Suitability and Outcomes of Micturating Cystograms in aneurin bevan university health Board

 

Background

 

 

• Micturating cystourethogram (MCUG)  is a fluoroscopic study of the lower urinary tract in which contrast is introduced into the bladder via a catheter.

• The purpose of the examination is to assess the bladder, urethra, postoperative anatomy and micturition in order to assess for bladder and urethral abnormalities, including vesicoureteric reflux (VUR). (fig.1)

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• NICE Guidelines state that MCUG should be conducted on all patients up to 6 months old with a history of atypical or recurrent UTI. (1) It is also conducted in our centre in cases of antenatally detected renal conditions such as hydronephrosis, single kidney and renal ectopia. (2) 

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• Owing to the small risk of infection following the procedure, NICE guidance recommends a 3-day course of antibiotic prophylaxis, with the MCUG occurring on the second day.  

 

Aims

 

 

• Review the NICE Guidelines for UTI under 16s

• Compare the indications for MCUG based on the guidelines with those requested

• Determine efficiency of appointments with regard minimising cancellations

• Assess outcomes of the MCUG including short term complications

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• 100% appropriate referral criteria for MCUG 

• 100% of patient have a prior USS

• 0% cancellations

• 0% post-procedural UTI

 

Results 

 

 

• There were 65 visits in total with 62MCUG studies conducted 100% ofpatient had an ultrasound studyprior to MCUG

• 100% of the referrals made wereappropriate, with 32 studiesrelating to paediatric UTI and 31 tounderlying renal conditions(fig.2)

• 3/65 (4.6%) of visits were cancelleddue to inadequate staffing

• There were a total of 3(5%) readmissions within 7 days ofthe procedure with only 1 (1.6%)admitted with post-procedural UTI

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• Additional datapoints werecollected on analysing the data, forexample:

•  Recurrent UTI indication gave0% yield of positive MCUG

•  9/24 (38%) of studies for atypicalUTI has positive MCUG findings

•  Sepsis indication gave high yieldof positive MCUG (40%)

•  Of the positive MCUG findings,only 1 was managed surgically