X-ray of the bladder: how to prepare and what complications there may be. Survey radiography of the urinary system

X-ray Bladder– variety contrast study. The study allows you to detect changes in shape and pathological formations (X-ray “minus-shadow” syndrome). Possesses high degree reliability. Used in urology and surgery.

An alternative replacement for this X-ray diagnosis can only be magnetic resonance angiography. These research methods have different purposes and purposes, so they should not be compared.

What does a contrast x-ray of the urinary system show?

Contrast X-ray urinary system shows the following diseases:

• stones;
• foreign bodies;
• tumors;
• diverticula;
• chronic cystitis;
• pathological narrowing;
• fistulas (artificial passages between organs);
• Vesicoureteral reflux.

Contrast radiography of the bladder is performed to evaluate the causes of urinary incontinence. It allows you to analyze the excretory function of the kidneys. 24 minutes after contrast administration, physiologically at normal operation of the renal excretory system in the projection of the pelvis and calyces, only remnants of iodide radiopaque urografin can be traced. If a lot of the substance is retained, slow urine excretion can be suspected.

Should a child be afraid of cystography with contrast?

Cystography is prescribed for children starting from the 5th month. Some parents are afraid of the procedure, as it involves radiation and contrast injection.

Cystography is prescribed to identify serious pathology, and therefore is necessary if recommended by a doctor.

In order not to be afraid, we describe to parents the stages of the procedure:

1. A urinary catheter (contrast tube) is inserted through the urethra.
2. A contrast agent is given before and after urination.
3. If x-rays are performed on small children, anesthesia is administered.
4. Preparation requires fasting and stopping drinking liquids 3 hours before the examination.
5. The duration of cystography is 10 minutes.
6. After 20 minutes, the child can be given food and drink (when he wakes up from anesthesia).

Doctors observe the baby for 2 hours after the X-ray. During this time, the bladder should be emptied and the urinary contrast material should be removed.

At home, the child should be given furagin to drink to prevent inflammation.

Obviously there is nothing to be afraid of, as side effects are rare.

How to do an x-ray of the urinary system

X-ray of the urinary system and bladder may be:

• ascending;
• descending.

An ascending x-ray is taken after contrast genitourinary tract. For these purposes, 150-200 ml of the substance is sufficient. The patient is advised to bend his knees and hip joints.

The vertical direction of the central beam during exposure allows clear visualization of the bladder. To prevent shadows of the pubic bones from superimposing, it is necessary to conduct research in three intersecting planes: right and left oblique, axial.

Ascending is carried out using urinary catheter(as in the example above).

Descending urography is carried out simultaneously with excretory urography 30 minutes - 1 hour after the contrast enters the bloodstream. By this time, the substance densely fills the bladder and provides clear visualization of the contours of the organ.

Descending research is used when, for certain reasons, a catheter must be inserted into the bladder, showing the structure of the urethra, bladder, location prostate gland.

What does the bladder look like on a photo?

In the image, a normal bladder is characterized by the following indicators:

• pyramidal or oblong shape;
• oval or rounded contours.

What does the genitourinary system look like on x-ray in women, men and children:

1. In women, the bladder shape is oval. Its transverse size is larger than its longitudinal one. The cystogram visualizes the concavity of the outer contour.
2. In children, the organ is pear-shaped. It faces with its narrowed part towards pubic bones. Physiologically, the shadow of the bladder is located at the level of the pubic symphysis.

Cystography with liquid contrast clearly shows pelvic tumors (adenoma, stones, diverticula). On the axial radiograph in men, it can be seen triangular shape organ. In this case, the bag-like protrusions look like areas of clearing against the background of an intense metallic shadow.

Fibroids and an increase in the size of the uterus take on a saddle shape when contrasted. Depending on the position of the uterus, the compression may be located in the middle part of the bladder.

Asymmetrical deformation causes the most bizarre shapes, which the radiologist classifies as a sign pathological changes.

Cystocele is a pathological displacement of the bladder in which the lower contour is located below the pubic symphysis. X-rays for this disease are valuable before planning surgery.

Contraindications to x-ray diagnostics of the urinary tract

Contraindications to x-ray diagnostics of the urinary tract are:

1. Acute inflammatory processes of the urethra.
2. Diseases of the seminal vesicles and prostate gland.

The conditions described above are not contraindicated for ascending cystography.

In conclusion, I would like to note that radiography of the urinary tract of a child is performed in case of emergency, since it has a radiation load on the pelvic organs. Cystography for adults is carried out on the basis of research.

X-ray studies of the urinary system remain the highest quality and most promising. Over the long period of existence of this diagnostic method, one can note its gradual development.

There are several ways to conduct a bladder examination. One of them is ultrasound (ultrasound examination). This procedure is quite safe.

Ultrasound of the bladder

How is an ultrasound of the bladder performed?

Ultrasound examination of the bladder helps to assess the volume of the bladder, urinary retention in a patient for one reason or another, the volume of residual urine in patients who have decreased urine production for any reason. Bladder ultrasound can also be used to identify and evaluate the structure of the bladder.

Ultrasound examination of the bladder is also used to evaluate bladder function for incontinence and urinary tract retention.

How does the process of examining the bladder occur? Uses special ultrasound scanner, which is powered by a battery. It consists of a portable unit and an attached ultrasound. During examination of the patient's abdomen, a special sensor, which is ultrasonic, transmits sound waves. These, in turn, are displayed on the transducer. Data on the condition of the bladder during the study are transferred to a computer. Bladder volume is calculated automatically. The procedure lasts about two minutes. It eliminates the complications associated with catheterization. It should also be said that this procedure is non-invasive.

It is very important that ultrasound examination of the bladder does not have any complications.

After the process is completed, you need to unhook the sensors and wipe the gel off the skin.

Bladder examination

The diagnosis of a disease such as cystitis is made based on a doctor’s examination and laboratory data.

What about laboratory data? Firstly, this general analysis urine, in which the doctor can detect the presence of pus. Next laboratory test point genitourinary system- This is urine culture. This analysis helps to find out the nature of the pathogen that caused the inflammation. It is also necessary to take a general blood test in order to find out the severity of inflammation in the body.

Sometimes it is necessary to do an immunogram in order to identify immune disorders. However, most often the examination of the bladder is carried out by cystoscopy. This examination allows you to examine the bladder from the inside, as well as determine the to a large extent probability of the nature of the disease and its prevalence.

Ultrasound of the bladder - preparation for the study

One of the most informative methods research and diagnosis of diseases is ultrasound of the bladder. His preparation is minimal. In addition, this method is absolutely painless and safe. Ultrasound can be performed even on the youngest patients. This is why ultrasound has become so widespread and is used in a wide variety of areas of medicine. For ultrasound of some organs, no special preparation is required, for others there are special rules. So, if the doctor has prescribed an ultrasound for you, preparation is simply necessary. If you ignore it, the study will be uninformative and the results will be unreliable. Since ultrasound is used to diagnose whole line diseases, it is better to spend time preparing for the procedure.

So, ultrasound of the bladder is prescribed for bladder injuries, tumors and cystic formations, suspected bladder disease, stones, blood in the urine, bladder outlet obstruction, to study the urodynamics of the upper urinary tract. In addition, ultrasound of the bladder is performed to monitor the treatment process, for research and during a preventive medical examination.

What do you need to know if you are going to do this research? Remember that before an ultrasound of the bladder, preparation is as follows:

What time of day should I go for an ultrasound of the bladder? If you have the opportunity to choose the time for the procedure, it is better to stop at morning hours. In this case, the study is carried out on an empty stomach. If an ultrasound of the bladder is to be performed in the second half, then a light breakfast is acceptable, but no later than 6 hours before the procedure.

What foods should not be consumed before undergoing a bladder ultrasound? A couple of days before the upcoming test, eliminate foods from your diet that can cause increased gas formation in the intestines. This is whole milk, legumes, raw vegetables and fruits, carbonated drinks, black bread, grapes, mayonnaise, high-calorie confectionery.

What to do if you have increased gas formation? When increased gas formation– a few days before the examination, you need to start taking enterosorbents (espumisan, Activated carbon).

What should you tell your doctor before performing an ultrasound of the bladder? If two days before the ultrasound of the bladder you had a colonoscopy or fibrogastroscopy, tell your doctor about this, in which case the ultrasound examination must be rescheduled. After an X-ray of the stomach or intestines using contrast, it is necessary to pause for 3-4 days.

How much fluid do you need to drink for a bladder ultrasound? An ultrasound is performed with a full bladder; you need to drink about a liter of liquid an hour before the examination.

X-ray of the bladder

How is a bladder x-ray performed?

X-rays are performed in hospitals or clinics to diagnose diseases related to the urinary system.

There are two types of bladder x-ray:

• urethrography;
• cystography.

With urethrography, it is possible to diagnose diseases associated with the urethra. In this type of x-ray examination of the bladder, a specialist can see urethral injuries, sand in the canals, foreign bodies and formations.

Cystography is used to diagnose diseases associated with the prostate gland and directly with bladder. This study gives a complete picture of the described organs; with an x-ray examination, tumors, stones and sand, foreign bodies and chronic cystitis can be seen. Cystography is used to treat urinary incontinence problems.

These tests can be done while you are at rest or while you are urinating. An x-ray examination of the bladder is carried out in a special x-ray room, with the patient lying on a couch. The entire study is carried out under the supervision of a urologist, who comments on the condition of the organs being examined. For full picture During the examination, a contrast agent is injected into the urethra, and an X-ray is taken at the doctor’s command.

Features of a bladder x-ray

The examination is not very painful and most often takes place without much suffering for the patient. But if the patient is too sensitive to pain, a bladder examination is performed under local anesthesia. Special preparation is required from the patient before the study. Before starting an x-ray examination, the patient must observe for several days special diet. The diet should contain a minimum of carbohydrates. Before the x-ray of the bladder itself, the patient must have a complete bowel movement. The day before an x-ray examination of the bladder, an enema is done, and this procedure is repeated in the morning before the x-ray. Depending on the state of the intestines, the urologist may prescribe charcoal or a laxative, which must be taken several days before the examination.

For a more accurate diagnosis of the disease, an x-ray examination of the bladder is performed together with ultrasound examination or computed tomography. All these studies are carried out, both comprehensively and independently, to obtain reliable information about the patient’s disease.

Radiation examination methods are used in urology to identify problems with the urinary system. They give a clear picture of the condition of the bladder and urethra. These methods include x-rays of the bladder - cystography and urethra - urethrography using a contrast agent.

What are the types of radiation methods for urological examination, and in what cases are they prescribed?

Both bladder cystography and urethrography are types of x-ray examinations. In this case, urethrography is an examination of the urethra, and cystography is an examination of the bladder.

There are ascending and descending urethrography.

Ascending examination is performed on men.

The patient is placed in horizontal position and a radiopaque liquid is injected into the urethra. At the moment of maximum filling of the urethra, the penis is raised and a picture is taken. Carrying out such an examination for women is very problematic (due to the peculiarities of the anatomy).

Descending (mictional) urethrography is often combined with cystography.

Inserted into the urethra a large number of contrast fluid (so that the bladder is also full). The patient is then asked to urinate and a picture is taken of the bowel movement.

Other types of urological X-ray examinations:

• Urography (kidney examination);
• Retrograde ureteropyelography (ureters are examined);
• Pyelography (examination of the kidney cavities);
• Pneumorenus (assessment of the external contours of the kidneys and adrenal glands).

The purpose of all of the above procedures is to obtain a clear image of the necessary part of the genitourinary system using contrast material. X-ray images will help in diagnosing various diseases and selecting the optimal treatment method.

Urethrography in men is usually performed to identify the causes of decreased urine flow, benign tumors prostate gland, strictures, .

Cystography is performed on both men and women to detect stones in the bladder and identify the causes of hematuria. Also X-ray examinations carried out if there is a suspicion of a rupture of the bladder wall.

Preparation for the procedure and procedure for urethro-cystography

Cystography and urethrography are often performed simultaneously, since the procedure is almost identical. Comprehensive examination bladder and urethra is called urethrocystography.

Recommendations for preparing for the study depend on the suspected disease. If the purpose of the procedure is discovered, then the patient must refuse to eat or drink heavily for at least 8 to 12 hours. In other cases you can live everyday life, adhering to your normal diet.

To stretch the bladder, the patient is given approximately 400-500 ml to drink an hour before the procedure. ordinary clean water. It is forbidden to urinate during this hour.

The examination is carried out in an X-ray room. The patient is put on a robe without metal fasteners, the piercings are removed from the genital area and navel, and then a catheter is inserted into the urethra.

Adult women and men are examined without anesthesia, and during the procedure a child may be given local anesthesia. A contrast agent (usually a liquid that darkens in color) is injected through the catheter. x-ray, but sometimes special gas is used).

Depending on the type of procedure, the picture is taken at the moment of maximum filling of the bladder (if retrograde cystography is prescribed), or during urination (if descending urethrography is necessary). At the end of the examination, the therapist will lubricate the urethral opening with a soothing gel with an antibacterial effect.

Contraindications for procedures

Before taking an X-ray of the patient’s bladder, the urologist will definitely examine medical card for serious health problems. In particular, the procedure will have to be postponed if:

• Radiotherapy was recently performed;
• Acute renal failure was diagnosed;
• There is a suspicion of the presence of acute inflammatory processes in the genitourinary system;
• Urethrorrhagia was detected.

Also, urethrocystography is postponed if a woman is carrying a child. The procedure can be performed in the first trimester of pregnancy, but only if the potential benefits of the examination significantly outweigh the risk of harm to the fetus.

What side effects may occur during urethrocystography?

One of the most common side effects of urethrocystography is an allergy to the contrast agent. To determine how the body reacts, the radiologist may administer a small amount of gadolinium beforehand.

Damage to the urethra may also occur. Most often, male patients are susceptible to such complications (especially if the procedure is performed on an emergency basis). Attempting to insert a catheter into an already wound can lead to stretching of the wound.

Infection may occur if a non-sterile catheter is used urinary tract. After the procedure is carried out in violation of the rules of asepsis, minor discomfort in the urethra usually occurs. Then it will develop strong burning sensation when urinating. If unpleasant symptoms does not go away within 24 hours, the doctor will prescribe antibiotics.

Other side effects that usually go away within 24 hours without further intervention medical personnel, include:

• Increased urge to urinate;
• Slight increase in temperature (up to 37º);
• Chills;
• Trembling in the lower extremities;
• Discharge of blood from the urethra.

The above complications usually do not pose any threat, but if the temperature rises above 38°, you need to see a doctor again.

Cystourethrography is performed quite often, so there is no need to worry before the procedure. Information about side effects you need to know in order to independently recognize a deterioration in your health and promptly seek help.

Survey radiography of the urinary system is the first step in the examination of urological patients. It allows you to assess the location of the kidneys, ureters (only in the case of calcification of their walls) and bladder, as well as identify space-occupying formations.

The results of the study do not depend on kidney function. Plain radiography makes it easier differential diagnosis urological diseases and diseases gastrointestinal tract, which often have a similar clinical picture. However, this method has a number of limitations and, as a rule, must be accompanied by more informative research, such as excretory urography and CT scan of the kidneys. You should not perform plain radiography of the urinary system after contrasting the intestines with barium.

Target

• Assess the size, shape and location of the kidneys.
• Identify nephrolithiasis.

Preparation

• It should be explained to the patient that the study makes it possible to diagnose certain diseases of the urinary system.
• You should not restrict food or fluid intake before having a plain x-ray. The patient is informed who will perform the test and where, and that it will take no more than a few minutes.

Procedure and aftercare

• The patient is placed supine on the X-ray table. He should lie flat with his hands behind his head. To assess the correctness (symmetry) of placement, they are guided by the position of the iliac crests.
• If the patient cannot extend his arms above his head or maintain this position, he is placed on his left side with his right arm extended upward.
• A single x-ray is taken.

Precautionary measures

To avoid irradiation of the testicles, the external genitalia in men are covered with a protective shield. In women, protection of the ovaries is impossible due to their close location to the organs of the urinary system.

Normal picture

In a survey image of the organs of the urinary system, the shadows of the kidneys are identified on both sides of the spine. Right kidney usually located slightly below the left. The sizes of both kidneys are approximately the same, the upper poles are inclined towards spinal column(thus, the longitudinal axes of the kidneys are located parallel to the edges of the vertebral muscles). The ureters are visible only when their walls are calcified. The ability to visualize the bladder depends on the density of its walls and the amount of urine. As a rule, the shadow of the bladder is visible on plain radiographs, but not as clearly as the shadow of the kidneys.

Deviation from the norm

An increase in the size of both kidneys occurs in polycystic disease, multiple myeloma, lymphomas, amyloidosis, diabetes mellitus, hydronephrosis. A tumor, cyst, or hydronephrosis can cause an increase in the size of the kidney. A decrease in the size of both kidneys is characteristic of the final stage of glomerulonephritis or chronic bilateral pyelonephritis. A significant decrease in the size of only one kidney may be a consequence of congenital hypoplasia and wrinkling (with chronic pyelonephritis or ischemia). Displacement of the kidneys is observed with tumors of the retroperitoneal space (for example, tumors of the adrenal glands). Focal weakening or strengthening of the shadow of the psoas muscle occurs with a tumor and abscess of the kidney, hematoma of the retroperitoneal space. Plain radiography reveals congenital anomalies position or absence of one of the kidneys. The presence of a horseshoe kidney should be assumed if the longitudinal axes of the kidneys are located parallel to the axis of the spine, and the lower poles are not clearly defined. Lobulation (unevenness) of the contours is characteristic of polycystic disease and wrinkling of the kidney (with pyelonephritis).

Stones, calcified walls of aneurysmally dilated vessels and atherosclerotic plaques can be visualized on a survey image in the form of radiopaque shadows. In addition, the appearance of shadows may be due to a tumor of the bladder, fecal stones and foreign bodies abdominal cavity or retroperitoneal space. Radiopaque shadows can be detected in any part of the urinary system, but their detection requires additional research. The only exception is coral stones, which are a clear cast of the pyelocaliceal system.

Factors influencing the result of the study

• Presence of gas, stool, contrast agent, or foreign bodies in the intestines (poor image quality).
• The presence of calcified fibromatous nodes of the uterus or space-occupying formations of the ovaries.
• Obesity or ascites (poor image quality).

B.H. Titova

"General radiography of the urinary system" and others

Unfortunately, urological pathologies meet very often. Diseases of the genitourinary system are common not only in adults, but also among children. To start treatment on time and prevent chronic course pathology, it is necessary to carry out a diagnosis. Identification of ailments is carried out using various instrumental and laboratory research. One of them is cystography. This is an unpleasant procedure, but in some cases it is considered necessary. Therefore, when appointing this study Parents are interested in: why is cystography performed on children, how is it done, what is needed for preparation? You should consult your doctor on these issues.

What is cystography?

Any doctor can answer the question of how cystography is done in children; however, to clarify all the nuances, it is better to contact a urologist or a specialist. First of all, you should know that this examination method is used to visualize the bladder. Cystography in children is diagnostic procedure carried out using an x-ray machine. Before taking a picture of the genitourinary system, it is necessary to inject a contrast agent. This research method is carried out in case of suspicion of various urological diseases. It is also necessary before surgical interventions. The organs that are visualized during cystography are the renal collecting system. This procedure is performed different ways, therefore, before preparing for it, it is necessary to clarify how cystography is done in children in a particular case. You should also be aware that there are contraindications for this study.

Cystography in children: how it’s done, photos of x-rays

Before performing cystography in urinary tract a contrast agent must be injected. Therefore, this procedure is painful. This is especially true for children. For this reason, the child needs to be mentally prepared for the study. It is important to explain how cystography is done for children: boys and girls. This is important, because the structure of the urethra in men and women has significant differences. You also need to tell your child why cystography is done and how important it is. If you prepare your baby correctly, the examination will not scare him. To learn more about this diagnostic method, you can see photos of X-ray images in this article. This will help you understand what changes are visualized due to the examination.

Cystography options

Depending on the method of administration of the contrast agent, there are 2 types of cystography. Among them:

1. Descending. It is performed by injecting dye into a vein. After some time, the contrast agent fills the bladder and an X-ray can be taken.
2. Ascending cystography. Contrast is injected into the urethra - urethra. In this way, organs can be visualized faster. This method is used more often because it is more convenient. However, there are contraindications to this study. IN similar cases Descending cystography is performed.

Since the diagnostic method involves inserting a catheter into the urethra, the procedure delivers discomfort. Also, during an X-ray examination, the device may emit loud sounds, which usually scares kids. Parents and children should be warned about this. Another option for the procedure is voiding cystography, which is performed at the time of urination. This method allows you to diagnose a wider range of urological pathologies.

What are the indications for cystography?

In addition to explaining how cystography is done in children, parents should also be made aware of why this unpleasant examination is needed. The following indications exist for this diagnostic method:

1. Suspicion of a bladder tumor.
2. Birth defects.
3. Stones or sand in the ureters.
4. Enuresis.
5. Tuberculosis of the genitourinary organs.
6. Reflux. This condition occurs when urine backflows into the kidneys. This is dangerous syndrome, as it leads to chronic pathologies.
7. Suspicion of complications arising from infectious diseases.

The symptoms of all these pathologies are similar, so it is impossible to diagnose a particular disease only by clinical picture. Reasons for examination may be following complaints: pain, urinary incontinence, frequent urge.

In what cases is cystography contraindicated?

Before the procedure, the doctor prescribes many laboratory tests. They are needed to find out whether there are contraindications to performing cystography. You should know that this diagnostic method cannot be carried out with inflammatory processes urinary organs. These include: cystitis, urethritis, pyelonephritis. All these diseases can be identified through general and special urine tests. In some cases, an ultrasound is required before performing cystography. It helps determine whether the bladder and kidneys are inflamed. All of the listed pathologies serve as contraindications for ascending cystography, since this method involves the insertion of a catheter. In case of inflammation, the instrument will only strengthen painful sensations, and may also aggravate infectious process. In these cases, the study should be postponed until the child recovers. In cases where cystography is urgently needed, it is performed in a descending manner. Allergy to contrast agents is also a contraindication. Does the child have increased reactivity? immune system, you should definitely find out before prescribing such diagnostic methods.

Preparing a child for research

After explaining how ureteral cystography is done in children, it is necessary to tell parents in detail about preparing for it. Because X-ray examination It is not advisable to carry out several times in a row; you should follow the doctor’s instructions in advance. Preparation for cystography includes bowel cleansing. For this purpose, the baby is prescribed a diet 2 days before the study. Carbonated drinks and cabbage should be excluded from the child’s diet. To remove excess gases, your baby can drink a few tablespoons of dill seed decoction. Cleansing enema should be done in the morning, immediately before cystography. In addition, when preparing children who have a tendency to allergic reactions, it is necessary to perform contrast tolerance tests.

Technique of the procedure

In order for the results to be reliable, it is necessary to follow the technique of performing cystography. This procedure includes the following steps:

1. Giving the child an even position on the X-ray machine. The first image is taken before the contrast agent is administered. The child should not move during the examination.
2. Introduction of contrast. The amount of dye depends on the age of the patient. If it's a child younger age, then he needs to administer from 50 to 100 ml. Children over 12 years of age are given the same dose as adult patients. It is 200-300 ml. The substances “Urografin” and “Iodamide” are used as a contrast.
3. Insertion of a catheter into the urethra.
4. Repeated x-ray examination in frontal and lateral projections.
5. Monitoring the child’s condition after the procedure.

Cystography is performed only in cases of special need. It's not just about pain similar method diagnostics, but also harmful effects x-rays on the baby's body. Nevertheless, there are cases when cystography cannot be avoided. These include suspicion of congenital anomalies of the genitourinary system, fistula tracts. In these conditions it is required surgery in young years.

What can be seen in the pictures: transcript

After receiving information about how cystography is done in children, the patient’s parents begin to be interested in the question: what can be seen in the pictures. The interpretation of the results is as follows:

1. Assessment of the size, shape and location of the organs of the urinary system. All this is visualized in the original (first) image.
2. Definition pathological formations or reflux.

Thanks to this method diagnostics, it is possible to see and compare them with each other. Also, X-ray images visualize the backflow of urine into the pyelocaliceal system of the kidney - reflux. If there are fistulas, the contrast agent comes out through an opening that should not normally be there. Stones or tumors in the bladder are visualized after the bladder is full. If any formations are present, pneumocystography is required (gas injection into the organ cavity). If they have stones in the ureters, the contrast agent cannot pass through them. Thanks to the changes visualized in the images, one can judge the presence of various pathologies.

Cystography in children. How it’s done: patient reviews

Despite the benefits of cystography, parental feedback is not always positive. This is due to the pain of the procedure. Nevertheless, when the disease is identified and timely assistance is provided, patients are satisfied. Indeed, despite the unpleasant sensations, the result of this study is necessary for making a diagnosis.