Although dynamic CCP can depict urinary abnormalities on the cystographic phase, it is a relatively invasive and time intensive examination and is generally not considered the initial imaging test of choice for patients with urinary dysfunction. Fluoroscopy Voiding Cystourethrography VCUG is a fluoroscopic technique that focuses on the bladder and urethra in the anterior compartment. Contrast is instilled into the bladder via a Foley catheter. Images are then taken in the upright position at rest and strain and during voiding. Cystocele is defined on VCUG as extension of the opacified urinary bladder below the level of the pubic symphysis, and the urethral angle can be measured relative to the vertical axis of the patient [14]. Change in position or angle of the urethra during straining can assess urethral hypermobility; however, a study by Walsh et al [60] in patients with SUI and POP demonstrated variable correlation in this regard between VCUG and the Q-tip test. A recent study demonstrated lower prevalence and degree of urethral hypermobility and cystoceles on VCUG compared with supine MR defecography [25]. VCUG may demonstrate opacification of urethral diverticula during the voiding phase, which can be associated with UI. In patients with suspected voiding dysfunction, VCUG may demonstrate funneling or involuntary leakage of urine during the straining phase, as well as indirect and direct findings of voiding dysfunction such as a trabeculated bladder, large postvoid bladder residual, inability to void during the examination, and urethral narrowing with or without upstream dilatation during the voiding phase. In the setting of severe voiding dysfunction, the urethra may not opacify, thus limiting evaluation.
Pelvic Floor Dysfunction in Females. Although dynamic CCP can depict urinary abnormalities on the cystographic phase, it is a relatively invasive and time intensive examination and is generally not considered the initial imaging test of choice for patients with urinary dysfunction. Fluoroscopy Voiding Cystourethrography VCUG is a fluoroscopic technique that focuses on the bladder and urethra in the anterior compartment. Contrast is instilled into the bladder via a Foley catheter. Images are then taken in the upright position at rest and strain and during voiding. Cystocele is defined on VCUG as extension of the opacified urinary bladder below the level of the pubic symphysis, and the urethral angle can be measured relative to the vertical axis of the patient [14]. Change in position or angle of the urethra during straining can assess urethral hypermobility; however, a study by Walsh et al [60] in patients with SUI and POP demonstrated variable correlation in this regard between VCUG and the Q-tip test. A recent study demonstrated lower prevalence and degree of urethral hypermobility and cystoceles on VCUG compared with supine MR defecography [25]. VCUG may demonstrate opacification of urethral diverticula during the voiding phase, which can be associated with UI. In patients with suspected voiding dysfunction, VCUG may demonstrate funneling or involuntary leakage of urine during the straining phase, as well as indirect and direct findings of voiding dysfunction such as a trabeculated bladder, large postvoid bladder residual, inability to void during the examination, and urethral narrowing with or without upstream dilatation during the voiding phase. In the setting of severe voiding dysfunction, the urethra may not opacify, thus limiting evaluation.