A Voiding What? Your Guide To Voiding Cystourethrograms

Every time your child takes a sip of water, milk, or their favorite juice, they are putting their urinary system to work. This system — which removes waste, makes hormones, creates red blood cells, and keeps their bones strong — plays an essential role in your child’s health and wellbeing.

Your child’s urinary system consists of their bladder, kidneys, ureters (the tubes that connect their kidneys to their bladder), and urethra. These all form a drainage system and together, they remove waste and extra fluid from your child’s body. In order for this system to work properly, all of the parts need to work together in the right way.

If something goes wrong in this system, your child’s physician may need to take a closer look at their urinary system using a urology test called a voiding cystourethrogram. This test uses fluoroscopy, which is an X-ray that takes pictures in real-time, allowing them to diagnose and treat your child’s condition.

What Happens During A Voiding Cystourethrogram?

There isn’t much preparation needed for this test, and sedation medication is rarely required. However, it’s helpful for both you and your child to know what to expect to ease any anxiety and make the procedure go as smoothly as possible.

The following steps will occur during your child’s voiding cystourethrogram:

1. A child life specialist will meet with you and your child to help explain the procedure so they can understand it, show you pictures of the room the procedure will occur in, and help your child develop a positive coping plan. Medical play, which is when you use a combination of real and pretend medical equipment to practice the procedure beforehand, can be used as a great way to help your child become familiar with the different medical equipment that they may see or experience during this appointment.
2. A radiology tech will be in the room (called a fluoro room) during the test. Two adults will be allowed to accompany your child to the exam room for preparation. However, only one caregiver may remain with your child during the X-ray, while the other caregiver steps behind the lead glass window. If you’re pregnant, you will be unable to stay in the room during the X-ray, but you are welcome to remain with your child during the catheter placement. If you’re planning on bringing other children with you, one adult will need to stay in the waiting area with them.
3. Once your child is in the fluoro room, they will need to change out of all of their clothes and into a hospital gown. After they have changed, you can help your child up onto the table to lie down. Boys will lay flat on their back with straight legs. Girls will lie on their backs making butterfly wings with their legs.
4. The radiology tech will clean your child’s opening where urine comes out (penis for boys and near the vagina for girls) with cold, wet, brown soap on a cotton swab 3 times.
5. Lidocaine gel may be used to help reduce the sensation of catheter placement. You and your child can decide if this would be beneficial. Lidocaine can be used on children who are 2 years or older and are able to lie still for 3 minutes to let the lidocaine take effect. During this time, it may be helpful to sing songs with your child, watch videos on an iPad, or play I Spy with items in the room.
6. The radiology tech will place the catheter. While the catheter is being inserted, your child may feel an uncomfortable pinch-like feeling. Deep breathing can help reduce this sensation. Once the catheter is in the correct position, your child may feel like they need to go to the bathroom.
7. The tech will place a small piece of tape to keep the catheter stay in the correct spot.
8. Using the catheter, the radiologist will fill the bladder with contrast material. The contrast temporarily changes the way your child’s urinary system looks on an X-ray, enabling the radiologist to see how their bladder fills and empties.
9. While your child’s bladder is being filled with contrast, the radiologist will take pictures of your child on their back and both sides using a special X-ray called a fluoroscope camera.
10. Once their bladder is full of contrast, your child will need to empty their bladder (go to the bathroom) while lying under the fluoroscope camera. The catheter will slide out while they are emptying their bladder. Your child shouldn’t feel any discomfort.

How Can I Prepare And Support My Child With Their VCUG?

It’s completely normal if your child feels anxious before or during their VCUG. However, there are ways to make them feel more comfortable during their procedure, including:

• Using developmentally appropriate words to explain to your child what will happen, such as describing the catheter as a small straw that helps water get to their bladder so the doctor can take pictures and see where that water goes
• Talking to them about the steps of the procedure, such as how the catheter may be an uncomfortable feeling right now, but that will go away soon after it is placed where it needs to be
• Reminding them that these pictures will help them feel better from their pain, infections, or discomfort
• Bringing a comforting item, such as a blanket or stuffed animal for your child to have with them during their scan
• Asking your child’s physician, nurse, or child life specialist what pain management options are available
• Providing support by holding their hand, validating their feelings, and engaging your child in a distraction such as looking at a book, playing a game, playing with toys, or watching videos on an iPad
• Participating in One Voice, an initiative to promote a calming environment by limiting the number of voices in the room so your child knows who to focus on, such as a caregiver or procedural staff professional
• Practicing deep breathing at home by pretending to blow out birthday candles or blowing bubbles
• Displaying a calm demeanor — your child picks up on your anxiety and often mirrors it
• Meet with one of our child life specialists — experts who can explain the procedure in child-friendly terms, and help you and your child understand what will happen at every stage of the test

Do you have more questions related to your child’s voiding cystourethrogram? Contact the Radiology Child Life Specialist at 402-955-4042 or the Radiology Department at 402-955-5602.

What To Do Next

For Patients

Your child will need an order from a provider to schedule a radiology procedure. Once the order is placed, call 402-955-6799 to schedule the procedure.

For Referring Providers

The Physicians’ Priority Line is your 24-hour link to pediatric specialists at Children’s for referrals, emergency and urgent consults, physician-to-physician consults, admissions, and transport services. Call 855-850-KIDS (5437).

Learn more about referring patients.