Cystourethrography

Question 1

What are some indications for cystourethrography?

Answer 1

• evaluation of the UB wall and urethra for thickness
• suspected non-mineralized uroliths
• urinary bladder masses
• urinary bladder rupture from trauma
• hematuria, stranguria

Question 2

What is being pointed to in this cystourethrograph?

Answer 2

filling defects where contrast is not taken up

Question 3

What is being pointed to in this cystourethrograph?

Answer 3

negative gas contrast

Question 4

What is being pointed to in this cystourethrograph?

Answer 4

positive iodine contrast

Question 5

What is being pointed to in this cystourethrograph?

Answer 5

negative gas contrast with positive iodine contrast in the middle

Question 6

What is seen in this cystourethrograph?

Answer 6

negative gas contrast only

Question 7

What positive contrast agent is most commonly used for cystourethrography? What is not used?

Answer 7

metal opaque iodinated non-ionic contrast media

barium

Question 8

What are 2 common negative contrasts used for cystourethrography?

Answer 8

1. room air - air embolism most common
2. CO2 - more soluble in blood makes air embolism less common

Question 9

How can air embolisms be avoided with cystourethrography?

Answer 9

place patient in left lateral recumbency

Question 10

When is positive contrast cystography best for observing?

Answer 10

evaluating location of the urinary bladder and tears

• place Foley ballooned catheter to ensure constrast remains within bladder

Question 11

What are the 2 steps to double contrast cystography?

Answer 11

1. administer negative gas first - 5-10 mL/kg
2. administer positive iodine diluted 50% with sterile physiologic (0.9%) saline - cats = 0.5-1 mL, dogs <25 lbs = 1-3 mL, dogs >25 lbs = 3-6 mL

position in different recumbency to allow positive contrast to outline the entirety of the UB

Question 12

What 4 things does urethrography allow us to visualize? How is it performed?

Answer 12

1. urethral teats
2. urethral stricture
3. urethral obstruction
4. urethral neoplasia

• allow positive contrast from bladder to exit via urethra
• inject positive contrast into urethra against pressure created in UB

Question 13

Feline fluoroscopic urethrogram:

Answer 13

broadly distended

Question 14

What is a contrast filling defect? What does it indicate? What does it allow?

Answer 14

absence of contrast from an area where contrast would normally be expected

presence of something abnormal occupying the space

aids in identification of luminal and mural lesions

Question 15

What is likely causing the observed filling defect?

Answer 15

• filling defect at trigone, common spot for TCC
• wall thickening