CYSTOMETRY

CYSTOMETROGRAM (CMG)

A test that measures the pressure inside the bladder in order to see how well the urinary
bladder is working.

Done when a muscle or nerve problem may be causing problems with how well the
bladder holds or releases urine.

PURPOSE:

To find the cause of the problem affecting the bladder sphincter or the bladder itself.

To measure how much urine can the bladder store and how much residual volume there is.

To help the physician and the patient she make decisions about the appropriate treatment
regimen.

To see how well the bladder works in people with progressive neurological diseases like
multiple sclerosis.

HOW TO PREPARE FOR THE TEST:

Generally, no special preparations are needed for this test. However, for infants and
children, preparation depends on the child's age, past experiences, and level of trust.

Before the test, patient must tell the healthcare provider if she is taking any medicines
because some meds and herbal supplements can affect bladder function. (e.g.
ANTIHISTAMINE)

Patient should also inform the healthcare provider if she is pregnant or is suspected to be.

HOW THE TEST IS PERFORMED:

1. Patient will be asked to void into a special container (UROFLOWMETER) that is interfaced
with a computer.
It records the (1) time it takes one to begin urinating; (2) the size, force, and
continuity of ones urinary stream; (3) the amount of urine; and (4) how long it
took one to empty ones bladder.
2. Patient will then lie down and a catheter is gently placed in her bladder to drain and
measure the remaining urine.
A smaller catheter is sometimes placed in ones rectum in order to measure the
abdominal pressure. Measuring electrodes, similar to the sticky pads used for
an EKG, are placed near the rectum.

The test usually takes 30 to 60 minutes, but it may take slightly longer if any special tests
are done.

After cystometry, one will need to keep track of how much she drinks and how much she
urinates for the next 24 hours. A burning sensation during urination is a common but
temporary side effect. Drinking lots of fluids will help relieve this sensation. One may be
given an antibiotic to help prevent a urinary tract infection.

One may feel sore after the test though a warm tub bath may be helpful to relieve the
soreness.

RISKS OF CYSTOMETRY:

Cystometry usually does not cause problems though there is always a slight risk of
developing a UTI when a catheter is inserted into the bladder.

If patient has a high spinal cord injury, she may have low heart rate, high blood
pressure, headache, and feel flushed or sweaty during the test. Report these symptoms to
the health professional conducting the test, since further testing may cause complications.

WHAT TO DO AFTER THE TEST:

Patient may need to urinate frequently, with some burning during and after urination for a
day or two. Therefore, patient must drink lots of fluids to help minimize the burning and to
prevent a urinary tract infection.

A pinkish tinge to the urine is common for several days after cystometry. But call the
doctor immediately if:

Urine remains red or you see blood clots after voiding X times
Have not been able to urinate 8 hours after the test.
Have a fever, chills, or severe pain in your flank or abdomen
Have symptoms of a urinary tract infection:
Pain or burning upon urination.
An urge to urinate frequently, but usually passing only small quantities of urine.
Dribbling or leakage of urine.
Urine that is reddish or pinkish, foul-smelling, or cloudy.
Pain or a feeling of heaviness in the lower abdomen.
CAUSES OF ABNORMAL RESULTS:

Enlarged prostate

Multiple sclerosis

Overactive bladder

Reduced bladder capacity

Spinal cord injury

Stroke

Urinary tract infection

CYSTOGRAM

Also known as a bladder scan, is an imaging technique. Doctors use it to diagnose

illnesses or abnormalities of the bladder, such as infection, distension, or incomplete
emptying.

During this exam, small amounts of a radioactive fluid are injected into the bladder
through a thin, flexible tube called a catheter. The fluid can show doctors areas of concern,
such as tumors or structural defects, when highlighted under a specialized scanner.

Why the Test Is Performed

Your doctor may recommend this test if youre having problems with your bladder. This
could include incomplete emptying of the bladder, leakage, or difficult urination. It is also
performed to diagnose the cause of urinary tract infections, particularly in children.

Some of the most common reasons a radionuclide cystogram are done include:

Bladder infection

Enlarged prostate gland

Nerve problems

Obstruction in urine flow

Urine refluxbackward flow of urine from bladder to the kidneys

The solution containing radioactive material is injected into the bladder through a catheter
in the urethra (the tube through which urine is expelled from the body). There may be
slight discomfort when the catheter is inserted and removed, but this typically subsides
shortly after the test.

Urine may appear slightly pink after the test due to bleeding from catheter insertion and
removal. Some people experience urinary tract infections as a result of the procedure, but
this is rare.

HOW TO PREPARE:

This requires no special preparation. You will have to remove all jewelry and change into a
hospital gown prior to the test. Your doctor will ask you questions about your medical
history and symptoms. Answering these questions as completely as possible can help your
doctor identify and minimize any other side effects of the procedure.

HOW THE TEST IS PERFORMED:

The test will be performed in a hospitals radiology department or in a specialized testing

facility.

Youll begin by lying down on a scanner table. A nurse will then insert a catheter into your
urethra and up into your bladder. This may cause some discomfort.

A solution containing radioactive tracers, which allows the doctor to view the affected
internal organs using X-ray, will flow through the catheter into your bladder. When your
bladder is full, images will be taken of your bladder using a special camera.

You may also have to urinate while images are taken. You may urinate into a urinal or
bedpan. More images are taken when your bladder is empty.

When the radiologist is finished with the images, the catheter will be removed and the test
terminated. You will be free to leave when the test is complete.

There is no risk of radioactive tracers remaining in your body because your bladder will
completely expel them during normal urination.

URODYNAMICS
A three-fold procedure that involves different tests including:
1. Measured voiding without a catheter
2. Filling phase Test
3. Emptying phase test

For complete urodynamic testing, a much smaller catheter is placed in the bladder so the
patient will be able to urinate around it. Because this special catheter has a sensor on the
tip, the computer can measure the pressure and volumes as the bladder fills and as the
patient empties it. Patient may be asked to cough or push so that the health care provider
can check for urine leakage.

VIDEOURODYNAMICS
Type of urodynamic test wherein x-rays can be taken during the test. In this case, instead of
water, a special fluid that shows up on x-ray is used to fill ones bladder rather than water or air.
HOW TO PREPARE FOR THE TEST:

Healthcare provider should also be notified by the patient if she has symptoms of a urinary
tract infection: pain or burning with urination, foul-smelling or cloudy urine, or an urge to
urinate more often than usual.

KUB ULTRASOUND (KIDNEY URETER BLADDER UTZ)

KUB refers to a diagnostic medical imaging technique of the abdomen and stands for
Kidneys, Ureters, and Bladder, although in fact the Ureters only show if they are
abnormally distended. A KUB ultrasound is an examination requested by your doctor to
evaluate the urinary tract (which includes the kidneys, ureters, and urinary bladder). In
the male patient, the prostate gland is also scanned.

A KUB Ultrasound may be requested:

To look for changes in the bladder wall

To look for changes in the kidney size or structure

To look for stones in the urinary tract

To evaluate reasons why you have recurrent kidney infection

To identify the cause of renal or pelvic pain

What happens during renal or KUB ultrasound?

The urinary bladder can only be properly assessed when full or distended, as bladder
volume measurements are taken whilst the bladder is full.

The bladder and both kidneys are also scanned after the bladder has been emptied to
evaluate the volume of urine retained

In the male patient the prostatic volume is measured.

DURING THE ULTRASOUND EXAMINATION:

Health care providers will make a detailed study of the size, shape and condition of
the:
Urinary bladder, both full and immediately after emptying (you will be sent to a lavatory to
empty your bladder)
Both right and left kidneys and their ureters
The prostate gland (males)
What preparation is required for the KUB Ultrasound scan?

A full bladder is required and you will need to drink a pint of water in the hour before your
scan. During this period, please do not empty your bladder.

What will happen during the examination?

The KUB ultrasound examination is non-invasive and painless.

You will be asked to lie on your back on the examination couch and expose your lower
abdomen.

Your highly qualified and experienced Sonographer will move a transducer lubricated with
warm gel over your lower abdomen to obtain the necessary images

INTRAVENOUS PYELOGRAPHY
DESCRIPTION:

IVP is the commonly performed test to determine urinary tract dysfunction or renal
disease.

Uses IV radiopaque contrast medium to visualize the kidney, ureter, bladder, and renal
pelvis.

The contrast medium concentrates in the blood and is filtered out by the glomeruli; it
passes out through the renal tubule and is concentrated in the urine.

Renal function is reflected by the length of time it takes the contrast medium to appear
and to be excreted by each kidney.

A series of x-rays is performed during a 30-minute period to view passage of the medium
through the kidney and ureter into the bladder.]

A final film is taken after the patient empties the bladder (post voiding film).

CT scan may be employed during examination to permit the examination of an individual

layer or plane of an organ that may be obscured by surrounding overlying structures.

INDICATIONS:

Evaluate known or suspected ureteral obstruction.

Evaluate function of the K/U/B.

Evaluate presence of renal, ureter, and bladder calculi.

Evaluate the cause of blood in the urine.

Aid in the diagnosis of renovascular hypertension

Evaluate space-occupying lesions or congenital anomalies of the urinary system.

Evaluate the effects of urinary system trauma

NORMAL FINDINGS:

Normal size of KUB.

Normal bladder and absence of masses or renal calculi, with prompt visualization of
contrast medium through the urinary system

ABNORMAL FINDINGS:

Absence of kidney (Congenital

Malformation)

Prostatic enlargement

Benign or Malignant kidney tumors.

Pyelonephritis

Renal cysts

Bladder tumors.

Congenital renal or urinary tract

abnormalities.

Renal hematomas

Renal or ureteral calculi

Glomerulonephritis

Soft-tissue masses

Hydronephrosis

Tumors of the collecting system

CONTRAINDICATIONS

Patients who are allergic to shellfish or iodinated dyes.

Patients who are severely dehydrated, because this can cause renal shutdown and failure
(Geriatric patients are particularly vulnerable).

Patients with renal insufficiency, as evidenced by a BUN value greater than 40 mg/dl,
because the iodinated nephrotoxic dye can worsen kidney function.

Patients with Multiple myeloma, because the iodinated nephrotoxic dye can worsen renal
function.

Patients who are pregnant, unless the benefits outweigh the risk of radiation exposure to
the fetus

POTENTIAL COMPLICATIONS

Allergy to dye

Infiltration of contrast dye

Renal failure ( This occurs most often in elderly patients who are dehydrated before the
dye injection)

Hypoglycemia or acidosis may occur in pt. who are taking (Glucophage) and receive iodine
dye

INTERFERING FACTORS

Fecal material, gas, or barium in the bowel may obscure visualization of the renal system.

Abnormal renal function studies may prevent adequate visualization of the urinary tract.

Retained barium from previous studies may obscure visualization. Studies using barium
(e.g., barium enema) should be scheduled after an IVP.

Procedure and Patient Care

Before:

Explain the procedure to the patient. Inform the pt. that several x-ray will be taken over 30
minutes.

Obtain informed consent If required by the institution.

Check the pt. for allergies to iodinated dye and shellfish.

Give the pt. a laxative as ordered, the evening before the test

Inform the pt. of the required food and fluid restrictions. Some institutions prefer
abstinence from solid for 8 hours before testing. Some allow a clear-liquid breakfast on the
test day.

Ensure adequate hydration for the patient before and after the test to avoid dye-induced
renal failure.

Note that pediatric pts. Will have decreased fasting times, as ordered on an individual
basis.

Note that elderly and debilitated pts. should have fasting times specifically for them.

Note the pts. Receiving high rates of IV fluids may have infusion rates decreased several
hours before the study to increase concentration of the dye within the urinary system.

Assess the pts. BUN and CREA levels. Abnormal renal function could deteriorate as a result
of the dye injection.

Schedule any barium studies after completion of the IVP.

Give the pt. an enema or suppository on the morning of the study, if ordered.

DURING:

Note the following procedural steps:

1. The pt. is taken to the radiology department and placed in a supine position.
2. A plain film of the abdomen (KUB) is taken to ensure that no residual stool obscures
visualization of the renal system. This also screens for calculi in the renal collecting
system.
3. Skin testing for iodine allergy is often done.

4. A peripheral IV line is started and a contrast dye (e.g., Hypaque, Renografin) is given.

5. X-ray films are taken at specific times, usually at 1, 5, 10, 15, 20, and 30 minutes and
sometimes longer, to follow the course of the dye from the cortex of the kidney to the
bladder.

6. Tomography may be performed to identify a mass.

7. The patient is taken on the bathroom and asked to void.

8. A post voiding film is taken to visualize the empty bladder, ureter temporarily to obtain
an better film of the collecting system in the upper part of the ureter. This is done by
compressing the abdomen with an inflatable rubber tube, which is wrapped tightly around
the abdomen slightly below the umbilicus.

Note that this test is performed by a radiologist in approximately 45 minutes.

Inform the pt. that the dye injection often causes a transitory flushing of the face, a feeling
of warmth, a salty taste in the mouth, or even transient nausea. Initial IV needle
placement and lying on a hard x-ray table are the only other discomforts associated with
IVP.

After:

Maintain the pt. on adequate oral or IV hydration for several hours after the IVP to
counteract fluid depletion caused by test preparation. Encourage fluid intake.

Assess the pt. urinary output. A decreased output may be an indication of renal failure.

Evaluate elderly and debilitated pts. For weakness because fasting necessary for test
preparation. Instruct these pts. to ambulate only with assistance.