Next Procedure - VCUG

The results of my son's (AJ) spinal MRI were normal - meaning no tethered cord.  The urologist still has concerns (considering reflux or a blockage) and has ordered a VCUG.  Unfortunately, the blood work he had done (CMP, TSH, ANA, CBC, C1 Estrase, C4, Serum IGE and Sed Rate) wasn't gathered correctly so that will have to be redone. In addition, the Allergist / Immunologist that we were seeing came to the conclusion that his symptoms (facial & foot swelling, rash - flat / non-itchy and joint pain / swelling) was no longer an issue he could help with and referred us to a Rheumatologist and Dermatologist.  At this point, doctors don't seem to think AJ's urinary concerns (enuresis, duplex kidney, hydronephrosis and bladder wall thickening) and his body rash, facial & foot swelling / joint pain are related.

Courtesy of  http://www.chp.edu/CHP/Voiding+Cystourethrogram, here is some information about a Pediatric VCUG:

Fast Facts About VCUG

• The VCUG is a video X-ray of the bladder and urinary tract.
• Your child may eat and drink as usual before the test.
• Your child will be awake at all times.
• The test takes about 30 minutes.
• He or she can resume normal activities afterward.

What Is A Voiding Cystourethrogram (VCUG)?

A voiding cystourethrogram (sis-toe-you-ree-throw-gram), or VCUG, is a video X-ray of the bladder and urinary tract at work. The bladder stores urine made by the kidneys until it is time for your child to go to the bathroom.  

• To begin the test, your child’s bladder will be filled with a special liquid that will be visible on an X-ray.  
• A VCUG shows doctors how well the bladder and urinary tract are working. This includes the tubes (ureters) that connect the kidneys to the bladder and the urethra, which is the tube connecting the bladder to the outside of the body.
• A VCUG gives doctors detailed information about your child’s bladder and urinary tract that they cannot learn from a physical examination or other kinds of tests. 

Home Preparation

• No special preparation is needed.  
• Eat and drink as usual.

The Test 

A VCUG is (usually) done at (a) Children’s Hospital. In the room will be a pediatric radiology doctor, an X-ray technologist and, sometimes, a nurse. You will see an X-ray machine, a long table and a television screen. You might explain to your child that the X-ray is a large camera for taking pictures that will be shown on the screen.

• Your child is awake during this test.
• The test takes about 30 minutes. 
• Your child will be asked to remove his or her clothing, put on a hospital gown and lie on the table on top of a soft white pad. What happens next depends on whether your child is a girl or boy. 

For Boys

A boy will be asked to lie on the table. The doctor or X-ray technologist will wash the tip of his penis around the opening where the urine comes out, using a cotton swab and liquid soap. This may feel cold.

• The X-ray technologist will then slide a tiny, soft tube, called a catheter, into the opening of the penis. This can be a bit unpleasant, and he may need comforting.
• The X-ray technologist will dim the lights in the room so that the television screen can be seen.
• The doctor will then begin to take X-rays, moving the X-ray machine over your child, but not touching him. The X-ray machine will make a clicking noise as it takes pictures.
• X-rays will be taken as the liquid flows through the catheter and into the child’s bladder. When the bladder is full, he will be asked to urinate into a special bottle. This will make the catheter fall out.
• More X-rays will be taken while he is emptying his bladder.

For Girls

A girl will be asked to lie on the table holding her legs in a “frog position,” bending her knees and putting the bottoms of her feet together. Using a cotton swab and a liquid soap, the doctor or X-ray technologist will wash between her legs to clean the skin. This may feel cold.  

• The X-ray technologist will then slide a tiny, soft tube, called a catheter, into the opening where the urine leaves her body. This can be a bit unpleasant, and she may need comforting.  
• The X-ray technologist will dim the lights in the room so that the television screen can be seen.  
• The doctor will then begin to take X-rays, moving the X-ray machine over your child, but not touching her. The X-ray machine will make a clicking noise as it takes pictures.
• X-rays will be taken as the liquid flows through the catheter and into your child’s bladder. When the bladder is full, she will be asked to urinate on a pad or in a bedpan. This will make the catheter fall out.
• The X-ray technologist will ask her to push out all of the liquid while more X-rays are taken. She may feel awkward, but it is an important part of the test.

After the Test

When the doctor and X-ray technologist have taken all the X-rays they need, they will check to make sure the pictures are clear, which takes only a few minutes. Before leaving, you will be given contact information for questions and you will be told about follow-up care.

• After a VCUG, your child might feel a little sore the next few times he or she has to urinate. Drinking more liquids may help relieve the soreness more quickly.
• A report of your child’s VCUG will be sent to the doctor who prescribed it, usually within 48 hours. If the results are urgent, the referring doctor will be contacted immediately.  
• Please contact the doctor who prescribed the VCUG for the results.