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画像検査 VI：排尿時膀胱尿道造影および膀胱造影
排尿時膀胱尿道造影（Voiding Cystourethrography, VCUG）および膀胱造影（Cystography）は、膀胱および尿道の構造と機能を評価するための専門的なX線検査です。
排尿時膀胱尿道造影（VCUG）
排尿時膀胱尿道造影（Voiding Cystourethrogram,…
排尿膀胱尿道造影法 (VCUG) は、膀胱機能、膀胱頸部、および尿道を評価する画像検査です。膀胱尿管逆流症、膀胱頸部閉塞、排尿後の残尿を検出するのに役立ちます。
この手順は、潤滑されたカテーテルを尿道から膀胱に挿入することから始まります。次に、造影剤を導入して尿路を強調します。
膀胱がいっぱいになると透視画像が撮影されるため、その構造をリアルタイムで評価できます。
その後、カテーテルを抜去し、患者に排尿を求めます。排尿中、膀胱頸部と尿道を通る尿の流れを評価するために、追加の画像が撮影されます。
排尿後、尿の残存を確認するために別の画像を撮影します。
次に、膀胱造影はVCUGに似ています。主に、排尿中のリアルタイム画像をキャプチャせずに、静的X線画像を使用して膀胱の異常を診断することに焦点を当てています。
膀胱造影では、造影剤を尿道カテーテルを介して膀胱に注入し、憩室や外傷などの構造的欠陥を強調します。
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Q1: What does a voiding cystourethrogram evaluate?
A VCUG is an imaging study that evaluates bladder function, the bladder neck, and the urethra. It helps detect vesicoureteral reflux, which is the backward flow of urine into the ureters, bladder neck obstruction, and post-void residual urine. This procedure provides real-time assessment of lower urinary tract structure and function during filling and emptying.
Q2: How does cystography differ from VCUG?
Cystography focuses primarily on diagnosing bladder structural abnormalities using static X-ray images without capturing real-time images during urination. Unlike VCUG, which evaluates bladder function during voiding, cystography captures images when the bladder is filled with contrast dye and after it empties, making it useful for identifying diverticula, tumors, trauma, or rupture.
Q3: What is the first step in performing a VCUG?
The procedure begins with inserting a lubricated catheter through the urethra into the bladder. A contrast agent is then introduced to highlight the urinary tract. Fluoroscopic images are captured as the bladder fills, allowing real-time assessment of its structure and any abnormalities present.
Q4: What imaging occurs during the voiding phase of VCUG?
After the catheter is removed, the patient is asked to urinate while additional X-ray images are captured to assess urine flow through the bladder neck and urethra. Following urination, another image is taken to check for residual urine in the bladder, which helps determine if it has emptied completely.
Q5: What pre-procedure preparation is required for these imaging studies?
Patients must provide informed consent after the healthcare provider explains the procedure, risks, and benefits. Allergy assessment is essential, especially to contrast agents, iodine, or latex. Patients are asked to empty their bladder before the procedure begins to ensure accurate imaging during filling and voiding phases.
Q6: What happens after cystography is completed?
After the procedure, patients may experience a burning sensation during urination, which usually resolves within a few hours. Drinking fluids is recommended to flush out the contrast dye and reduce irritation. Healthcare providers may schedule a follow-up appointment to review imaging results and plan the next steps in treatment.
Q7: How long does a cystography procedure typically take?
The entire cystography procedure usually takes 30 to 60 minutes. During this time, topical anesthesia is applied to the urethra to minimize discomfort, a catheter is inserted into the bladder, and contrast agent is injected to provide clear X-ray images at specific stages of bladder filling and emptying.