Cystography - Causes, symptoms and treatment. MF.

Cystography is an instrumental method for studying the bladder, which consists of an X-ray image after filling the organ with water-soluble contrast. Depending on the route of administration of the contrast medium, cystography is ascending or descending. Descending cystography is the last stage of excretory urography, when contrast is injected intravenously, after which it is excreted by the kidneys.

Descending cystography

Ascending cystography is performed after the bladder is filled with contrast through the urethra.

Retrograde( ascending) cystography

Indications for cystography

This form of examination can be used to evaluate the shape, size and position of the bladder. This allows you to put an accurate diagnosis in almost any disease of the body, because of which the number of indications for cystography is quite wide.

First, at a very young age, cystography can be used to diagnose congenital malformations. Such anomalies as atresia of the bladder or its duplication are set unprecedentedly.

In older patients, cystography is the method of choice for the diagnosis of such pathologies as bladder diverticula, malignant neoplasms or urolithiasis. Of course, with the advent of such modern technologies as ultrasound or computed tomography, cystography has slightly receded into the background, but has not lost its relevance.

It is mandatory to perform cystography for bladder or urolithic fistula damages. Contrast, leaving the bladder, makes it possible to establish the correct diagnosis and choose the right treatment.

Very rarely without cystography, the diagnosis of such diseases as inflammation of the perivascular cellulose or prostate cancer is avoided. In addition, it is often used for vesicoureteral reflux.

Contraindications to the procedure of cystography

As a rule, all contraindications to the procedure are related primarily to ascending cystography, since for its implementation it is necessary to introduce the urethral catheter into the bladder cavity. Based on this, it can not be performed with acute inflammatory diseases of the bladder, urethra and prostate. This can lead to an additional irritation of the mucosa and the progression of the inflammatory process.

In addition, cystography is strictly contraindicated in cases of massive hematuria or discharge of blood in the urine. The fact is that blood clots, which remain in the cavity of the bladder, may look like a filling defect - a specific sign of a tumor of the bladder. Also, the contrast medium can change the color of urine, which makes it difficult to clinically diagnose hematuria in the future.

As for descending cystography, it has exactly the same contraindications as excretory urography, which must be taken into account when assigning such a study.

Preparing for the

cystography procedure The preparation for the study also depends on which particular procedure procedure is in place. If we are talking about descending cystography, then before visiting the manipulation room, the patient needs to stock up with a contrast medium and a conventional twenty-gram syringe, through which this contrast will be introduced into the patient's vascular system.

In the same case, if it is a question of retrograde cystography, then the preparation should begin at least a day before it is held. It is absolutely necessary to achieve absolute purity of the external genital organs, since this directly affects the number of complications after the performed procedure. In the pharmacy, before manipulation, it is also necessary to buy a contrast agent and a urethral catheter to insert it into the patient's bladder cavity.

Cystography with the eyes of the patient

In principle, none of the methods of conducting cystography can be called pleasant for the patient. To transfer descending cystography is especially difficult for those patients who are afraid of intravenous and intramuscular injections, because it is with this manipulation that the procedure begins. Further everything follows the same plan as in excretory urography, only an x-ray is performed not after 10 minutes after the introduction of contrast, but after one hour. This is allowed to clearly see the radiographic picture of the bladder and to put the correct diagnosis.

Retrograde cystography for the patient begins with the placement of the urethral catheter. As a rule, this is accompanied by unpleasant sensations and in order to reduce them, often use drugs such as catechet that not only improve the sliding effect, but also reduce pain during the placement of the urethral catheter. After the required amount of contrast has been injected through the urethral catheter, the tube can be removed from the bladder cavity. As a rule, after this, the patient has a sharp urge to urinate, which must be tried to restrain, otherwise the results of the study will be incorrect.

After the examination procedure has been carried out, urine can change its coloration to a more intensive one. To this, you need to be prepared to not suspect yourself of any disease and do not go to the hospital immediately after returning from it.

Doctor's actions during cystography

The duties of the doctor during this study are also determined by the type of procedure. When carrying out a descending cystography, the doctor must only correctly assess the contrast radiographs of the bladder. The introduction of contrast agent and the conduct of radiology research is the responsibility of paramedical personnel. The urologist, considering the received contrast radiograph of the bladder, should correctly assess the shape, size, position of the latter and give a thorough medical conclusion about its functional state.

When performing retrograde cystography, the doctor is directly related not only to the decoding of the radiographs, but also to the conduct of the study itself. His duties include setting the urethral catheter and introducing a special contrast agent. After that, the patient goes to the X-ray room to obtain X-ray photographs of the contrasted bladder, the decoding of which again is the responsibility of the urologist.

Duration of the procedure and the length of stay in the hospital

Like everything else, the duration of the procedure also depends on the specific type of cystography. For example, when it descends, it should take at least at least sixty minutes, since this is the time it takes a contrast material from the human blood to enter its bladder. And if by this time to add thirty minutes to the preparation and half an hour to decode the radiograph, it turns out that for the entire procedure of descending cystography, it takes about two hours.

Despite the fact that retrograde cystography does not oblige the patient to wait an hour for the filtration of contrast medium, it takes no less time to perform it. The fact is that preparations for setting up the urethral catheter and for the setting itself can take up to forty minutes. The rest of the time, as a rule, is used for X-ray examination and decoding of images.

As for the time spent in hospital, it may not be at all, because in most cases, cystography, regardless of its kind, is performed on an outpatient basis. If the patient needs a ward regime, then he is not determined by the diagnostic procedure, but by the patient's main disease.

Possible complications in the cystography of

The most common complication that occurs with descending cystography is an allergic reaction to the administration of contrast media. As a rule, it develops according to the first type of reactivity and has the appearance of an attack of dyspnea or hives. Patients in this case complain of coughing, the inability of deep inspiration and the appearance of red itchy spots on different parts of the body.

To ensure that such a clinical condition does not have a progressive continuation, such patients receive emergency medical care in the form of intravenous hormonal drugs. As practice shows, the timely introduction of such drugs can completely stop the progress of clinical symptoms and lead to regression of the latter.

Along with allergic manifestations, the introduction of a contrast agent may manifest a nephrotoxic effect. In this case, patients note a sharp deterioration in the general condition, the appearance of headaches and dizziness. Also, they may have an unpleasant odor of acetone from the mouth. In this case, more serious medical measures are needed. As a rule, patients are placed in the intensive care unit, where they are given active infusion and detoxification therapy.

As for retrograde cystography, the above complications are excluded, since contrast is introduced directly into the cavity of the bladder, bypassing the human circulatory system.

Along with this, there may be many other specific complications. For example, if a urethral catheter is inserted, by mistake, an injury to the mucous membrane of the urethra can be caused. As a rule, this is noted in patients of older age, when the introduction of a rubber catheter is impossible due to benign prostatic hyperplasia and it is necessary to use metal tools.

In this case, if there is a traumatization of the mucous membrane of the urethra, but the contrast still falls into the cavity of the bladder, then the damage can be diagnosed already with this study.

The second complication that develops with retrograde cystography is acute urinary retention. Again, it affects older men, for the reasons mentioned. When you introduce a large amount of fluid together with a contrast agent into the bladder cavity, irritation of the nerve receptors in the muscular membrane of the organ and, as a result, reflex spasm of the sphincter can occur. The problem is diagnosed at a time when, following an X-ray, the patient notes the impossibility of urinating. The question is solved by setting the same urethral catheter or applying epicystostomy.

Rev.the doctor the urologist, the sexologist-andrologist Plotnikov А.N.