Retrograde cystography

You will lie on a table. A numbing medicine is applied to the opening to your urethra. A flexible tube (catheter) is inserted through your urethra into the bladder. Contrast dye flows through the tube until your bladder is full or you tell the technician that your bladder feels full.

When the bladder is full, you are placed in different positions so that x-rays can be taken. A final x-ray is taken once the catheter is removed and you have emptied your bladder. This reveals how well your bladder empties.

The test takes about 30 to 60 minutes.

You must sign an informed consent form. You must empty your bladder before the test. You will be asked questions to determine if you may have an allergic reaction to the contrast dye, or if you have a current infection that could make inserting the catheter difficult.

You may feel some pressure when the catheter is inserted. You will feel an urge to urinate when the contrast dye enters the bladder. The person performing the test will stop the flow when the pressure becomes uncomfortable. The urge to urinate will continue throughout the test.

After the test, the area where the catheter was placed may feel sore when you urinate.

You may need this test to examine your bladder for problems such as holes or tears, or to find out why you have repeated bladder infections. It is also used to look for problems such as:

• Abnormal connections between bladder tissue and a nearby structure (bladder fistulae)
• Bladder stones
• Pouch-like sacs called diverticula on the walls of the bladder or urethra
• Tumor of the bladder
• Urinary tract infection
• Vesicoureteric reflux (urine flowing backward from the bladder to the ureter)

The bladder appears normal.

Abnormal results may be due to:

• Bladder stones
• Blood clots
• Diverticula
• Infection or inflammation
• Lesions
• Vesicoureteric reflux

There is some risk for infection from the catheter. Symptoms may include:

• Burning during urination (after the first day)
• Chills
• Decreased blood pressure (hypotension)
• Fever
• Increased heart rate
• Increased breathing rate

The amount of radiation exposure is similar to that of other x-rays. As with any radiation exposure, nursing or pregnant women should only have this test if it is determined that the benefits outweigh the risks.

In males, testicles are shielded from the x-rays.

This test is not performed very often. It is most often done along with CT scan imaging for better resolution. Voiding cystourethrogram (VCUG) or cystoscopy is used more often.

Cystography - retrograde; Cystogram

Bishoff JT, Rastinehad AR. Urinary tract imaging: basic principles of CT, MRI, and plain film imaging. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 3.

Davis JE, Silverman MA. Urologic procedures. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 55.

Zagoria RJ, Dyer R, Brady C. An introduction to radiologic methods. In: Zagoria RJ, Dyer R, Brady C, eds. Genitourinary Imaging: The Requisites. 3rd ed. Philadelphia, PA: Elsevier; 2016:chap 1.

Updated by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.