RadteraCystogram (Conventional / CT Cystogram concept — Fluoro retrograde)
Fluoro+ ContrastAbdomen & Pelvisverify
Indications
- Suspected bladder rupture/trauma (intraperitoneal vs extraperitoneal)
- Postoperative bladder leak evaluation
- Vesicovaginal / vesicoenteric fistula
- Bladder diverticula
- Evaluation of bladder integrity before catheter removal
Patient prep
- Aseptic placement of urethral (Foley) catheter
- Confirm no active urethral injury before retrograde filling (if urethral injury suspected, do RUG first)
- Empty bladder before filling
Contrast
AgentDilute water-soluble iodinated contrast (e.g., diluted iodinated agent); no barium (peritoneal contamination risk)
Routetransurethral (retrograde) via catheter; suprapubic tube if present
DoseGravity instillation to bladder capacity (commonly ~300-400 mL in adults, until capacity/contraction)
TimingFluoroscopic/spot imaging during filling, at capacity, and after drainage
Technique
- Place catheter; instill dilute contrast by gravity under fluoroscopy
- Fill to adequate distention/capacity to detect subtle leaks
- Obtain scout, partial-fill, full-distention AP and oblique images
- Critically obtain a POST-DRAINAGE film — extraperitoneal leaks may only be seen after drainage
- Note pattern of any extravasation
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Scout / pre-contrast | AP pelvis | Baseline, pelvic fractures |
| 2 | Partial fill | AP | Early leak detection |
| 3 | Full distention | AP + obliques | Bladder contour, diverticula, fistula, leaks |
| 4 | Post-drainage | AP | Essential — extraperitoneal leak detection |
Key points
- Adequate distention is essential — under-filling misses leaks; always obtain a post-drainage image
- Extraperitoneal rupture: flame-shaped extravasation around bladder base/pelvis; usually managed conservatively with catheter
- Intraperitoneal rupture: contrast outlines bowel loops/paracolic gutters; usually requires surgery
- Never use barium — only water-soluble iodinated contrast
- If concurrent urethral injury suspected, perform retrograde urethrogram first
- CT cystogram is the modern trauma standard (retrograde-filled) but fluoro cystogram remains common for fistula/leak
References
• Radiopaedia: CT cystography / conventional cystography
• ACR–AUA practice guidance on bladder trauma imaging
• ACR Appropriateness Criteria: Urinary Tract Trauma
• ACR–AUA practice guidance on bladder trauma imaging
• ACR Appropriateness Criteria: Urinary Tract Trauma
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.