Norm of Retrograde Cystography
Normal and intact structure of the bladder and normal location of the bladder; absence of rupture, laceration, fistula, tumor, or reflux into the ureters.
Usage of Retrograde Cystography
Detection of anastomotic leak after surgery, bladder diverticuli, bladder tumors, calculi, clots or other foreign bodies, fistula, hematoma, pyelonephritis, and laceration or rupture of bladder, urinary tract infections, or vesicoureteral reflux. This test will often indicate irregularity of the bladder present in neurogenic bladders.
Description of Retrograde Cystography
Retrograde cystography is performed by filling the bladder by injection or gravity flow (by means of a syringe barrel) with opacified contrast medium and sometimes air through a catheter into the bladder. This is followed by radiographs of the pelvis and bladder with the client in several positions.
Professional Considerations of Retrograde Cystography
Consent form IS required.
Bleeding, infection, urinary tract obstruction. Allergic reaction to contrast medium (hives, itching, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death) is extremely rare. Contrast should not be used in clients who have a contrast allergy or clients who have suspected major trauma to the bladder with the possibility of venous uptake of contrast or intraperitoneal spill.
History of allergy to radiographic dye, iodine, or shellfish; in urethral obstruction or injury, inability to pass a urethral catheter; or during the acute phase of a urinary tract infection; pregnancy (if iodinated contrast material is used, because of radioactive iodine crossing the blood-placental barrier).
- Obtain a straight urinary catheter and a catheter insertion tray, 50–300 mL of radiographic dye, and a syringe.
- The client should disrobe below the waist or wear a gown.
- Obtain baseline vital signs.
- Have emergency equipment readily available.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- The client is positioned supine on the radiographic table.
- A baseline kidney-ureter-bladder (KUB) radiograph is taken.
- 200–300 mL (50–100 mL for infants) of radiographic dye is instilled into the bladder by a catheter inserted through the urethra. It is recommended that the contrast be instilled through gravity using the barrel of a catheter-tipped syringe.
- After the catheter is clamped, the client is assisted to several different positions by a tilt table; the physical position changes for radiographic examination of the bladder and surrounding areas.
- The catheter is unclamped, the bladder fluid is allowed to drain, and final radiographs are taken.
- Monitor vital signs every 15 minutes × 4, then every 30 minutes × 2, then hourly × 4, and then every 2 hours for 24 hours after the test only if there is gross extravasation or major trauma is identified.
- Encourage the oral intake of fluids where not contraindicated.
- Have the client and family members observe for signs of allergic reaction to the dye (listed under Risks) for 24 hours.
- Observe for urinary retention or symptoms of urinary tract infection (fever; chills; tachycardia; tachypnea; abdominal, flank, or suprapubic pain; hesitancy and frequency; dysuria; and hematuria). Notify the physician for any of these signs.
- See Client and Family Teaching.
Client and Family Teaching
- A clear liquid diet and a cathartic the day before the test may improve the clarity of the results by minimizing intestinal gas and the amount of stool.
- After the procedure, save all the urine voided for the next day and report chills or painful urination. Blood in the urine that lasts more than 4–6 hours is abnormal.
Factors That Affect Results
- This test should not be performed within 1 week of a previous intestinal barium examination.
- The clarity of the radiographic images may be diminished by the presence of excess gas or stool in the lower gastrointestinal tract.