Radiology of urinary system Dr. Sameer Abdul Lateef

LEARNING OBJECTIVES *Revision of different radiological investigations of urinary system. *Revision of radiological anatomy of the renal tract on KUB, IVU and US *Applications of KUB,IVU, CT and US examinations of the renal tract . *Recognize radiological features of common urological conditions .

URINARY TRACT Plain abdomen (KUB) Preparation Methods of examination: Plain abdomen (KUB) Preparation Pt should follow low residue diet for 1-2 days prior to examination. laxative taken day before NPO after midnight Psoas muscle

KUB

IVU- Intravenous Urogram ! Formerly erroneously known as IVP- Intravenous pyelogram! pyelo refers to renal pelvis and calyces only study also shows ureters, bladder, and sometimes urethra

Indications For Urography Demonstrate physiologic function and structure of urinary system Evaluate abd. Masses, renal cysts and tumors Urolithiasis (stones) Pyelonephritis (Inflammation of kidney) Hydronephrosis (distension of renal pelvis and calyces with urine) Effects of trauma Pre-op evaluation Renal hypertension

IVU ( Intra Venous Urography) Contrast examination for demonstrating urinary tract and testing renal function Stages of IVU: Preparation. 1--Plain (KUB) Contrast : should be water soluble e.g. urographine , conray , hypaque.& omnipaque 2 min)) 2--Nephrogram Few min 5 – 10 ) ) 3--Pyelogram Compression. 4-– Release stage. After 15-20 min 5--Cystogram stage.

Compression

Contrast Media and Adverse Reactions Crucial not to leave pt alone for first 5 minutes after injection! Mild reactions warmth flushing hives, Nausea/Vomiting, respiratory edema (accumulation of fluid in lungs) Severe reactions Anaphylactic shock (sudden allergic response associated with a sudden drop in blood pressure and difficulty breathing). Can lead to death in a matter of minutes)

Contrast Media Excretory urography (IVU) generally uses a 50 to 70% iodine solution Lower concentrations for bladder studies due to large amount required to fill bladder (30%) Non-ionic contrast is generally used More expensive, but- Patients less likely to have reactions with nonionic

Kidneys 2 bean shaped bodies situated behind peritoneum Asymmetrical - left is slightly longer and narrower than right How come Rt kidney slightly lower than Lt kidney? Liver Lie in an oblique plane (opposite si jt direction) Normally extend from T-12 to L3

Nephrogram

pyelogram

AP Projection- IVU (cont’d) Must include entire KUB region Should include prostatic region on older males

And cystogram stage Release stage

Ascending pylogram Descending pylogram Ascending cystogram

Cystography Radiologic exam of urinary bladder Contrast administration usually performed retrograde (against normal flow of urine)

Cystography Indicated for: Vesicoureteral reflux (backward flow of urine into ureters) Recurrent lower urinary tract infection Neurogenic bladder: (dysfunction due to disease of central nervous system or peripheral nerves)

Cystography indications cont’d Bladder trauma Prostate enlargement Lower urinary tract fistulae Urethral stricture Posterior urethral valves (obstructive congenital defect of the male urethra)

Ultrasound Procedure of choice for people who should avoid radiation including pregnant women Very sensitive for diagnosis of obstruction, stones and can detect radiolucent stones missed on KUB. However, may miss small stones and ureteral stones.

Ultrasound Procedure of choice Procedure of choice for people who should avoid radiation including pregnant women Very sensitive for diagnosis of obstruction, stones and can detect radiolucent stones missed on KUB. However, may miss small stones and ureteral stones. for people who should aoideral stones

CT scan