Cystographic Examination Technique With Clinical Vesicorectal Fistula At The Radiology Installation Of Sleman Hospital

Abstract

Background: Vesicorectal fistula is a rare condition characterized by the formation of an abnormal channel between the urinary bladder and the rectum. One of the contrast-media radiological examinations effective for establishing the diagnosis of this condition is cystography. At the Radiology Installation of RSUD (Regional General hospital) Sleman Regional Hospital, cystography examinations for clinical vesicorectal fistula use plain AP, post-contrast AP, lateral, and Left Posterior Oblique (LPO) projections; the RPO projection is not used in cystography examinations for clinical vesicorectal fistula. This case therefore differs from the theory and is rarely found at the Radiology Installation of RSUD Sleman. This study aims to determine the cystography examination technique and the role of each projection used at the Radiology Installation of RSUD Sleman. Methods: This study employed a qualitative method with a case study approach. The study was conducted at the Radiology Installation of RSUD Sleman from September to October 2025. Data were collected through direct observation, interviews, and documentation. The data were then presented narratively, verified against the literature, and used to draw conclusions. Results: The cystography examination for clinical vesicorectal fistula at Sleman Regional Hospital was performed without special preparation, as the patient arrived with a catheter already in place. The contrast medium used iohexol diluted with water (ratio 1:4), administered in a volume of 200 cc through the catheter. The radiographic projections employed plain AP pelvis, post-contrast AP, lateral, and LPO. The use of the lateral projection was crucial for separating the visualization of the urinary bladder and rectum anatomy in the sagittal plane, while the LPO projection served to open up the superposition of the fistula area. Based on the radiologist's expert assessment, the contrast medium was seen to directly fill the rectosigmoid area up to the descending colon due to the presence of a wide fistula channel. Conclusion: The cystography examination procedure for clinical vesicorectal fistula at RSUD Sleman has been carried out effectively and informatively. The combination of routine projections was considered optimal for showing the location of contrast leakage and visualizing the fistula channel. The RPO projection was not used because the required diagnostic information was already fulfilled through the LPO projection, thereby minimizing examination time, optimizing radiation protection, and maintaining patient comfort