwork to complete.

Before beginning the exam, your child will change into a hospital gown. A technologist will assist him or her onto the x-ray table and place his or her legs in a frog-like position. Babies and small children may be wrapped snuggly with a blanket or otherwise restrained to help them stay still during the exam.

The technologist will clean the opening to the urethra with special soap and water. Using a sterile technique to avoid causing infection, the technologist will gently insert a small catheter into the urethra and advance it into the bladder.

A fluoroscope, a machine with a c-shaped arm, will be moved into position above your child’s pelvis. The fluoroscope will take continuous x-ray images of your child’s bladder as it fills and empties. These images display on a monitor that the radiologist will watch.

Contrast material, a fluid that will enhance the x-ray images, is slowly inserted into your child’s bladder. The radiologist will watch the x-ray images as the bladder fills to see if the fluid goes backward into the ureters.

After the bladder is full, the catheter is removed. The fluoroscope will continue to take images as your child empties his or her bladder. The radiologist will also study these images for signs of reflux. After your child has voided his or her bladder, another image will be taken to see how well the bladder emptied.

The VCUG can take from 10 to 30 minutes, depending on the time it takes for your child’s bladder to fill and empty.

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Recovering from this Imaging Exam

Your child can return to his or her normal activities immediately after the exam.

Some children experience some pain with urination for 24 hours after the exam due to the catheterization. Call your doctor if your child:

Getting Your Child's Exam Results

Trained and experienced pediatric radiologists interpret all exams, and then report the specific results to the physician who ordered your exam. Your physician will usually receive the report on the day of the exam. Your physician will then pass the results onto you. Our radiologists and technologists will be happy to answer questions about the exam procedure itself; however, they will not provide the exam results at the time the exam is performed.

Additional Information

The information on this page was taken in part from some of the following web sites. Visit these sites for additional information on voiding cystourethrograms.

Sources

Since reflux runs in families, siblings of patients may need to undergo a VCUG as well This exam may be needed for an infant or child who has dilated kidneys that were noticed on a pre- or post-natal ultrasound