Cystography - Causes, Symptoms and Treatment .MF .
Cystography - this instrumental method studies the bladder, which is the X-ray image after filling the body of water-soluble contrast.Depending on the route of administration of contrast agent cystography is ascending or descending. Downward cystography is the last stage of excretory urography, when the contrast is injected intravenously, after which it is excreted by the kidneys.
Rising same cystography performed after the bladder is filled with contrast via the urethra.
Retrograde (ascending) cystography
With this study method can estimate the shape, size and position of the bladder.This allows accurate diagnosis in almost any disease of the body, which is why the number of indications for cystography wide enough.
Firstly, at the very young age cystography can be used for the diagnosis of congenital malformations.Such anomalies atresia like bladder or doubling placed unprecedented.
In older patients cystography is the method of choice
is mandatory to conduct cystography when damaged bladder or mochekishechnyh fistulas.Contrast, going beyond the bladder, gives an opportunity to establish the correct diagnosis and choose the right treatment.
Very rarely manages without cystography diagnosis of diseases such as inflammation paravesical fiber or prostate cancer.In addition, it is often used and vesicoureteral reflux.
Contraindications to perform procedures cystography
As a rule, all contraindications to perform this procedure relate primarily ascending cystography, because its implementation must enter the urethral catheter into the bladder cavity.Accordingly, it can not perform in acute inflammatory diseases of the bladder, urethra, and prostate.This can lead to additional irritation of the mucosa and the progression of the inflammatory process.
addition, cystography strictly contraindicated with massive hematuria, or blood in the urine separation.The fact that blood clots, which in this case remain in the cavity of the bladder on the radiograph may appear as a filling defect - specific feature of the bladder tumor.Also, the contrast agent can change the color of urine, which complicate the clinical diagnosis of hematuria in the future.
As descending cystography, it has exactly the same contraindications as excretory urography, it is necessary to consider appointing such a study.
Preparing for cystography
procedure Preparing to study also depends on what kind of procedure procedure takes place.If we are talking about the descending cystography, before the handling office visits the patient must be reserved and conventional contrast agent dvadtsatigrammovym syringe, through which the contrast will be introduced into the vascular system of the patient.
In the same case, if it is a retrograde cystography, the preparation should begin at least one day prior to its implementation.It is imperative to achieve the absolute purity of the external genitalia, as it directly affects the number of complications after the procedure.The pharmacy before manipulation also need to buy a contrast agent and a urethral catheter, which it will be introduced into the cavity of the patient's urinary bladder.
Cystography eyes patient
In principle, none of the methods of cystography can not be called pleasant for the patient.Move downward cystography is especially difficult for those patients who are afraid of intravenous and intramuscular injection, because it is this manipulation and carrying out the procedure begins.After that, everything is on the same plan as in the excretory urography, only an X-ray is not performed 10 minutes after injection of contrast, and after one hour.It is allowed to clearly see the X-ray picture of the bladder and make the correct diagnosis.
Carrying retrograde cystography for the patient begins from the moment of the urethral catheter.Typically, this is accompanied by discomfort and to reduce them, often use such drugs as katezhel, which not only improve the sliding effect, but also reduce the pain at the time of the urethral catheter.After the desired amount of contrast, the tube may be removed from the cavity of the bladder will be administered by urethral catheter.As a rule, after a patient has been a sharp urge to urinate, which is necessary to try to contain, or results of the study prove to be incorrect.
After investigation procedure will be carried out, the urine may change its color more intense.To this must be ready, so as not to be suspected at any illness and does not go to the hospital immediately after his return from it.
doctor Operations During cystography
doctor Responsibilities during this study also determined by the type of procedure.During the descending cystography doctor must only correctly assess contrast radiographs bladder.The introduction of a contrast agent and carrying out X-ray examination is the responsibility of nurses.The urologist also considering the resulting X-ray contrast bladder must evaluate correctly the form, size, position of the latter and give a thorough medical report on its functional state.
During the retrograde cystography doctor is directly related not only to the X-ray decoding, but also to the conduct of the study.His responsibilities include formulation of a urethral catheter and the introduction on it a special contrast agent.After the patient is sent to the X-ray room for X-ray images of the bladder contrast, deciphering which again is the responsibility of the urologist.
duration of the procedure and the length of stay in hospital
Like everything else, the duration of the procedure also depends on the specific form of cystography.For example, when it is descending embodiment, it should occupy a minimum of not less than sixty minutes, since this time is necessary ingress of contrast medium from human blood in his bladder.And if at this time to add thirty minutes to prepare and half an hour to decipher radiographs, it turns out that the whole procedure of the descending cystography take about two hours.
Despite the fact that retrograde cystography does not require the patient to wait for an hour filtration contrast agent, for its implementation do not need less time.The fact that preparations for the staging of urethral catheter and the very formulation can take up to forty minutes.Rest of the time, as a rule, is used for X-ray examination and interpretation of images.
As to the time of hospital stay, it may not be, because in most cases, cystography, regardless of its kind, conducted on an outpatient basis.If the patient needs and ward mode, it is not defined diagnostic procedure, and the patient's primary disease.
Possible complications during cystography
most common complication that occurs when descending cystography, is an allergic reaction to the administration of a contrast agent.As a rule, it is developing the first type of reactivity and has kind of an attack of shortness of breath or urticaria.Patients in this case complain of cough, inability to deep breath and the appearance of itchy red spots in different parts of the body.
similar to the clinical condition had progressive continuation of such patients is a medical emergency in the form of intravenous administration of hormonal preparations.As practice shows, the timely introduction of such drugs can completely halt the progress of clinical symptoms and lead to regression of the past.
Together with allergic manifestations, the introduction of a contrast agent can show and nephrotoxic effect.In this case, patients note a dramatic deterioration in the general condition, the occurrence of headaches and dizziness.Also, they may experience an unpleasant smell of acetone breath.In this case, we need more than a serious medical event.As a rule, patients are placed in the intensive care unit, where he held an active infusion therapy and detoxification.
As retrograde cystography, when it excluded the above complications, because the contrast is injected directly into the cavity of the bladder, bypassing the human circulatory system.
At the same time, there may be a lot of other specific complications.For instance, when administered to a urethral catheter, by mistake, it can be applied to the mucous membrane injury urethra.As a rule, this is noted in older patients, when the introduction of the rubber catheter is impossible due to benign prostatic hyperplasia, and we have to use metal tools.
Thus, if there is trauma urethral mucosa, but the contrast is still falls into the cavity of the bladder, the damage may already be diagnosed with this study.
second complication that develops in retrograde cystography - an acute urinary retention.Again, she was exposed to older men, due to the above reasons.The introduction of large amounts of fluid along with a contrast agent into the cavity of the bladder can cause irritation of the nerve receptors in the body of the muscle membrane and, as a result, reflex spasm of the sphincter.The problem is diagnosed at a time when the X-ray after the patient noted the inability to urinate.The issue of the statement of the urethral catheter or the imposition epitsistostomy.
Ed.urologist, sexologist-andrologist Plotnikov AN