Cystography

Cystography is a radiologic examination of the urinary bladder in which a radiopaque contrast medium is introduced into the bladder to visualize its shape, walls, and surrounding structures. It is performed using fluoroscopy or computed tomography (CT) to assess bladder anatomy, integrity, and any abnormal communication with the urinary tract.

There are two commonly used forms. Retrograde cystography (often referred to as plain cystography) involves instilling contrast directly into the bladder via a catheter to produce static images and assess bladder contour, wall integrity, and potential leaks. Voiding cystourethrography (VCUG) combines radiographic imaging with the patient’s act of urination to evaluate the urethra during voiding and to detect vesicoureteral reflux. CT cystography involves filling the bladder with contrast and acquiring CT images, offering high-resolution cross-sectional visualization and improving detection of intraperitoneal or extraperitoneal bladder injuries and other pathology.

Indications include suspected bladder rupture after pelvic trauma, evaluation of bladder perforation or fistula, assessment of vesicoureteral reflux in children and adults, detection of bladder tumors or diverticula, and characterization of bladder lesions when standard imaging is inconclusive.

Procedure and interpretation are guided by clinical questions. After sterile catheterization, a measured amount of radiopaque contrast is instilled to fill the bladder to near capacity. Imaging is performed in multiple projections, with VCUG capturing images during urination. Findings such as contrast leakage beyond the bladder wall indicate rupture; reflux of contrast into the ureters or kidneys suggests vesicoureteral reflux; irregular bladder contours or intravesical masses point to tumors or other pathology.

Risks include radiation exposure and potential adverse reactions to contrast material; catheterization carries infection risk. Cystography remains a focused, information-rich technique when detailed bladder visualization is required.