Cystography
A Cystography (or cystogram) is an X-ray study of the bladder and urethra. A contrast dye is gently placed into the bladder so the urinary system shows up clearly on the images.
Patient-first guide to bladder imaging
Understand Your Cystography & VCUG With Confidence
This page walks you through the Cystography and VCUG procedures in simple language—what they are, how to prepare, what happens during the test, and how doctors interpret VUR grades.
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Short on time? Scan the quick sections for what to expect before, during, and after your exam.
Overview
What Are Cystography and VCUG?
Two related imaging tests that help your care team see how your bladder and urethra are working and whether urine is flowing in the right direction.
VCUG (Voiding Study)
Voiding Cystourethrography (VCUG) is a specialized cystography performed while you empty your bladder. It shows how urine moves and whether any flows backward toward the kidneys.
VUR Diagnosis
VCUG is the gold-standard test for Vesicoureteral Reflux (VUR), a condition where urine travels backward from the bladder up toward the kidneys instead of out of the body.
To evaluate the bladder and urethra, doctors use an imaging test called cystography. A small catheter is placed into the bladder, contrast dye is instilled, and a series of X-ray images are taken. This lets the radiologist see the shape of the bladder, the urethra, and how well everything is working.
A Voiding Cystourethrography (VCUG) is the most common form of cystography. After the bladder is filled with contrast, images are captured while you urinate. This helps your care team look for vesicoureteral reflux (VUR)—urine flowing backward toward the kidneys instead of in the normal direction. Understanding what will happen and why the test is ordered can make the experience less stressful for you or your child.
Step 1
Preparing for Your Cystography or VCUG
Good preparation keeps the visit smoother and helps your team capture clear, useful images.
Essential pre-procedure checklist
Most people do not need special fasting before a cystography or VCUG, but a few simple steps make a big difference. Use this checklist to get ready and follow any extra instructions from your imaging center.
1
Medication review
Tell your provider about all current medicines, including blood thinners, diabetes medications, and any antibiotics. Never stop medicines without medical advice.
2
Allergies and sensitivities
Share any history of allergies—especially to iodine, contrast dye, latex, or prior reactions to imaging tests. Bring a list of past reactions if possible.
3
Comfortable clothing
Wear loose, easy-to-change clothing. In most cases you will change into a hospital gown before the procedure begins to keep images clear of zippers and snaps.
4
Hydration and bladder instructions
Your care team may ask you to drink normally, drink a bit extra, or limit fluids before the exam. Follow the instructions you receive, especially if your child is the patient.
For age-specific tips, see the dedicated pediatric guide: VCUG preparation for children.
Step 2
What Happens During the Cystography Procedure?
A two-part process: filling the bladder with contrast and then capturing images as you empty.
Phase 1: Catheter placement & contrast fill
The procedure begins with careful placement of a small urinary catheter through the urethra into the bladder. This step can feel uncomfortable or briefly stinging, but staff work slowly and explain each part.
Once the catheter is in place, contrast dye flows into the bladder. As the bladder fills, the technologist takes X-ray images to study the bladder’s shape and check for structural concerns such as diverticula, fistulas, or abnormal outlines.
Phase 2: Voiding (VCUG portion)
When your bladder is full, you will be asked to empty it while standing, sitting, or lying—depending on the setup and age of the patient. During this time, the radiologist captures rapid images of the contrast as it leaves the bladder.
This is the key part of Voiding Cystourethrography (VCUG). The images reveal whether contrast flows in the right direction or backward toward the kidneys, which would suggest Vesicoureteral Reflux (VUR).
Worried about radiation exposure? Learn more in: Radiation safety in diagnostic imaging.
Step 3
Understanding Your Cystography Results & VUR
What radiologists look for, how VUR is graded, and what those grades usually mean for treatment decisions.
After the images are taken, the radiologist reviews how the bladder fills and empties, the outline of the bladder and urethra, and whether any contrast moves backward toward the kidneys. When VUR is present, it is usually graded on a five-point scale from I (mild) to V (severe).
Mild grades might only need monitoring and preventive antibiotics. Higher grades, especially in children with repeated infections or kidney changes, may call for closer follow-up or surgical consultation. Your doctor will explain which findings apply to you or your child and how they connect to overall kidney health.
For more technical details, health professionals often refer to: NIDDK information on VUR (external resource) .
VUR grading
Vesicoureteral Reflux (VUR) Grading Scale
VUR grades help your care team match treatment intensity to the severity of backward flow and kidney involvement.
When VCUG confirms VUR, the radiologist chooses a grade between I and V. Lower grades often improve over time, especially in children, while higher grades can require more active treatment. This table summarizes common descriptions and typical management approaches; always rely on your own clinician’s advice for personal decisions.
| Grade | What the images show | Typical treatment approach |
|---|---|---|
| Grade I | Reflux into the ureter only, without reaching the renal pelvis (the area that collects urine in the kidney). | Observation and sometimes low-dose antibiotics, especially in children with infections. |
| Grade II | Reflux up to the renal pelvis but no widening (dilation) of the ureter or collecting system. | Antibiotic prophylaxis and regular monitoring; many children outgrow lower grades over time. |
| Grade III | Mild to moderate dilation of the ureter and collecting system while the inner edges of the kidney cups remain relatively sharp. | Closer follow-up, medication, and periodic imaging; in some cases, surgical options are discussed. |
| Grade IV | Moderate dilation and some twisting (tortuosity) of the ureter with blunting of the kidney calyces. | Often strong consideration for surgical or endoscopic correction, especially with repeated infections. |
| Grade V | Severe dilation and tortuosity with major changes in kidney structure and marked blunting of the calyces. | Surgical intervention is commonly recommended to protect long-term kidney function. |
Questions
Cystography & VCUG: Common Patient Questions
Short, practical answers to the questions patients and parents ask most often before this test.
What is the difference between Cystography and VCUG?
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Cystography is a broad term for an X-ray study of the bladder using contrast dye. Voiding Cystourethrography (VCUG) is a specific type done while a person is urinating. This allows the radiologist to see whether urine flows in the normal direction or backward toward the kidneys (VUR).
Is a Cystography procedure painful?
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Most people describe the test as uncomfortable rather than painful. The catheter insertion can sting or feel strange for a short moment. As the bladder fills, you may feel pressure or fullness, similar to needing to urinate urgently, which usually eases once the test is finished.
How long does a VCUG or Cystography exam take?
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From check-in to completion, most exams take about 30–60 minutes. The imaging portion is usually much shorter—the extra time covers preparation, positioning, and explanation of each step.
Why is a VCUG important for diagnosing VUR?
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VCUG shows how contrast moves in real time as the bladder fills and empties. If VUR is present, the dye clearly appears moving up the ureters toward the kidneys. This detailed view helps your team decide on monitoring, medication, or possible procedures.
Are there side effects from the contrast dye?
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Most patients do well with bladder contrast. Rarely, people notice a metallic taste, flushing, or signs of allergy. Because the dye is placed into the bladder rather than directly into a vein, full-body reactions are less common than with some other imaging tests. Report any unusual symptoms to staff right away.
Do I need to fast before the test?
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For most people, fasting is not required. You may be asked to adjust fluid intake depending on your age or other scheduled procedures. Always follow the instructions provided by your clinic or hospital.
Is Cystography safe for children?
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Yes. VCUG is frequently used in infants and children with recurrent urinary tract infections. Radiology teams use child-friendly positioning, distraction, and minimal radiation doses to keep the exam as safe and comfortable as possible.
What should I expect right after the procedure?
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Once the catheter is removed, you may feel a slight burning sensation while urinating for a short time. Drinking extra water often helps flush the contrast and ease discomfort. Contact your healthcare provider if you notice fever, difficulty passing urine, or pain that does not improve.
How soon will I know the results?
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Many facilities can provide a preliminary impression shortly after the exam. The official radiology report is usually sent to your ordering physician within 24–48 hours, and they will review the findings with you or your child’s caregiver.
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What else can Cystography detect besides VUR?
Cystography can also reveal bladder tumors, pockets or outpouchings (diverticula), fistulas between the bladder and nearby organs, urethral narrowing, and problems with how completely the bladder empties.
Explore more on Cystography.com
Continue your learning with related tools and guides designed to support kidney and bladder health decisions.