Either high osmolar contrast agent such as diatrizoate or low osmolar contrast agent such as Iotalamic acid with concentration of 150 mg per ml can be used. The urinary bladder is catheterised under aseptic technique. The contrast medium is slowly injected or dripped in slowly. The level of bladder filling is observed by taking intermittent images using fluoroscopy. The early filling of the bladder should be monitored carefully to detect any accidental placement of the catheter in distal ureter or vagina and to detect any reflux of contrast into the ureters. The bladder should be filled up with as much contrast as possible until the subject is unable to tolerate it or when there is no more contrast going into the bladder. If the subject is able to pee himself, then catheter can be removed for the subject to pee. If there is no confidence that the subject is able to pee, then urinary catheter should remain in place. It is more convenient for adults to pee in erect position with a urine receiver. Meanwhile, children can pee while lie down on table with a urine receiver. Infants and smaller children can lie down on table and pee on absorbent pads. For those children or infants with neuropathic bladder, pressure on the suprabic region can help them to pee. Fluoroscopic spot images and videos are taken during micturition phase to detect any reflux. The lower ureter is best seen on anterior oblique position. In males, peeing should be done in oblique or lateral positions to visualise the whole of urethra. Finally, the whole abdomen is imaged to detect any undetected reflux in pervious images. Any urine left in the bladder after peeing is also recorded in this image. Lateral views is useful to evaluate any fistula from the bladder connecting into the rectum or vagina. Oblique views is used to evaluate any leaks from the bladder or urethra. Stress views are useful in urodynamic studies. Verumontanum appears elongated and proximal bulbal urethra has less conical appearance.
Voiding cystourethrography
Urinary tract ultrasound
Retrograde urethrogram
Cystography
Cystometry
Computed tomography urography
Cystoscopy
Urine cytology