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Voiding Cystourethrogram (VCUG / MCUG)

Fluoro+ ContrastPediatricverify

Indications

Vesicoureteral reflux (esp. after febrile UTI in children)
Recurrent urinary tract infections
Posterior urethral valves (boys)
Neurogenic bladder evaluation
Anatomic abnormalities (ureterocele, bladder/urethral diverticula)
Postoperative reflux assessment

Patient prep

No fasting required
Document recent UTI status — defer if active infection (perform when infection treated/clear)
Sterile technique for catheterization; appropriate catheter size for age/weight
Child life / caregiver support for pediatric patients

Contrast

AgentDilute water-soluble iodinated contrast

Routetransurethral via catheter (retrograde bladder filling), then voiding

DoseGravity-fill to age/weight-estimated bladder capacity (children: (age+2) x 30 mL approximation) or until voiding/leak around catheter

TimingFluoroscopic imaging during filling, at capacity, and critically DURING voiding

Technique

Catheterize bladder sterile; fill with dilute contrast by gravity under intermittent fluoroscopy to minimize dose
Obtain images during filling and at capacity to assess bladder contour and any reflux
Capture spot images of any ureteral reflux and grade it (I-V)
Image the urethra DURING voiding — catheter removed or left in per protocol — especially lateral/oblique in boys for posterior urethral valves
Post-void images of bladder and any refluxed upper tracts

Series / Sequences

#	Series / Sequence	Plane	Notes
1	Scout	AP pelvis/abdomen	Baseline
2	Early/partial fill	AP	Ureterocele, early reflux
3	Full bladder	AP + obliques	Capacity, contour, diverticula
4	Voiding urethra	Oblique (boys: steep oblique/lateral)	Posterior urethral valves, stricture, reflux during voiding
5	Reflux documentation	AP	Grade I-V, level of refluxed contrast
6	Post-void	AP	Residual, drainage of refluxed upper tracts

Key points

Minimize fluoroscopy time and use pulsed/last-image-hold — pediatric dose reduction is paramount
Reflux often occurs during voiding — voiding-phase imaging is essential and cannot be skipped
Grade reflux I (ureter only) to V (gross dilation/tortuosity with blunted calyces)
Oblique voiding views in boys are critical for posterior urethral valves
Use water-soluble iodinated contrast only
Avoid during active UTI; contrast-induced cystitis is rare
Contrast-enhanced voiding urosonography (no radiation) is an increasing alternative in children

References

• ACR–SPR Practice Parameter for the Performance of Voiding Cystourethrography in Children
• Establishing a Standard Protocol for the Voiding Cystourethrography — PubMed 27940792
• Radiopaedia: Micturating cystourethrogram (MCUG/VCUG)

Source: Researched — verify against your institution

‹ PreviousXR Bone Age (Pediatric Left Hand and Wrist)Next ›CT Chest / Abdomen / Pelvis (Oncologic Staging)

Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.