How is Voiding Cystourethrogram performed?
The bladder is catheterized using sterile technique, and under fluoroscopy, the bladder is filled to capacity with iodinated contrast material. An approximation of the expected normal bladder capacity (mL) in a child is calculated by (age [in years] + 2) × 30. The catheter is removed, and the child voids while on the fluoroscopy table. During the procedure, the anatomy of the lower urinary tract and bladder function are examined, a series of radiographic images is obtained, and the presence or absence of reflux of contrast material (i.e., VUR) into the ureters is determined.
How is Voiding Cystourethrogram modified in infants?
A cyclic study is typically performed. Infants usually void around the small catheter that is placed through the urethra into the bladder; multiple cycles of voiding and bladder filling are studied. This method also increases the probability that reflux, if present, will be elicited and detectable.
When should Voiding Cystourethrogram be performed?
According to recent American Academy of Pediatrics guidelines (from the Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management), a VCUG should be performed after a second well-documented UTI in both boys and girls.
Voiding Cystourethrogram is indicated if renal and bladder US demonstrates hydronephrosis, scarring, or other indications of high-grade VUR or obstructive uropathy.