Cystogram: Uses, Side Effects, Procedure, Results

What to expect when undergoing this test

A cystogram is a medical examination that entails obtaining images of your urinary bladder with an X-ray. The examination is mainly used to diagnose bladder issues and is performed by a radiologist with the assistance of an X-ray technician.

what to expect during a cystogram
Illustration by JR Bee, Verywell 

Purpose of Test

A cystogram is most commonly used to diagnose urinary reflux, also known as vesicoureteral reflux or simply reflux. The condition is often characterized by recurring urinary tract infections (UTIs). If you complain about that and your doctor suspects that you may have urinary reflux, he will order a cystogram.

To ensure that your bladder isn’t torn and that there is no structural damage to it, your doctor may also order this test if you report having experienced an injury to your pelvic area. Also, having problems urinating—painful urination, blood in the urine, and frequent urination—may lead your doctor to suspect you have a bladder polyp or tumor and he may have you undergo a cystogram.

Prior to or after some spinal surgeries, your doctor may want to probe for any problems with the nerves connecting the spine to the bladder, and a cystogram may be used to do that.

If you’re asked to urinate and additional x-rays are taken while you empty your bladder, the test is no longer just a cystogram. It's instead referred to as a voiding cystogram.

Limitations

Note that a cystogram cannot be used to diagnose every single problem that involves your bladder. Your doctor will strategically recommend the test based on the symptoms you present and your medical history.

Similar Examinations

A cystogram is very similar to a cystoscopy in terms of the conditions they are used to identify and diagnose. However, they differ procedurally.

With a cystoscopy, an x-ray isn’t used to visualize the bladder. Instead, a thin tube is inserted into your bladder through your urinary opening, and a small camera that’s attached to the tube (a cystoscope) shows the doctor what he needs to see.

What Is a Cystoscopy?

Risks and Contraindications

There is a slight risk of developing a bladder infection after you undergo a cystography, but this is rare. All materials used should be sterile. The catheter that’s inserted into your bladder during the test may also cause bleeding and/or blood in your urine. This is not a cause for alarm—your doctor will explain how long this may last, what's normal in terms of the amount of blood, and what to do if bleeding does occur.

Because this examination involves the use of x-ray, you will be exposed to radiation. Fortunately, the level of radioactivity you will be exposed to is minimal and ideally shouldn’t have any side effects. However, to be on the safe side, if you’ve undergone medical x-rays in the past, you should tell your doctor about it.

How Much Is Too Much Radiation Exposure?

Contraindications

It is not advisable to undergo a cystogram if you’re pregnant, as exposure to radiation during pregnancy can lead to birth defects. You should inform your doctor if there is any possibility at all that you could be pregnant.

People with sensitivities or allergies to medicines and contrast dyes may not be able to undergo this examination either. You should list all your food and drug allergies to your doctor beforehand.

Your full medical history should be available to your doctor. Although unlikely, there may be certain conditions or risk factors you have that would need evaluation and discussion before a cystogram is ordered.

Before the Test

Once your doctor recommends this test, you can expect to discuss your medical background, recent illnesses, and current state of health, including any drugs or supplements you are currently taking. You should divulge any allergies you may have to medicines, iodine, contrast dye, and/or latex to your doctor.

Your doctor will give you clear instructions on how to prepare for the test. Sometimes, but not always, the test requires not eating beforehand and only drinking liquids on the day of the test. It may also involve the use of laxatives or the need to undergo an enema.

You may be asked to sign a consent form either at the doctor’s office or at the site of the examination. You should read the form very carefully and ask questions about parts you are unclear about.

Timing

The actual exam could take up to an hour. Some time is taken before the procedure to allow the radiographer to explain the procedure to you and ask you questions about your state of health and any allergies. If you haven’t already filled out the consent form at your doctor’s office, you should expect to spend some time filling and signing it before the test.

Location

A cystogram normally takes place in the radiology department of a hospital.

What to Wear

You can dress normally, as you’ll be given a hospital dressing gown to change into when it’s time for the test. If you’d prefer, you can bring along your own slippers.

Food and Drink

This depends on the instructions that your doctor has given you. Some doctors may insist that you don’t eat food and only drink liquids during the day of the examination, while others may not suggest that based on your unique case.

Cost and Health Insurance

Depending on your health insurance provider, you may need to submit a pre-authorization request. The hospital staff may be able to handle this for you, but it’s best to confirm with them and your insurance provider, too.

What to Bring

You should bring along a form of personal identification, your health insurance card, as well as your test order form (if you were given one). If you’re paying for the examination completely out of pocket, or are covering some of the costs, you should bring along a form of payment or find out if you can be billed at a later time.

Since a cystogram does not involve any anesthetic or sedative, you don’t have to go with a friend or family member. You will be able to drive yourself home.

During the Test

Pre-Test

The radiographer will explain the entire procedure to you. He should also address any questions or concerns you may have.

You may be required to fill out and sign a consent form giving your permission for the examination to be carried out.

You will be asked to change into the hospital dressing gown, after which you’ll be directed to the restroom to empty out your bladder.

Throughout the Test

In general, here's what you can expect.

  1. You’ll be asked to lay on your back on the x-ray table.
  2. A nurse may wash or clean your genital area.
  3. The radiologist will insert a small catheter into your urethra (your urethra is the opening you urinate from). The catheter may be held in place by using skin tape to secure it to your inner thigh. You may feel some discomfort or unpleasantness when the catheter is being inserted—communicate what you feel with the technician.
  4. The radiologist will fill up your bladder with the contrast agent (x-ray dye) through the catheter. X-ray dye makes it easier for your organs to be visible on x-rays. After this is done, it’s normal for you to strongly feel like you have to pee.
  5. The radiologist will take x-ray pictures. You may be asked to move into different positions to enable the radiologist to get better views of your organs.
  6. The catheter will then be removed, and you’ll be allowed to use the restroom. It’s possible that a final x-ray will be taken when you return from the restroom in order for the radiologist to check if your bladder emptied itself completely or there’s still contrast dye left in it.

    Note that if you’re having a voiding cystogram, when the catheter has been removed, you’ll be asked to empty your bladder while x-ray pictures are taken as you’re urinating. In this case, you may be provided a screen to give you some privacy when you’re urinating. It’s advisable to ask about that if you feel like you’d be embarrassed urinating uncovered in front of people.

    After the Test

    There’s no downtime after this examination and you can return to your regular life immediately afterward.

    You may feel a slight burning sensation when you try to urinate after. This is normal and will resolve itself within 12 to 24 hours. You should drink more water and fluids for the rest of the day to help flush out any remnants of the x-ray dye. This will also help prevent an infection.

    If you notice any bleeding or experience a fever or trouble urinating, you should see your doctor immediately.

    Interpreting Results

    The radiologist who performed the examination will interpret your test results and send a report back to your doctor. The results and accompanying report will help your doctor determine the cause(s) of your urinary tract infections or bladder problems. Your doctor will discuss the results and its implications with you during your next follow-up appointment.

    Follow-Up

    The medical steps your doctor will recommend for you will depend on your results. If you’re diagnosed with urinary reflux, you will likely be prescribed antibiotics to deal with the UTIs and you may have to undergo surgery to fix the defect in the valve that normally should keep urine from flowing back. If you have a tumor or polyp that’s cancerous, you may need to be treated with chemotherapy, radiation and/or surgery.

    A Word From Verywell

    It’s normal to feel anxious about undergoing medical examinations. The sometimes nerve-wracking uncertainty about what the results are going to be is something almost everyone has experienced at some point. Hope for the best, but if you choose to, prepare for the possibility of unfavorable results and be ready to discuss your options extensively with your doctor. If you have close friends or family, it may also be helpful to talk about your fears and worries to them, as sharing could help you cope better.

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