Voiding Cystourethrogram (VCUG)

After the patient's bladder is filled with a liquid called contrast material, an X-ray machine sends beams of radiation through the abdomen and pelvis, and images are recorded on special film or a computer. These images help doctors see problems in parts of the urinary system, including the bladder, urethra (the tube connecting the bladder with the outside of the body), and the ureters (the tubes connecting the kidneys to the bladder).

A radiologist takes the X-rays using a technique called fluoroscopy. While the contrast material fills your child's bladder, and then while your child empties the bladder, the radiologist watches an onscreen X-ray video of the liquid moving through the urinary system and a series of X-ray films is recorded.

In general, X-rays are very safe. Although there is some risk to the body with any exposure to radiation, the amount used in a VCUG is small and not considered dangerous. It's important to know that Nemours radiologists use the minimum amount of radiation required to perform the study properly.

 
What does a VCUG show?

A VCUG can show whether the urine is moving in the right direction. Normally, urine flows from the kidneys down to the bladder through the ureters. When urine goes back up toward the kidneys, it's called vesicoureteral reflux (VUR), which a VCUG can detect. Sometimes VUR only occurs while urinating (voiding), which is why the VCUG includes taking X-ray images while the bladder is being emptied.

 
About Sedation

At times, fear, anxiety, and developmental stage of a child contribute to his or her ability to cooperate with medical procedures. Pediatric procedural sedation can be used to decrease discomfort and anxiety for your child.

Sedation is available for VCUG and a separate sedation appointment would be needed to be scheduled prior to the study.

Providing sedation means a child is given medicine to make the child more relaxed. When a child is sedated, he or she may better tolerate a medical procedure and will probably not remember it.

The sedation team aims for mild to moderate sedation, meaning that your child will be relaxed, but awake enough to answer questions and to sense a full bladder.Typical sedatives for this procedure include midazolam (Versed), given orally or as a nasal spray, or nitrous oxide (“laughing gas”) given with a mask. This procedure takes about 10 minutes for catheter placement and bladder filling, and another few minutes for the child to urinate.

Bedwetting

Bedwetting is an issue that millions of families face every night. It is extremely common among young kids but can last into the teen years.

Doctors don't know for sure what causes bedwetting or why it stops. But it is often a natural part of development, and kids usually grow out of it. Most of the time bedwetting is not a sign of any deeper medical or emotional issues.

All the same, bedwetting can be very stressful for families. Kids can feel embarrassed and guilty about wetting the bed and anxious about spending the night at a friend's house or at camp. Parents often feel helpless to stop it.

Bedwetting may last for a while, but providing emotional support and reassurance can help your child feel better until it stops.

How Common Is Bedwetting?

Nocturnal enuresis, the medical name for bedwetting, is a common problem in kids, especially children under the 6 years old. About 13% of 6-year-olds wet the bed, while about 5% of 10-year-olds do.

Bedwetting often runs in families: many kids who wet the bed have a relative who did, too. If both parents wet the bed when they were young, it's very likely that their child will.

Coping With Bedwetting

Bedwetting usually goes away on its own. But until it does, it can be embarrassing and uncomfortable for your child. So it's important to provide support and positive reinforcement during this process.

Reassure your child that bedwetting is a normal part of growing up and that it's not going to last forever. It may comfort your child to hear about other family members who also struggled with it when they were young.

Remind your child to go to the bathroom one final time before bedtime. Try to have your child drink more fluids during the daytime hours and less at night. Avoid caffeine-containing drinks. Many parents find that using a motivational system, such as stickers for dry nights with a small reward (such as a book) after a certain number of stickers, can work well. Bedwetting alarms also can be helpful.

When your child wakes with wet sheets, don't yell or punish him or her. Have your child help you change the sheets. Explain that this isn't punishment, but it is a part of the process. It may even help your child feel better knowing that he or she helped out. Offer praise when your child has a dry night.

When to Call the Doctor

Bedwetting that begins abruptly or is accompanied by other symptoms can be a sign of another medical condition, so talk with your doctor.

The doctor may check for signs of a urinary tract infection (UTI), constipation, bladder problems, diabetes, or severe stress.

Call the doctor if your child:

  • suddenly starts wetting the bed after being consistently dry for at least 6 months
  • begins to wet his or her pants during the day
  • snores at night
  • complains of a burning sensation or pain when urinating
  • has to urinate frequently
  • is drinking or eating much more than usual
  • has swelling of the feet or ankles
  • your child is still wetting the bed at age 7 years

Also let the doctor know if your child is experiencing a lot of stress, if you're feeling frustrated with the situation, or could use some help. In the meantime, your support and patience can go a long way in helping your child feel better about the bedwetting.

Remember, the long-term outlook is excellent and in almost all cases dry days are just ahead.

Reviewed by: Mary L. Gavin, MD
Date reviewed: January 2012