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Pediatric Voiding Cystourethrogram

Last updated April 14, 2018

Pediatric Voiding Cystourethrogram (VCUG) procedure is used to examine the bladder and lower urinary tract, by using fluoroscopy with contrast material, in children.


Background Information:

What are the other Names for the Procedure?

  • Children’s VCUG
  • Children’s Voiding Cystourethrogram
  • Pediatric VCUG

What is Pediatric Voiding Cystourethrogram radiology procedure? (General Explanation)

  • Pediatric Voiding Cystourethrogram (VCUG) procedure is used to examine the bladder and lower urinary tract, by using fluoroscopy with contrast material, in children
  • Fluoroscopy uses X-rays to produce images and help the physician examine the internal organs in motion, using a contrast material

What part of the Body does the Procedure involve?

Pediatric Voiding Cystourethrogram procedure involves the genital area of a child.

Why is the Pediatric Voiding Cystourethrogram radiology procedure Performed?

  • Pediatric Voiding Cystourethrogram is used after urinary tract infection, to check for the presence of vesicoureteral reflux
  • It checks for any abnormalities in the flow of urine

Vesicoureteral (VU) reflux:

  • Urine is produced by the kidney; it flows from the kidneys to the bladder, via the ureter
  • Valves prevent the backing-up of urine, from bladder to the kidney
  • The urine is eliminated from the body through the urethra, which exits the bladder
  • In VU reflux, urine backs-up from the bladder, to the lower ureter or kidney
  • A vesicoureteral reflux may be congenital bladder obstruction, or the improper emptying of a urinary bladder, or an UTI (urinary tract infection)

What is the Equipment used? (Description of Equipment)

  • Fluoroscopy
    • X-ray machine is used in fluoroscopy
    • Fluoroscopy, basically converts the x-ray images in real-time to video images
  • Catheter, a hollow plastic tube, is used to inject the contrast material into the bladder

What are the Recent Advances in the Procedure?

There have been no recent advances to replace the Pediatric Voiding Cystourethrogram procedure. 

What is the Cost of performing the Pediatric Voiding Cystourethrogram radiology procedure?

The cost of Pediatric Voiding Cystourethrogram procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities. 

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary. 

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Voiding Cystourethrogram procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.radiologyinfo.org/en/info.cfm?pg=voidcysto

http://www.childrenshospital.org/health-topics/procedures/voiding-cystourethrogram

http://www.acr.org/~/media/62930639ac564e00a2c3a48fe9e3cf0f.pdf

Prior to Pediatric Voiding Cystourethrogram radiology procedure:

How does the Pediatric Voiding Cystourethrogram radiology procedure work?

The Pediatric Voiding Cystourethrogram procedure works in the following manner:

  • X-rays passes through the body and information is recorded on the recording plate, on the other side of the body
  • Fluoroscopy uses contrast material along with an x-ray machine, to produce real-time images of the organs, or joints in motion

How is the Pediatric Voiding Cystourethrogram radiology procedure Performed?

  • The patient is positioned on the examination table
  • The genital area is thoroughly cleaned
  • A catheter is inserted through the urethra (which carries urine from bladder, to outside of the body)
  • The contrast material is injected through the catheter in the bladder
  • After the bladder is completely full, the patient will urinate. This is monitored using fluoroscopy, in order to detect any abnormalities in the urine flow
  • The bladder and urethra are also checked for their normal shape
  • The presence of contrast material in the ureter and kidney is checked, to see if vesicoureteral reflux is present. The VU reflux involves a backing-up of the urine from bladder, to the kidneys or to the lower ureter
  • The catheter is removed after the procedure is complete

Where is the Procedure Performed?

Pediatric Voiding Cystourethrogram is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

A Voiding Cystourethrogram procedure is performed by an interventional radiologist.

How long will the Procedure take?

The Pediatric Voiding Cystourethrogram procedure may take about 15-30 minutes. However, there may be some waiting time involved, before and after the procedure.

Who interprets the Result?

A radiologist interprets the result of the exam.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Pediatric Voiding Cystourethrogram procedure:

  • The physician should be informed about all the medications that are currently being taken
  • The child’s previous medical conditions including all surgical and medical history should be discussed with physician, to see if it complicates the procedure performed
  • The patient should inform the physician, if they are allergic to contrast material used during the procedure
  • The patient need not fast, prior to the procedure

What is the Consent Process before the Procedure?

A physician will request your consent for Pediatric Voiding Cystourethrogram procedure using an Informed Consent Form. 

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent. 

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of a Pediatric Voiding Cystourethrogram procedure:

  • The radiation does not remain in the body, after the procedure
  • VCUG helps a physician in deciding, if a therapy or surgery is needed
  • The procedure provides a detailed anatomical picture of the urinary system, to make the diagnosis and prevent further kidney damage

Following are the risks of a Pediatric VCUG procedure:

  • There may be allergic reaction from the contrast dye used in preparation
  • There is very minimal risk of developing cancer from x-ray radiation
  • Discomfort, while urinating may occur after the procedure, which often resolves in 12 hours or less

What are the Limitations of the Pediatric Voiding Cystourethrogram radiology procedure?

The limitations of this procedure include:

  • It cannot be performed, if the patient suffers from a urinary tract infection
  • The procedure cannot be used to detect or evaluate obstruction of urine flow from kidneys

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

  • What is a Pediatric Voiding Cystourethrogram procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • What are the possible side effects from the procedure? How can I minimize these side effects?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Pediatric Voiding Cystourethrogram radiology procedure:

What is to be expected during the Pediatric Voiding Cystourethrogram radiology procedure?

The patient may experience slight discomfort at the time of catheter insertion and when the bladder is filled completely with a contrast material.

What kind of Anesthesia is given, during the Procedure?

Since the Pediatric VCUG procedure is a minimally invasive procedure, anesthesia is rarely used during the procedure. 

How much Blood will you lose, during the Procedure?

Since the procedure is a minimally invasive procedure, the blood loss involved during the procedure is minimal. 

What are the possible Risks and Complications during the Pediatric Voiding Cystourethrogram radiology procedure?

Rarely, there may be an allergic reaction from the contrast dye used in the preparations.

What Post-Operative Care is needed at the Healthcare Facility after the Pediatric Voiding Cystourethrogram radiology procedure?

  • Generally, no significant post-operative care is needed at the healthcare facility
  • However, a short period of observation may be occasionally recommended by your healthcare provider

After the Pediatric Voiding Cystourethrogram radiology procedure:

What is to be expected after the Pediatric Voiding Cystourethrogram radiology procedure?

The patient may experience slight discomfort while urinating, after the procedure. But, this often resolves within 12 hours or less.

When do you need to call your Physician?

Do inform your healthcare provider:

  • If there is significant pain after the procedure, or there is bleeding from the catheter insertion site
  • If you experience any fever or chills

What Post-Operative Care is needed at Home after the Pediatric Voiding Cystourethrogram radiology procedure?

No specific post-operative care is needed at home after the procedure. 

How long does it normally take to fully recover, from the Procedure?

The whole procedure takes only about 30 minutes and the patient may resume their normal activities, immediately on completion of the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Pediatric Voiding Cystourethrogram procedure does not involve the removal of any body tissue. 

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient 

Who will you receive a Bill from, after the Pediatric Voiding Cystourethrogram radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital, where the procedure is performed
  • Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Pediatric Voiding Cystourethrogram procedure is performed.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Feb. 22, 2014
Last updated: April 14, 2018