Voiding Cystourethrography

The voiding cystourethrogram (VCUG), which involves bladder catheterization and then fluoroscopic imaging of bladder filling and voiding, is the “gold standard” procedure for the diagnosis of vesicoureteral reflux in children. However, it can be associated with significant distress and discomfort for children. Child Life Specialists are essential to preprocedure preparation and coping strategies for all children, but some patients may also require procedural sedation. Oral or intranasal midazolam and nitrous oxide are the two most commonly used agents, each with its own advantages. Some children may benefit from even deeper levels of sedation, including dissociative sedation/analgesia with oral or intravenous ketamine, deep sedation with intravenous propofol, or even general anesthesia with inhaled anesthetics such as sevoflurane. The choice of regimen should be a joint decision among the multidisciplinary team members to best meet the needs of the child.