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X-ray of the bladder for adults and children

, medical expert
Last reviewed: 17.10.2021
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Bladder X-rays are one of the most common medical procedures. However, it requires prior preparation. Has its own indications and contraindications for conducting.

As a rule, any X-ray examination of the organs of the urinary system begins with a plain X-ray. In this case, the kidneys and upper urinary tract are subject to research. You will need to prepare in advance for the procedure. In particular, in the evening, on the eve of the study, it is necessary to carry out a preliminary cleansing enema. On the morning of the study itself, you can have a light breakfast. If an X-ray examination of the bladder is carried out, one cleansing enema in the morning, directly on the day of the procedure, is often sufficient. If the procedure is planned for young people who have a fairly well functioning intestine, in particular, there are no problems with its cleansing, an X-ray examination may not be required. [1]

The procedure itself is as follows: first, an image of the kidney area is taken, then the ureter and bladder are examined. The procedure allows you to assess the shape, position of the kidneys, their functional and anatomical features, as well as the specifics of the construction of the surrounding bone skeleton and muscles. The overview image also shows the edge of the psoas muscle quite clearly. This makes it possible to assess her condition and to exclude the radiation of pain in the presence of acute or chronic pain syndrome. The survey procedure allows you to assess the general condition of the body, to assess the features of the location and functioning of the organs of the genitourinary tract. It is also possible to timely detect stones in the kidneys and ureters, study the structural and functional features of the bladder. In men, the prostate gland and urethra are subject to additional research. Oxalates, phosphates and carbonates are especially well visualized in plain X-ray, since they very well block X-rays. The surrounding tissues are much less able to trap X-rays, therefore the presence of stones contrasts sharply with the surrounding tissues. In the form of a faint shadow, urates, xanthine or cystine stones can be found.

Sometimes, using plain radiography, phlebolitis can be diagnosed. This is an inflammatory-degenerative disease of the veins of the genitourinary tract. It occurs mainly in the pelvic cavity. In this case, individual parts of the veins are subject to calcification. In some cases, nearby lymph nodes may be calcified, which happens if there are areas of neoplasms. In order to confirm or deny the presence of a neoplasm, additional research methods are used. In particular, you can visualize stones and separate them from shadows using an overview image, which is taken in a direct or oblique projection. In this case, a catheter is inserted into the ureter. If a stone is present in the kidneys or ureter, its shadow completely coincides with the shadow of the catheter in both projections. If the shadow comes from phlebolitis, lymph nodes, neoplasms, it is located separately from the catheter, often turns in the opposite direction.

Cystography

Cystography means one of the types of X-ray examination of the genitourinary tract. The procedure is carried out when the bladder is filled with sergozin solution. If it is absent or impossible to introduce, gas (oxygen) is used. Accordingly, an x-ray is obtained, which shows the cavity of the bladder. By the nature of the image, one can judge the presence or absence of pathological changes in the genitourinary tract. So, normally, the bladder is completely filled with a contrast agent, and has a rounded shape. At the same time, the density of the contrast agent is the same, its contours are even.

Using the method of cystography and its various modifications, it is possible to reveal the shadows of stones, including the shadows of urates. So, urates have the form of X-ray negative areas. With the help of cystography, a differential diagnosis can be made for many pathological conditions. In particular, it is possible to finely differentiate the localization of the urinary stone. So, if the stone is located in the bladder, or in the lower segment of the ureter, it will be clearly visible on an x-ray. The procedure allows for a differentiated diagnosis in urology and gynecology. In particular, using this method, it is possible to distinguish the shadow of a calcified myomatous node affecting the uterus from the shadow of a stone or neoplasm (node) located in the genitourinary tract. Bladder calculus can be diagnosed. Often the method of cystography is used to diagnose diverticula (volvulus) of the bladder, to identify anomalies in its development. An important role is given to the diagnosis of the tumor process. At the same time, both benign and malignant neoplasms can be easily diagnosed. In addition, it is possible to estimate the size, localization features, size, degree of infiltration of the tumor process, the bladder wall. [2]

An important role of cystography is played in the diagnosis of tuberculous lesions of the bladder, in the development of a viral or bacterial infection. This is especially important in the event that it is not possible to conduct a catheterization of the bladder. Using the cystography method, you can determine the uretecele, accurately establish its size, localization, and other important characteristics. This method is indispensable in the diagnosis of a hernia of the bladder, in determining the degree of deviation of the bladder, which is extremely important when performing plastic surgery. In particular, this method is used both immediately before the procedure for plastic surgery of the bladder, and immediately after it. In gynecology, this method makes it possible to reveal the presence of a connection between diseases of the bladder and uterus, as well as its appendages, to determine the degree of their mutual influence on the course of the pathological process, on the development of dysuric pathologies and disorders. The method is used to differentiate conditions such as pericystitis, paracystitis, and other forms of cystitis. Using this method, you can recognize various forms of cystic fistulas, diagnose various forms of reflux. It is also possible to diagnose neurogenic forms of bladder disease.

The cystography method is indispensable in the diagnosis of congenital and acquired anomalies of the bladder. First of all, we are talking about conditions such as exstrophy of the bladder, anomalies of the apex of the bladder, urachus, double bladder.

In the presence of a doubled bladder, this is clearly visible in the picture. So, the bladder is divided into two independent parts using a septum. Moreover, each cavity has a separate communication with the urethra. That is, the urethra is separate for each part of the urethra... In fact. A double urethra is visualized in the picture. Or one of the halves of the bladder opens into the urethra. The cystogram is the basis for the diagnosis. Moreover, additional research methods are often not required. When analyzing the images, you can see that two halves of the bladder are clearly visible on them. There is a clear partition between them. In the apex region, this septum is represented by an oval outline. A shadow appears that resembles a heart of cards. Also, sometimes with the help of a cystogram, anomalies of the bladder, manifested in the form of an hourglass, can be diagnosed. In this case, one half of the bubble is located directly above the other. In this case, the study is carried out in the craniocaudal direction.

Bladder urography

By urography of the bladder is meant a diagnostic procedure in which a solution of a monatomic, diatomic or triatomic compound of iodine (respectively, sergozin, diodon, or triiotrast) is injected into a vein. The molecules of these substances are excreted by the kidneys. In this case, there is no elimination of free iodine. Accordingly, a phenomenon such as iodism occurs, as a result of which contrasting of the urinary tract occurs. The contrast agent completely fills the renal pelvis, is secreted through the ureter and penetrates into the bladder. A series of pictures is taken (at regular intervals). In this case, all sections of the urinary tract are examined. The first picture is taken 7-10 minutes after the injection of the contrast medium, the second picture is taken approximately 15-20 minutes later, the third - 30-40 minutes after the injection of the contrast medium. [3]

The procedure has a number of advantages, in particular, it is an absolutely painless method. It is non-invasive, the risk of injury is completely excluded. Pre-catheterization of the bladder and cystoscopy are not required. Also, the advantage of the method is that it is possible to study the morphological picture of the urinary tract, as well as to study their structural and functional state, to investigate the structural and functional features of the urinary tract, kidneys (both one and two at the same time). Nevertheless, it should be noted that the image clarity sometimes leaves much to be desired, in particular, it is significantly inferior to the methods of retrograde pyelography. It is especially difficult to conduct research with this method in the event that kidney function is reduced.

It should also be borne in mind that the procedure has some contraindications. In particular, the procedure cannot be carried out in case of acute liver diseases, with many diseases of the blood and dysfunction of hematopoiesis, with Gravesism, as well as during menstruation. High azotemia is a strict contraindication.

Indications for the procedure

The main indications for the X-ray of the bladder are the pathology of the kidneys and urinary system. The procedure is performed in case of structural, functional disorders of the kidneys, ureters, urinary bladder, in the presence of acute and chronic inflammatory processes, with suspicion of the development of a tumor process, traumatic injury, congenital anomalies of the genitourinary tract. The presence of diverticula, altered function of the urinary system, can serve as a direct indication for X-ray examination of the genitourinary tract. It should be noted that this procedure can be used for both men and women, and even for children. Attention is drawn to the fact that the procedure can be carried out with urological and gynecological diseases and suspicions of them, has an important diagnostic value. The procedure plays an important role in differential diagnosis. [4]

The procedure is carried out with the development of an atypical process in the bladder. It can be inflammation, cystic formations, tumors). If there are stones, sand, other formations and foreign bodies in the bladder, this procedure is also performed. The indication for conducting is also the presence of acquired and congenital anomalies of the bladder, urinary incontinence of various origins, the presence of enterovisical fistulas. Often prescribed in the presence of complications of various origins that arise after an infectious or inflammatory process. The indications are such diagnoses as urethritis, cystitis, urolithiasis, and suspicion of these pathologies. It is also carried out for injuries, when planning surgical operations, after them. [5]

Preparation

The procedure is quite simple and does not require serious preparation. However, there are some guidelines to follow. This will make the procedure as informative, as accurate and efficient as possible. So, a few days before the procedure, you need to exclude the use of some products, in particular, those that lead to intense gas formation. You should exclude coffee, strong tea, carbonated drinks, cabbage, beans, peas, and other legumes. Dairy products are contraindicated. Immediately before the manipulation, a cleansing enema is performed, or laxatives can be taken. With a good excretory function of the intestine, you can not do an enema.

Technique of the x-ray of the bladder

For the procedure, the patient is asked to take a horizontal position. A sterile catheter is then inserted into the bladder cavity. With its help, about 200-250 ml of liquid is injected. The technique for further carrying out the procedure is quite simple. After the bladder has filled with contrast agent, the examination begins. Pictures are taken. They are done in different directions, in several projections. This allows you to make the image in multiple positions. In particular, the image is taken in a supine position, lying on its side. The procedure is performed at the time of urine flow, and immediately after that. Then the catheter is removed, and a control image is taken (an image of an empty bladder is taken). [6]

A top-down procedure is also possible, in which a contrast agent is injected into a vein. Then, after about 40-60 minutes, the procedure is performed. Nevertheless, this method is not convenient enough, it is characterized by a certain degree of pain. Anesthesia is applied if necessary. [7]

X-ray of the kidneys and bladder

One of the most common procedures is an X-ray of the kidneys and bladder. The procedure is performed in the presence of inflammatory and infectious processes, as well as in the diagnosis of kidney and bladder anomalies. The procedure is indicated for suspected diverticulosis, bladder exstrophy. In case of exstrophy of the urinary bladder, the absence of symphysis on the X-ray image draws attention first of all. This is due to the divergence of the pubic bones. The bones diverge by about 8-12 cm. The anterior pelvic semicircle remains underdeveloped. Other abnormalities are often visualized, affecting primarily the skeletal system. Also, the pathological process is often accompanied by abnormal development of the kidneys and upper urinary tract.

X-rays of the kidneys and bladder are also the only definitive diagnostic method for bladder diverticula. First of all, it should be noted that diverticula can be congenital or acquired. Both conditions can be detected by cystography. The former are often called true and the latter false. This is due to the fact that false diverticula are often the result of the development of congestion, and are formed in patients with various disorders of the outflow of urine from the bladder. Also, this disease often occurs against the background of the prostate, with difficulty urinating. A contrast agent is used to conduct an X-ray. So, when diagnosing, it should be borne in mind that during the formation of a true diverticulum, at the place of its connection with the bladder, a muscle pulp is formed. With the rapid introduction of a contrast agent, as well as in the event that an unheated substance is used, muscle pulp may be clamped, which will complicate the further administration of contrast and make the procedure impossible or difficult. Therefore, if true diverticulosis is suspected, a warmed contrast agent should be used. Its temperature should not be lower than body temperature. You also need to inject the substance slowly, in a small amount (no more than 150 ml).

X-ray of the bladder with contrast agent

Bladder X-rays are often used to diagnose bladder disorders. The procedure is performed using an endoscope. It is carried out if there is evidence. Can be performed at any age. Allows you to assess the basic parameters of the bladder. To do this, a contrast agent is poured into it (in the form of a special solution). First of all, using this method, you can assess the structural features of the organ, as well as its integrity. Allows you to timely identify pathology and start timely treatment. This procedure is prescribed mainly by a urologist, less often by a surgeon.

There are two methods of performing the procedure: bottom-up and top-down. In the ascending method, contrast is injected into the bladder using a catheter. The total amount of contrast agent is 150-200 ml. In the second case, with the descending method of the procedure, intravenous contrast is used. It takes approximately 45 minutes for the substance to reach the ureter. Several variants of contrast agents are widely used, in particular, triombrast, urografin, iodamine. X-ray allows you to quickly identify the pathology of the bladder. It is especially important to use this method for reflux, cystitis, fistulas, in the presence of neoplasms, with diverticula, calculi, anomalies of the genitourinary tract and kidneys. [8]

This method allows you to diagnose various forms of urinary incontinence, as well as assess the excretory function of the kidneys. This is done approximately 30 minutes after the procedure.

X-ray of the bladder of a child

Sometimes it becomes necessary to conduct an X-ray of the bladder of a child. The procedure is not performed on newborns. Spending it no earlier than 5 months. Doctors often use this method when absolutely necessary, since radiation or administration of a contrast agent in childhood is not desirable. However, sometimes there is no other choice. In this case, you need to prepare in advance for the procedure. So, about a week before the procedure, the child should be on a diet. Foods that cause gas incontinence and bloating should be excluded. On the day of the procedure, a cleansing enema is performed. This allows the colon cleanse to be achieved. Basically, a medicinal enema is carried out, with the use of anti-inflammatory drugs. This avoids inflammation. Before the procedure, a drug test is performed. [9]

Indications for carrying out the procedure for children are conditions such as inflammation, infectious processes, the presence of structural and functional changes in the kidneys, urinary tract.

The technique is as follows: first, the required amount of contrast agent is injected through the urethra. The contrast is introduced before my selection, and after that. Children under one year old, as well as restless children, are given anesthesia. Do not eat or drink 6 hours before the start of the procedure. The duration of the procedure is approximately 15 minutes. However, after the procedure, the child must be under the supervision of doctors for 2 hours. During this time, the child must empty the bladder so that the contrast agent is completely out of the body. It will take about 24 hours for complete elimination. At this time, you need to drink plenty of fluids.

Contraindications to the procedure

The procedure has certain contraindications for use, for example, it cannot be carried out with recent operations on the bladder. In case of obstruction of the bladder, it is also not recommended to carry out the procedure. A strict contraindication is the presence of an acute inflammatory process in an acute form. The procedure is not performed during pregnancy, especially in the early stages. With a strong allergic reaction and intolerance to contrast agents, this procedure is also not performed. The procedure is contraindicated in acute hepatic and renal failure.

Complications after the procedure

The procedure has practically no consequences. So, after the procedure, there may be an increased thirst for some time, especially in children. On the first day after the procedure, an abundant drink is required, since the contrast agent is removed. Some people may have a contrast intolerance, so a drug test should be done in advance. For children, the procedure is often done under general anesthesia, so medical supervision is required for 2-3 hours. [10]

As a rule, there are no complications after a bladder X-ray procedure. So, the only possible complication is an allergic reaction to a contrast agent. Therefore, in order to avoid complications, it is necessary to conduct a drug test in advance.

Care after the procedure

Bladder X-rays are relatively simple procedures that do not cause complications and do not require special care after the procedure. Adults can resume their normal daily routine immediately after the procedure. Children should be under medical supervision for 2-3 hours. This is due to the fact that the procedure for children is carried out mainly with the use of a contrast agent and anesthesia, therefore, it is required to monitor the child's reaction until the contrast and anesthesia are fully removed. During the day after the procedure, you need to drink plenty of fluids, which will speed up the removal of contrast.

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