1. Micturating
Cystourethrogram
Presenter: Dr. Dheeraj Kumar
MRIT, Ph.D. (Radiology and Imaging)
Assistant Professor
Medical Radiology and Imaging Technology
School of Health Sciences, CSJM University, Kanpur
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2. Micturating Cystourethrogram (MCU)
• Define MCU clearly:
• MCU stands for Micturating Cystourethrogram.
• it's a radiographic procedure used to visualize the urinary bladder and lower
urinary tract.
• MCU involves real-time imaging during urination (micturition).
• Distinguish MCU from other radiological techniques briefly.
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3. Indications for MCU
• Provide a comprehensive list of situations or conditions where MCU is commonly used:
• Evaluating vesicoureteral reflux (VUR) in children: Mention its significance in pediatric care.
• Assessing urinary incontinence and dysfunctional voiding in adults: Emphasize its relevance in
adult urology.
• Detecting structural abnormalities: This includes strictures, diverticula, or any anatomical issues.
• Postoperative or post-injury bladder function evaluation: Highlight its role in post-surgical
care.
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4. • Urinary tract infection
• Dysuria
• Dysfunctional voiding
• Hydronephrosis and/or hydroureter
• Bladder outlet obstruction
• Hematuria
• Trauma
• Urinary incontinence
• Neurogenic dysfunction of the bladder, e.g. Spinal dysraphism
• Congenital anomalies of the genitourinary tract
• Postoperative evaluation of the urinary tract
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5. Evaluating Vesicoureteral Reflux (VUR) in
Children
• Significance in Pediatric Care: MCU is
particularly vital in pediatric medicine, as it helps
diagnose and assess vesicoureteral reflux (VUR) in
children. VUR is the abnormal flow of urine from
the bladder back into the ureters and kidneys. Left
untreated, VUR can lead to urinary tract infections
(UTIs) and potential kidney damage. MCU allows
healthcare providers to visualize and grade the
reflux, aiding in treatment decisions and follow-up
care for young patients.
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6. Assessing Urinary Incontinence and
Dysfunctional Voiding in Adults
• Relevance in Adult Urology: MCU isn't limited to
pediatrics; it plays a significant role in adult urology
as well. For adults experiencing urinary incontinence
or dysfunctional voiding, MCU helps identify
underlying causes. Whether it's stress incontinence,
urge incontinence, or other voiding disorders, MCU
provides real-time imaging to evaluate bladder and
urethral function, enabling tailored treatment plans
for adult patients.
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7. Detecting Structural Abnormalities
• Strictures, Diverticula, and Anatomical
Issues: MCU is a powerful diagnostic tool for
detecting various structural abnormalities within
the urinary tract. This includes conditions such
as urethral strictures (narrowing of the urethra),
bladder diverticula (pouch-like protrusions), or
any anatomical anomalies. Accurate
visualization and assessment of these issues are
essential for determining appropriate treatment
strategies.
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8. Postoperative or Post-Injury Bladder Function
Evaluation
• Role in Post-Surgical Care: After surgical procedures involving the
urinary tract or in cases of traumatic injury, MCU assists in evaluating
bladder function. It helps healthcare providers assess whether the
surgery was successful or if there are any complications. For post-
injury scenarios, MCU aids in determining the extent of damage to the
urinary system and guides treatment decisions.
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9. Procedure and Patient Preparation
• Micturating Cystourethrogram (MCU) is a procedure that requires
careful planning and patient preparation to ensure its safety and
effectiveness. Here's a breakdown of the steps involved in preparing
for an MCU:
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10. Scout film
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11. Informed Consent and Patient Education
• Crucial Importance: Obtaining informed consent from the patient or their
legal guardian is a critical first step. It ensures that the patient fully
understands the procedure, its purpose, potential risks, and benefits.
Informed consent is essential both ethically and legally.
• Patient Education: Patient education is equally crucial. Explain the MCU
procedure in clear and understandable terms, addressing any questions or
concerns the patient may have. This not only fosters trust but also helps
alleviate anxiety and apprehension.
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12. Maintaining Patient Privacy and Comfort
• Ensuring Comfort: Patient comfort is paramount for a successful
MCU. Emphasize that a comfortable and relaxed patient is more likely
to cooperate during the procedure, leading to better-quality images.
• Privacy: Ensure that the patient's privacy is respected throughout the
process. Use appropriate draping and provide changing facilities when
needed to maintain dignity and comfort.
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13. Allergies to Contrast Agents
• Highlight the Need: Stress the importance of checking for allergies to
contrast agents before the procedure. Allergies can lead to adverse reactions,
ranging from mild hives to severe anaphylactic reactions.
• Precautionary Measures: Explain that healthcare providers should ask the
patient about any prior reactions to contrast agents. In cases of known
allergies, alternative contrast agents or pre-medication may be necessary to
prevent adverse reactions.
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14. Pre-Procedure Bladder Voiding
• Importance of an Empty Bladder: Make it clear why an empty bladder is
necessary before conducting an MCU. A full bladder can interfere with the
procedure by obstructing the view of the urinary tract. Instruct the patient to
void their bladder completely before the MCU.
• Timing: Provide guidance on the timing of voiding; it should be done just
before the procedure to ensure the bladder is as empty as possible.
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15. Patient Positioning on the Imaging Table
• Ideal Positioning: Describe the ideal positioning for the MCU procedure.
Typically, the patient will be lying on their back on the imaging table with
their legs spread apart. This positioning allows for clear visualization of the
bladder and urethra.
• Comfort and Stability: Explain that the patient's comfort and stability are
essential during positioning. Padding or cushions may be used to enhance
comfort, and straps or supports may be employed to maintain the desired
posture.
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16. Imaging Equipment and Contrast Agents
• The successful execution of a Micturating Cystourethrogram (MCU)
relies on a combination of specialized imaging equipment and contrast
agents. Let's delve into the details of these essential components:
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17. Fluoroscopy Equipment with a Digital Detector
• Role of Fluoroscopy: Fluoroscopy is a fundamental component of MCU, as it enables
real-time imaging. Unlike traditional X-rays, which produce static images, fluoroscopy
provides dynamic, continuous X-ray images. This dynamic visualization is crucial for
capturing the filling, storage, and voiding phases of the bladder and urethra during
micturition.
• Digital Detector: The use of a digital detector enhances image quality and efficiency.
Digital detectors allow for immediate image capture and display, reducing the need for
lengthy processing times. This aids in real-time assessment and expedites the procedure.
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20. Types of Contrast Agents (Iodinated or Water-
Soluble)
• Choice of Contrast Agents: Two primary types of contrast agents are
commonly used in MCU:
• Iodinated Contrast Agents: These contain iodine and are often used in MCU. They
provide excellent radiopacity, enhancing the visibility of the urinary tract structures.
However, some patients may have iodine allergies, necessitating precautions.
• Water-Soluble Contrast Agents: These agents are less likely to cause allergic
reactions. While they may not offer the same level of radiopacity as iodinated agents,
they are suitable for patients with known allergies or sensitivities.
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22. Catheters and Tubing for Contrast
Administration
• Role in Contrast Delivery: Catheters and tubing are instrumental in
delivering the contrast agent into the patient's bladder. A catheter is
introduced through the urethra into the bladder, allowing precise control
over the contrast injection.
• Minimizing Patient Discomfort: Explain that healthcare providers take
great care to minimize patient discomfort during catheter insertion.
Lubrication and local anesthesia may be used as needed to ensure a smooth
and pain-free procedure.
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24. Radiation Protection Gear
(Lead Aprons and Shields)
• Emphasis on Safety: Safety is a paramount concern in radiology, and MCU is no exception.
Mention the use of lead aprons and shields, which are essential for minimizing radiation exposure
to both patients and healthcare providers.
• Lead Aprons: Healthcare providers wear lead aprons to shield themselves from scattered radiation
during the procedure. This protective gear helps reduce the risk of radiation exposure.
• Patient Protection: While lead aprons are not typically placed on patients during MCU, the
procedure's design minimizes radiation exposure to the patient by focusing the X-ray beam only on
the area of interest.
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26. Image Acquisition
• Describe in detail how images are acquired during an MCU:
• Contrast agent introduction via catheter: the process of introducing the contrast
agent into the patient's bladder.
• Real-time fluoroscopic imaging during micturition: images are captured while the
patient is urinating.
• Sequential images capturing filling, storage, and voiding phases: the need for a
comprehensive view of the bladder and urinary tract.
• Dynamic evaluation of bladder and urethral function: the dynamic nature of
MCU, which allows for functional assessment.
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28. Interpretation and Reporting
• on the interpretation process:
• Radiologist's role in analyzing images for abnormalities.
• Elements evaluated: bladder capacity, shape, compliance.
• Detection of reflux into the ureters (VUR).
• The significance of detailed reporting for clinical decision-making.
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29. Case Studies
To better understand the clinical
significance of Micturating
Cystourethrogram (MCU), let's
explore real-life case examples
where MCU played a pivotal role
in diagnosis and treatment
planning:
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30. Case 1: Pediatric Patient with Suspected
Vesicoureteral Reflux (VUR)
• Background:
• A 5-year-old male patient presented with a history of recurrent urinary
tract infections (UTIs).
• Suspected vesicoureteral reflux (VUR), a condition where urine flows
backward from the bladder into the ureters and potentially into the
kidneys.
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32. Role of MCU
• MCU was performed to confirm the presence and grade of VUR.
• During the procedure, contrast agent was introduced into the bladder,
and real-time fluoroscopy captured the filling, storage, and voiding
phases.
• The MCU images clearly showed the reflux of contrast into the
ureters, confirming the diagnosis of VUR.
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33. Treatment Planning
• Based on the MCU findings, the healthcare team developed an
appropriate treatment plan.
• The grade of VUR determined through MCU guided decisions
regarding medical management or surgical intervention.
• Regular follow-up MCUs were scheduled to monitor treatment
effectiveness and the resolution of VUR over time.
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34. Case 2: Adult with Urinary Incontinence
• Background:
• A 45-year-old female patient complained of urinary incontinence,
particularly during activities that increased intra-abdominal pressure
(stress incontinence).
• The patient also reported frequent urination and urgency.
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37. Role of MCU:
• MCU was performed to assess bladder function and identify the cause
of urinary incontinence.
• Dynamic imaging during micturition allowed visualization of bladder
and urethral dynamics.
• The procedure revealed urinary leakage during increased intra-
abdominal pressure, confirming stress incontinence.
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38. Treatment Planning:
• MCU findings played a crucial role in treatment planning.
• Non-invasive therapies, such as pelvic floor exercises or behavioral
modifications, were recommended for mild stress incontinence.
• In more severe cases, surgical options like sling procedures were
considered.
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39. Case 3: Postoperative Bladder Function
Assessment
• Background:
• A 62-year-old male patient underwent surgery to address bladder
outlet obstruction due to an enlarged prostate (benign prostatic
hyperplasia, BPH).
• Following surgery, the patient experienced urinary retention and
incomplete bladder emptying.
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41. Role of MCU:
• MCU was conducted to evaluate postoperative bladder function.
• Real-time imaging assessed bladder capacity, contractility, and urethral
patency.
• The procedure identified residual urine in the bladder, indicating
incomplete voiding.
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42. Treatment Planning:
• Based on MCU findings, the healthcare team adjusted the patient's
treatment plan.
• Catheterization and medication were prescribed to address the
postoperative urinary retention.
• Subsequent MCUs were scheduled to monitor the effectiveness of
treatment and ensure the restoration of normal bladder function.
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43. Benefits and Risks
• advantages of MCU:
• Accurate diagnosis of urinary tract conditions.
• Facilitates treatment planning and monitoring. Risks:
• risks or discomfort:
• Minimal radiation exposure.
• Rare allergic reactions to contrast agents.
• Patient discomfort during catheter insertion.
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44. References
1. Smith, E. A., & Dillman, J. R. (2017). Vesicoureteral reflux. Radiologic Clinics, 55(5), 991-1006.
2. Lebowitz, R. L., Olbing, H., & Parkkulainen, K. V. (1985). Imaging and radiologic management of urinary
tract infection. The Pediatric Clinics of North America, 32(1), 205-226.
3. Huang, L., Sant, G. R., & Tu, L. (2000). Vesicoureteral reflux in adults. Journal of Urology, 164(3), 722-
725.
4. Brenner, D. J., & Hall, E. J. (2007). Computed tomography—An increasing source of radiation exposure.
New England Journal of Medicine, 357(22), 2277-2284.
5. Kavanagh, E. C., & Ryan, S. (2010). Vesicoureteric reflux. Pediatric Radiology, 40(6), 956-965.
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45. Thank You
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