Imaging in Genitourinary System dr. Harry Galuh Nugraha, Sp.Rad
ANATOMY Genitourinary System Urinary System Kidney Ureter Bladder Urethra
ANATOMY
ANATOMY Genitourinary System Genital/Reproductive Male Female Testis Uterus Epidydimis Salphynx Vas deferen Ovaries Ejaculatory duct Cervix Prostate Vagina Seminal vesicle Penis
ANATOMY Male Reproductive System
ANATOMY Female Reproductive System
ANATOMY KIDNEY Bean shaped (convex laterally & concave medially) Length: ±11,5cm or 31/2 vertebral body) Width: ±5-8cm Thickness: ±3cm Retroperitoneal Between Th12- L3 Right kidney is lower ± 1cm than left kidney
ANATOMY KIDNEY
ANATOMY KIDNEY
ANATOMY URETER Diameter 1mm-1cm Length: 25-30cm Retroperitoneal Three normal narrowing area Pelvoureter junction (PUJ) Pelvic brim where the iliac vessels cross the ureter Vesicoureter junction (VUJ)
ANATOMY URETER
ANATOMY BLADDER Urine reservoir Posterosuperior to the pubic bone Position: Empty: In the pelvic cavity Full: Extend to the abdominal cavity Capacity Adult: 350-500 cc Children: (Age [in year] + 2) x 30 cc
ANATOMY BLADDER
ANATOMY URETHRA Length: Male: 17,5-20cm Female: 4cm Male urethra divided by inferior aspect of urogenital diaphragm into: Anterior part Cavernous/Penile part Bulbar part Posterior part Membranous part Prostatic part
ANATOMY URETHRA
ANATOMY
IMAGING MODALITIES Plain abdominal x ray BNO-IVP Retrograde uretrography/cystography/urethrocystography Bipolar Urethrocystography Voiding Cystourethrography Ultrasonography CT Scan MRI Nuclear Imaging Hysterosalphingography
PLAIN ABDOMINAL X-RAY Routine Good quality films will show the kidney outlines Enlargement (mass/hydronephrosis) can be recognized Calcification Opaque calculi in the kidney, ureter or bladder Nephrocalcinosis : calcification in the renal parenchym. Air distribution in the bowel Sentinel loop
NORMAL
KIDNEY STONE
KIDNEY STONE
URETERAL STONE
BLADDER STONE
IMAGING MODALITIES Plain abdominal x ray BNO-IVP Retrograde uretrography/cystography/urethrocystography Bipolar Urethrocystography Voiding Cystourethrography Ultrasonography CT Scan MRI Nuclear Imaging Hysterosalphingography
BNO-IVP Blass = Urinary bladder, Nier = Kidney, Overzicht = Examination Synonim: Intravenous urography Excretory urography Intravenous pyelography
BNO-IVP Use contrast media intravenously Anatomic function: Depict the minor calyx, major calyx, renal pelvis, ureter, urinary bladder. Physiologic function: Assess the kidney function in contrast media filtration and excretion.
BNO-IVP Indication Evaluate mass or cyst Urolithiasis (calculi in the kidney or urinary tract) Pyelonephritis Glomerulonephritis Hydronephrosis Trauma Renal hypertension
BNO-IVP Contraindication Allergy Asthma Anuria Renal failure Cardiovascular disease Severe liver function abnormality Diabetes mellitus Sickle cell disease Multiple myeloma Pheochromocytoma Pregnancy
BNO-IVP Contraindication Allergy Asthma Anuria Renal failure Cardiovascular disease Severe liver function abnormality Diabetes mellitus Sickle cell disease Multiple myeloma Pheochromocytoma Pregnancy
BNO-IVP Procedure 1-3minute : Nephrogram phase Ureteral compression 5 minute : Excretory function 15 minute : Pelvocalyceal system Compression can be released if the pelvocalyceal system has been seen adequately 30 minute : After the compression was released to see the urinary tract from the kidney to the bladder 45-60 minute : fullbladder Post voiding : passage of contrast agent
BNO-IVP Contraindication of compression : Suspected stone Acute abdomen Following abdominal surgery Large abdominal mass Aortic aneurysm Use trendelenburg position instead
BNO IVP
1-3 Minute
5 Minute
15 Minute
30 Minute
Full Blast
Post Voiding
HYDRONEPHROSIS CAUSED BY URETERIC STONE (Black arrow
IMAGING MODALITIES Plain abdominal x ray BNO-IVP Retrograde uretrography/cystography/urethrocystography Bipolar Urethrocystography Voiding Cystourethrography Ultrasonography CT Scan MRI Hysterosalphingography
Retrograde Urethrography To assess the urethra The contrast media is injected from the distal to the proximal part of the urethra (retrograde or ascending)
Retrograde Urethrography Indication Urethral rupture Urethral stricture Congenital anomaly Urethral fistule Urethral diverticle Urethral obstruction Hematuria Recurrent urinary tract infection Slow urinary flow Urinary mass
Retrograde Urethrography Contraindication Acute urinary tract infection
Retrograde Urethrography
Retrograde Urethrography Urethral rupture
Retrograde Urethrography Urethral stricture with periurethral abscess
Retrograde Cystography To assess the urinary bladder The contrast media is injected through the urinary catheter into the urinary bladder Retrograde to the urinary flow
Retrograde Cystography Indication Recurrent urinary tract infection Suspicion of urinary bladder rupture Stone Mass Inflammation Diverticle Fistule Incontinentia Hematuria Measure the urinary volume post micturition Assess the integrity of the anastomosis or suture post operative
Retrograde Cystography Contraindication Pregnancy Urethral rupture (contraindication to the urinary catheter insertion)
Retrograde Cystography
Retrograde Urethrocystography To assess the urinary bladder and the urethra. Combination of the retrograde urethrography and cystography. The contrast media is injected through the external urethral orificium to fill the urethra and then the urinary bladder.
IMAGING MODALITIES Plain abdominal x ray BNO-IVP Retrograde & antegrade pyelography Retrograde uretrography/cystography/urethrocystography Bipolar Urethrocystography Voiding Cystourethrography Ultrasonography CT Scan MRI Hysterosalphingography
Bipolar Urethrocystography To assess the urethra from the proximal and distal aspects. Retrograde from the distal urethra Antegrade from the cystostomy catheter Patient is asked to void so that the contrast media will fill the proximal part of the urethra.
Bipolar Urethrocystography Indication Assess the proximal and distal margin of obstruction (stricture, stone, mass) in the urethra Contraindication Allergy to contrast media
IMAGING MODALITIES Plain abdominal x ray BNO-IVP Retrograde & antegrade pyelography Retrograde uretrography/cystography/urethrocystography Bipolar Urethrocystography Ultrasonography CT Scan MRI Hysterosalphingography
Ultrasonography The kidneys are well shown by ultrasound Mass Cyst (simple or polycystic) Hydronephrosis Stone Nephrostomy guiding
Ultrasonography Renal Mass
Ultrasonography Simple cyst
Ultrasonography Hydronephrosis
Ultrasonography Kidney stone
Ultrasonography The distended urinary bladder is also well shown by abdominal ultrasound Mass Stone Inflammation Infection Diverticle
Ultrasonography Urinary Bladder Mass
Ultrasonography Urinary bladder stone
IMAGING MODALITIES Plain abdominal x ray BNO-IVP Retrograde & antegrade pyelography Retrograde uretrography/cystography/urethrocystography Bipolar Urethrocystography Ultrasonography CT Scan MRI Hysterosalphingography
CT scan Mass, cyst and various lesion of the kidneys are all well shown Gold standard in urinary tract stone Staging in tumour
CT scan Ureteric stone with hydronephrosis
IMAGING MODALITIES Plain abdominal x ray BNO-IVP Retrograde & antegrade pyelography Retrograde uretrography/cystography/urethrocystography Bipolar Urethrocystography Ultrasonography CT Scan MRI Hysterosalphingography
MRI Staging in tumour Superior to CT in staging the bladder and prostatic tumour Good contrast resolution
MRI Renal mass
IMAGING MODALITIES Plain abdominal x ray BNO-IVP Retrograde & antegrade pyelography Retrograde uretrography/cystography/urethrocystography Bipolar Urethrocystography Ultrasonography CT Scan MRI Hysterosalphingography
Hysterosalpingography Primarily demonstrate the uterus and the salpynx (fallopian tube)
Hysterosalpingography Indication Infertility assessment Obstruction (can be therapeutic) Anatomic anomaly (e.g.uterine bicornis) Intrauterine pathology Endometrial polyps Uterine fibroids Intrauterine adhesion Post operative assessment after tubal ligation or reconstructive surgery
Hysterosalpingography Contraindication Pregnancy (performed 7-10 days after the onset of menstruation) Acute pelvic inflammatory disease Active uterine bleeding
Hysterosalpingography
Left Hydrosalpynx
Uterus bicornis
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