Children’s (Paediatric) Micturating Cysto-urethrogram

Author: Dr Timothy Cain*

What are the prerequisites for having a micturating cysto-urethrogram done?

MCUs are performed in children with abnormal renal ultrasound studies suspicious of vesico-ureteric reflux or with recurrent proven urinary tract infections (UTIs). Children over twelve months of age without abnormal ultrasound findings are generally not investigated by MCU unless they have been reviewed by an urologist. There remains some controversy about the role of imaging in the investigation of children with UTIs but ultrasound findings usually determine the need for additional investigations or intervention.

Radiologists require a clearly written (legible) request with sufficient clinical information to ensure that the most appropriate examination is performed. Not only does this enable the correct study to be performed, it also enables provision of a meaningful report.

What are the absolute contraindications for a micturating cysto-urethrogram?

Active UTI is a contraindication for MCU. Meatal stenosis in boys or vulval adhesions in girls are a contraindication as the catheter cannot be safely inserted into the urethra or the bladder when these conditions are present. These conditions are also often associated with recurrent UTIs and should be treated before vesico-ureteric reflux is considered.

What are the relative contraindications for a micturating cysto-urethrogram?

A normal well performed renal ultrasound study is usually sufficient to exclude significant vesico-ureteric reflux in a child with a urinary tract infection. Low grade reflux is no longer routinely surgically treated. Toilet trained children may have an indirect nuclear medicine cystogram study as an alternative but this requires an intravenous injection, so should be reserved for children with good indications for further investigation.

What are the adverse effects of a micturating cysto-urethrogram?

Some children (and parents) find the procedure uncomfortable, particularly if the child becomes distressed with a full bladder and is unwilling or unable to void. There is a small risk of urinary tract infection that is a consequence of bladder catheterisation. Very small children usually cope with the test very well.

Are there alternative imaging tests, interventions or surgical procedures to a micturating cysto-urethrogram?

Older children requiring investigation of recurrent urinary tract infections may benefit from a nuclear medicine renal scan with indirect or direct isotope cystogram study. These are often less traumatic and the indirect cystogram study does not require bladder catheterisation. An MCU only needs to be performed if the renal ultrasound is abnormal or the patient has significant symptoms that warrant investigation by a urologist.

*The author has no conflict of interest with this topic.

Page last modified on 26/7/2017.

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