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Urinary Tract

PLEASE
TURN ALL CELL
PHONES TO SILENT
MODE

References
Text book of radiographic positioning and related anatomy; Kenneth
L.Bontrager,5th, 6th edition
Merrills Atlas of Radiographic Positions and Radiologic Procedures,
P.W. Ballinger, E.D. Frank
Radiographic Procedures: by Stephen Chapman

Urinary System
Structure :Consists of
Two kidneys
Two ureters
Urinary bladder
Urethra

Location

The Kidneys

Located behind peritoneum on posterior


abdominal wall on either side of
vertebral column.

The Kidneys
Location
Adrenal glands rest on
top
Lumbar vertebrae and
rib cage partially
protect
Right kidney slightly
lower than left

The Kidneys
Location

Each kidney encased


in fibrous connective
tissue covered with
fat

A layer of connective
tissue supports and
anchors each kidney

Ureters , Bladder & Urethra


Ureters
Tubes through which urine
flows from kidneys to
urinary bladder.
Urinary bladder
Stores urine
Urethra
Transports urine from bladder to outside of body
Difference in length between males and females

Urinary Tract

Methods of imaging

- Ultrasound
- Plain film
- Execretion Urography (IVU)
- Micturiating cystourethrography
- Ascending urethrography
- Retrograde pyelography
- Antegrade pyelography
- computerized tomography (CT)
- magnetic resonance imaging (MRI)
- Radionuclide imaging

Diagnosing Processes
Radiological Procedures
Ultrasound
ultrasound is one of the
most valuable investigations
of the urinary tract, its is
effective in evaluating renal
size,growth,masses,renal
obstruction, bladder residual
volumes and Prostatic size

Ultrasound of the prostate

Normal X-ray of the Abdomen


KUB - PUT

Calcifications

Radiological Procedures
Contrast Examinations
Intravenous Urography (I.V.U)

IVU is one of the most valuable investigations


of the urinary tract, its is effective in
evaluating
renal function.
After injection of contrast medium(50-100ml)
the contrast rapidly reaches the kidneys and
excreted by glomerular filtration.
Through a sequence of films (5,10,15 min) the
function of the kidneys can be detected in
addition to other abnormalities till the contrast
reaches the urinary bladder.

IVU- Non visualization of the


left Kidney

Horseshoe Kidney

Duplex Kidney

Pelvic
Kidney

Cysto urography
Indication
- Vesico-ureteric reflux
- Study of urethra during Micturition
- bladder abnormalities
- Stress incontinence
Contraindications
- Acute urinary tract infection

Cysto urography

Equipment
- fluoroscopic unit with spot film
&tilting table
- video recorder
- Foley catheter
- Contrast medium
HOCM OR LOCM 150

Cysto urography

Patient preparation
Micturition prior to the exam
Plain ( preliminary film)
coned view of the bladder
Films
- Lateral bladder
- oblique
- removal of the catheter
- lateral bladder during micturition

Cysto urography

After care
- in cases of Dysuria analgesic is helpful
- antibiotics if reflux is indicated
Complications
Due to contrast medium
- adverse reaction due to absorption of contrast
medium by the bladder mucosa
- cystitis
Due to Technique
- Acute urinary tract infection
- Catheter trauma
- Perforation due to bladder over distension

Cysto urography

Technique
Vesico-ureteric reflux
- this indicated commonly for children
- with patient supine the catheter is introduced
into the bladder ( using aseptic technique)
- contrast medium is slowly injected and filling of
bladder is monitored by fluoroscopy
- Any reflux is recorded on spot films
- Spot films are taken during micturition
- The lower ureter is best seen in the anterior
oblique position
- finally a full length view of the abdomen is taken to
demonstrate any reflux of contrast into the kidneys
- In case of vesico -vaginal or recto- vesical fistula films are taken
in the lateral position
- to demonstrate stress incontinence the catheter is left in site until
patient is in the erect position

Cyctogram showing
Bladder Diverticula

Urethrogram showing
Multiple Strictures

Normal Urethrogram

Retrograde pyelography
Indication
- Demonstration of the site, length, and the
nature of obstructive lesion
- demonstration of the pelvicalyceal
system after unsatisfactory IVU
Contraindications
- Acute urinary tract infection
Contrast medium
HOCM or LOCM 10 ml not dense to obscure small
lesions

Retrograde pyelography

Patient preparation
As for surgery
Plain ( preliminary film)
full length supine abdomen
Technique
- In the theatre catheterization of the ureter via
cystoscope
- In the x-ray department
- Urine is aspirated under fluoroscopic control
- contrast medium is injected slowly (3-5 ml are
usually enough to fill the pelvis
- if there is a pelviureteric junction obstruction the contrast
in the pelvis is aspirated
- films are taken and then the catheter is withdrawn ,first to 10 cm
below the renal pelvis, and then just above the ureteric orifice
- about 2 ml of contrast is injected at each of these levels and films taken
- films include supine & and both 35 anterior obliqueof the ureters

Retrograde pyelography

After care
- Post anesthetic observations
- antibiotics may be used
Complications
Due to contrast medium
- adverse reaction due to absorption from pelvis
- Due to Technique
- Introducing of infection
- Mucosal damage to the ureter
- Perforation of the ureter or pelvis by the
catheter

Antegrade pyelography

Indicated If retrograde is not possible.


The patient lies in a prone position.
A fine needle,is inserted into the pelvicalyceal
system under local anaesthesia and fluoroscopic
control and with the aid of ultrasound also
The contrast is injected to visualize the calyces,
pelvis, and uretrs
Contrast medium is inroduced until the level of
obstruction is outlined.