Fluoroscopy: Voiding Cystourethrogram (VCUG) A VCUG is an x-ray exam used to assess the performance of the bladder, specifically to see whether or not urine is pushed back up towards the kidneys during urination. This is called reflux. In order to visualize the bladder, it is filled with a contrast material that appears dark on the x-ray. A specialized x-ray machine called a fluoroscope is used during the exam that allows for viewing of the bladder on a TV monitor while it is filling and emptying (similar to the use of a home video camera). Procedure: A VCUG is performed in a specialized x-ray room, with x-ray personnel and a radiologist. Before the procedure begins, all clothing will be removed (including underpants) and a hospital gown will be provided. A TV and DVD are available for use to distract children, and a favorite DVD may be brought from home to play during the procedure. To fill up the bladder with the contrast material, it is necessary to place a catheter through the urethra into the bladder. A qualified radiologic technologist or a nurse performs this procedure, called catherization. The area is first washed with an antiseptic solution, and a numbing jelly (topical lidocaine) is used to keep discomfort to a minimum. One end of the catheter is then threaded through the urethra into the bladder. Once it is in place, it is secured to the skin with tape. The other end of the catheter is hooked into a small bottle of contrast. This allows the contrast material to flow into the bladder while the radiologist observes on the TV monitor. While the contrast is flowing, the radiologist will take several images and ask that the patient (child) roll up from side to side. Once the bladder is full, the catheter is removed and urination occurs on the x-ray table while the radiologist observes with the TV monitor. Towels and bedpans are provided to catch the urinated contrast. This step must happen on the x-ray table, as when the bladder contracts to release the urine, this is the most common time that reflux will occur. After the bladder is emptied, the radiologist will take more images, and the test will be complete. After the procedure, the patient (child) may experience some pain or burning with urination. Extra liquids are recommended for the next 24 hours. If you have any questions or concerns returning home from your procedure, contact your primary care physician. Many times, parents ask if their child can be sedated for the test. Sedation is generally not recommended because the child must be awake and alert enough to be able to urinate when the bladder is full. Even light sedation with oral medication is not helpful, as it tends to increase the fearfulness of the child and does not aid in the catheter insertion. The numbing jelly and the distraction of the child with the DVD and toys usually are sufficient enough to allow the test to occur. In very rare cases where sedation is necessary, a pediatric specialist can administer a short-acting IV sedation. This will require withholding food and drink before the test, placement of an IV, and monitoring of the child during and after the test.