Cystography is the standard examination for bladder trauma. It is an invasive procedure requiring the use of contrast material. An anteroposterior (AP) pelvic or KUB film should be obtained as a scout film before contrast material is introduced.
Using sterile technique, a 16- or 18-Fr Foley catheter is carefully placed into the bladder. A 60-mL pistonless catheter-tip syringe is attached to the Foley and contrast material is poured into the syringe. Contrast is then allowed to enter the bladder via gravity as the syringe is placed above the level of the patient's bladder. The bladder is allowed to fill until extravasation occurs or the bladder is filled (400 mL). If bladder contraction occurs during filling, an additional 50 mL is injected by hand. In children below age 11, estimated bladder capacity is calculated based on the formula (age in years +2) * 30. Incomplete filling of the bladder can limit the quality of the study. To accurately exclude bladder rupture and extravasation, the bladder must be filled with at least 250 mL of contrast material.
Cystograms should be done using fluoroscopy or plain films in the AP oblique, and lateral projections. If there is an associated pelvic fracture, the patient should be kept in the supine position to avoid possible disruption of any retropubic hematomas. To detect posterior perforations, an AP film should always be obtained after bladder drainage.
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