What is cystography?

Cystography is an imaging test that can help diagnose problems in your bladder. It uses X-rays. They may be X-ray pictures or fluoroscopy, a kind of X-ray movie.

During cystography, the healthcare provider will insert a thin tube called a urinary catheter and inject contrast dye into your bladder. The contrast dye will let the provider see your bladder more clearly. They will take X-rays of the bladder. Cystography is sometimes combined with other procedures. For example, cystourethrography images the bladder and the urethra. The provider may also use fluoroscopy to watch how the bladder empties while you urinate (voiding cystourethrography). Cystography may show whether any urine backs up into the kidneys (vesicoureteral reflux). CT cystography is sometimes used following trauma or recent surgery.

X-rays use a small amount of radiation to create images of your bones and internal organs. X-rays are most often used to find bone or joint problems or to check the heart and lungs. Cystography is one type of X-ray.

Why might I need cystography?

You might need cystography to find out the cause of:

• Blood in your urine (hematuria)

• Urinary tract infections that keep coming back

• Problems emptying your bladder

• Urinary reflux, when urine flows back into one or both ureters and, in some cases, to one or both kidneys

• Urinary incontinence

Other reasons that you may need cystography:

• Trauma to the bladder. The test will let your healthcare provider see if you have a tear in the wall of your bladder.

• A blockage in or narrowing (strictures) of the ureters or urethra

• Before or after certain spine surgeries. This will let your provider see possible problems with the nerves leading to the bladder from the spine.

Your healthcare provider may have other reasons to recommend cystography.

What are the risks of cystography?

You may want to ask your healthcare provider about the amount of radiation used during the test. Also ask about the risks as they apply to you.

Consider writing down all X-rays you get, including past scans and X-rays for other health reasons. Show this list to your provider. The risks of radiation exposure may be tied to the number of X-rays you have and the X-ray treatments you have over time.

Tell your provider if:

• You're pregnant or think you may be pregnant. Radiation exposure during pregnancy may lead to birth defects.

• You're allergic to or sensitive to medicines, contrast dyes, local anesthesia, iodine, or latex

• You have kidney failure or other kidney problems

You're at risk for a bladder infection because a thin tube (catheter) is put into your bladder during the test. The catheter may also cause bleeding or hematuria.

Certain things can make the results of the test less accurate. These include:

• You have gas or stool in your intestines

• You have barium in your intestines from a recent barium enema

You may not be able to have cystography if you:

• Have a urinary tract infection

• Are pregnant

• Are allergic to contrast dyes

You may have other risks depending on your specific health condition. Be sure to talk with your healthcare provider about any concerns you have before the procedure.

How do I get ready for cystography?

• Your healthcare provider will explain the procedure to you. Ask them any questions you have about the procedure.

• You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.

• You may need to stop eating and drinking before the test. Your provider will give you specific instructions. Generally, this means no food after midnight and only clear liquids the day of the test. You may be told to drink additional clear liquids the day before and day of the procedure.

• Tell your provider if you're pregnant or think you may be pregnant.

• Tell your provider if you have had a reaction to any contrast dye or if you're allergic to iodine.

• Tell your provider if you're sensitive or allergic to any medicines, latex, tape, or anesthetic medicines (local and general).

• Tell your provider about all medicines you're taking. This includes prescriptions and over-the-counter medicines and herbal supplements.

• Tell your healthcare provider if you are taking the diabetes medicine metformin. You may be told to stop taking this medicine before the scan.

• Tell your healthcare provider if you are breastfeeding. If contrast material is used, talk with the radiologist about when to resume breastfeeding after contrast is injected.

• Tell your provider if you've had a bleeding disorder. Also tell your provider if you're taking blood-thinning medicine (anticoagulant), aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the test.

• Tell your provider if you have kidney disease.

• You may be told to take a laxative the night before the test. Or you may be given an enema or medicine to make you have a bowel movement the morning of the test.

• Follow any other instructions your healthcare provider gives you to get ready.

What happens during cystography?

You may have a cystography test as an outpatient or as part of your stay in a hospital. The way the test is done may vary depending on your condition and your healthcare provider's practices.

Generally, a cystography follows this process:

1. You'll be asked to remove any clothing, jewelry, or other objects that might get in the way of the test.

2. You'll be asked to remove clothing and given a gown to wear.

3. You'll be asked to empty your bladder before the test.

4. You will lie on your back on the X-ray table.

5. The healthcare provider will put a thin tube (catheter) into your bladder. They'll use this to inject the contrast dye into the bladder.

6. The provider will take an X-ray of the kidney, ureter, and bladder to make sure they can see the urinary system. For men, the provider may put a lead shield over the testes to protect the gonads from the X-rays.

7. The provider will inject the contrast dye into the bladder through the catheter. They'll clamp the catheter tubing to keep the dye from draining out of the bladder.

8. The provider will take X-rays while the dye is injected and afterward. You may be asked to change position for different X-ray views of the urinary system.

9. If you're having a voiding cystography, the provider will remove the catheter and you'll be asked to urinate. The provider will take X-ray or fluoroscopy films while you urinate. You may be allowed to sit or stand if you're not able to urinate while lying down.

10. If you're not having a voiding cystography, the provider will remove the catheter after all the X-ray views have been taken.

What happens after cystography?

You don't need any special care after a cystography. You may go back to your usual diet and activities, unless your healthcare provider tells you differently.

You should drink additional fluids for a day or so after the test. This will help the contrast dye flush out of your system. This will also help prevent a bladder infection.

You may have mild pain when you urinate. Or you may see a pink color in your urine for a day or two after the test. This is normal.

Call your healthcare provider right away if any of these happen:

• Pain when you urinate gets worse or lasts longer than 2 days

• Fever or chills

• Pain in your belly

• Blood in the urine

• You have less urine than usual

Your provider may give you other instructions, depending on your situation.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure