Endoscopy and Radiology for Lower Urinary Tract Dysfunction Hann-Chorng Kuo Department of Urology Buddhist Tzu Chi General Hospital.

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Presentation transcript:

Endoscopy and Radiology for Lower Urinary Tract Dysfunction Hann-Chorng Kuo Department of Urology Buddhist Tzu Chi General Hospital

Lower Urinary Tract Urinary bladder Ureteral orifices Trigone Bladder neck Prostate and prostatic urethra Urethral sphincter Urethra (posterior, bulbous, anterior)

Bladder wall in Cystoscopy Smooth bladder wall Trabeculated bladder wall Diverticulum Pseudodiverticulum Bladder tumor External compression

Smooth Bladder Wall

Trabeculation of Bladder Wall

Bladder Tumor

Bladder mucosa Normal mucosa and vasculature Hyperemia Ischemia Hemorrhagic cystitis Cystitis cystica Pseudomembranous trigonitis Granulomatous cystitis

Normal Mucosal Vasculature

Hyperemia and Inflammation

Hemorrhagic cystitis

Cystitis Cystica

Pseudomembranous Trigonitis

Granulomatous Cystitis

Tuberculosis Cystitis

Prostatic enlargement Benign prostatic enlargement Prostatic cancer

Bladder Neck Obstruction

Urethral Stricture Bladder neck contracture Membranous urethral stricture Anterior urethral stricture Anterior urethral valve Meatal stenosis

Urethral Stricture

Ureteral Orifice Normal cone shape Horseshoe shape Stadium shape Golf hole shape Short submucosal ureteral tunnel

Ureteral Orifice

Chronic Inflammation of Female Bladder Neck

Female Urethral Incompetence Bladder neck incompetence Urethral incompetence

Interstitial Cystitis

Painful Bladder Syndrome

Bladder Stone

Bladder musculature

Uroradiology in Lower Urinary Tract Dysfunction Intravenous pyelography (IVP) Retrograde pyelography Cystography Voiding cystourethrography Retrograde urethrography Beaded chain cystourethrograph Magnetic resonance image (MRI)

Intravenous pyelography in Benign Prostatic Hyperplasia

Inravenous Pyelography in High Grade Cystocele

Retrograde Pyelography in Ureteral stricture

Voiding Cystourethrography Bladder neck dysfunction Prostatic obstruction Urethral stricture Anterior urethral valve Vesicoureteral reflux Bladder diverticulum

Cystography on Straining

Urethral Incompetence

Bladder Base Indentation Prostate Enlargement

Voiding Cystourethrography Prostatic Obstruction

Voiding Cystourethrography in DESD and after Sphincterotomy

Voiding Cystourethrography Anterior urethral valve

Voiding Cystourethrography Dysfunctional voiding

Voiding Cystourethrography Urethral meatal stricture

Transrectal sonography Prostatic configuration Urethral stricture Bladder neck incompetence Bladder base hypermobility Intravesical pathology

Prostate Configuration Prostatic urethra Transition zone of prostate Seminal vesicle Ejaculatory duct Peripheral zone of prostate Bladder neck

Transrectal sonography of the Prostate, Seminal vesicle, Urethra

Prostatic Enlargement

Transition Zone Index (TZI) Transition zone vol/ total prostate vol A TZI of 0.5 indicates highly suspicious prostatic obstruction TZI correlates poorly with total prostatic volume

Measurement of TZI

Female Urethral Structure

Female Urethra in SUI

Hypermobility of Bladder Base

Beaded-Chain Cystourethrography

MRI of Cystocele

MRI of Large Cystocele & Enterocele

MRI of Rectocele

MRI of Uterine Prolapse