1. Intravenous pyelogram Intravenous urogram
IVP - IVU
Intravenous pyelogram
Intravenous urogram

2. Urinary Anatomy Two kidneys Two ureters One urinary bladder
One urethra
Note: the suprarenal glands are part of the endocrine system.

3. Kidney anatomy Kidneys are located posteriorly in the abdomen
The right kidney is lower than the left due to the position of the liver.
Kidneys and ureters are primarily retroperitoneal.
Distal ureters, the bladder and the urethra are infraperitoneal.

4. Kidney position
The psoas major muscles cause the longitudinal plane of the kidneys to form a 20° angle with the midsagittal plane.
The muscles expand as they progress inferior causing the upper poles to be closer to the midline than the lower pole which create about a 20° angle.
The inferior vena cava and the aorta are anterior to the kidney.

5. Kidney position
The large psoas muscles and spine cause the kidneys to also rotate backwards approximately 30° to the coronal plane

6. Radiographic view RPO and LPO visualize the up-side kidney
RPO – left
LPO – right
RAO and LAO visualize the downside kidney
RAO – right
LAO – left

7. Kidney position
Normally the kidneys will be situated halfway between the xiphoid process and the iliac crest.
The average right kidney is 1cm lower than the left.
In the erect position the kidneys will drop approx. 2 inches.
Nephroptosis – kidneys drop lower than normal.

8. Microscopic Structure
Collecting System
Cortex: Nephrons ▼
Medulla: Renal pyramids (8-18)
Renal papilla (openings)
Minor calyces (4-13)
Major calyces (2-3)
Renal pelvis
Ureter

9. Kidney Anatomy
Renal papilla – opening in the collection tubules from the renal pyramid
Renal pyramid – part of the collecting system found in the medulla (made of 8-18 conical masses)
Major and minor calyces – hollow flat tubes
Renal pelvis – major collection area
Ureter – connect kidneys to bladder.

10. Renal parenchyma
Cortex – layer of tissue containing the nephron (functional unit of the kidney). Under the cortex is the medulla which contains the structures responsible for channeling the filtrate from the nephrons to a series of tubules and collection reservoirs.
The term used to describe the total functional portion of the kidney is the renal parenchyma.

11. Microscopic anatomy
Nephron – responsible for filtering blood; there is over 1 million of them in each kidney.
The loop of henle
Glomeruli – small capillary tufts in the cortex
Afferent vessels carry blood to the glomerus
Efferent vessels carry blood away from the glomerus
Bowman’s capsule – surrounds the glomerulus and is also called the glomerular capsule.

12. Urinary flow
Filtration takes place in the glomerulus and then it is transported to the proximal convoluted tubules
Then to the loop of Henle, collecting tubules and the major then minor calyces.
The filtrate is collected into the renal pelvis and transported to the bladder through the ureters.

13. Urine production Average daily input of water is about 2.5 liters
100% is filtered; 99% is reabsorbed and returns to the blood to help control the pH and electrolytes of the body.
1% is eliminated from the body, which equals about 1.5 liters (1500 cc).

14. ureters Length is 28 – 34 cm in length and 1mm to 1cm in diameter
Positioned on the anterior aspect of the psoas muscles, extending posteriorly until they enter the back of the bladder.

15. Vesicle junctions
UPJ – ureteropelvic junction (junction of renal pelvis and proximal ureter)
Pelvic brim – iliac blood vessels cross over the ureter.
UVJ – ureterovesical junction (junction between the distal ureter and the bladder).
Urine is directed downward by the process of peristalsis and gravity.

16. Bladder
Musculomembranous sac that serves as a reservoir for urine. The bladder will flatten when empty and greatly expanded when full.
Ureters enter the posterior aspect of the bladder at the ureteral opening.
Trigone – triangular shaped muscular portion of the bladder formed at the entrance of the two ureters and the proximal opening of the urethra. It is attached to the pelvic floor by connective tissue.
The prostate gland is found inferior to the male bladder and surrounds the proximal urethra
Prostate-produces fluid to improve motility of sperm

17. Bladder terms
Micturition – to urinate or to void; elimination of urine
Incontinence – uncontrolled leakage or urine from the bladder
Retention – inability to void or eliminate urine
Average bladder capacity is about 350 – 500 mm liters; around 250 mm liters (1/2 to 2/3rd full gives you the urge to void)

18. Male organs
Urinary bladder is anterior to the rectum and posterior to the symphysis
Prostate gland is inferior to the urinary bladder
Urethra is approximately 17.5 – 20 cm in the average male. It travels from the bladder to the prostate gland and then exits at the glans penis.
Penis has two functions: passage for semen and the eliminations of urine.

19. Female organs
Ovaries are superior to the uterus; the uterus is anterior to the rectum and posterior and superior to the urinary bladder.
Fundus is superior and lies onto the bladder, the cervix is posterior but still anterior to the bladder.
The female urethra is approximately 3.84 to 4 cms (1-1 ½ inches) long in the female.
The shorter urethra makes woman more susceptible to UTI.

20. Female organs

21. Radiographic Anatomy Minor calyces Major calyces Renal pelvis
Ureteropelvic junction
Proximal ureter
Distal ureter
Urinary bladder

22. Radiographic Anatomy Distal ureter Urinary Bladder Region of trigone
Region of the prostate gland
Urethra

23. Urinary procedures IVP/ IVU Hypertensive IVU Retrograde Urography
Retrograde cystography
Voiding cystourethrography
Bead Chain Cystogram

24. Excretory Urography—IVU
Correct term
Intravenous urogram (IVU): Radiographic examination of the urinary system
Purpose of IVU (
Visualize the collecting portion of the urinary system.
Assess the functional ability of the kidneys (a timed procedure).
See pathology

25. Patient Preparation for an IVU
Light evening meal prior to the procedure
Bowel-cleansing laxative
NPO after midnight (minimum of 8 hours)
Enema on the morning of the examination
Voiding prior to procedure

26. Ureteric Compression
A method to enhance filling of pelvicalyceal system

27. IVU—Basic Routine Scout radiograph Injection Sample imaging routine
Note time at beginning of injection.
Sample imaging routine
1 min nephrogram or nephrotomography
5 min AP supine
10-15 min AP supine
20 min posterior obliques
Postvoid (prone or erect)

28. Hypertensive IVU
Performed to see if the kidneys are the cause of high blood pressure.
Tomograms of the kidneys (nephrotomogram) are done starting at 1 minute post injection.

29. Retrograde Urography
Nonfunctional surgical examination of the urinary system to check for the location of calculi and/or other reasons for obstruction.
Retrograde means backward or against the flow.

30. Retrograde urethrography
A non-functional study of the male urethra.
A device known as a Brodney clamp is attached to the distal penis and allows for the injection of contrast media.
The 30° right posterior oblique prevents superimposition of the bony pelvis over the urethra.

31. Retrograde cystography
Nonfunctional examination of the urinary bladder used to rule out trauma, calculi, tumor and inflammatory disease.
Bladder can hold about 350 – 500 mm liters of contrast.
Contrast media is allowed to flow in by gravity only, so as not to accidentally rupture the bladder.

32. A combined retrograde urethrogram and cystogram, obtained via a suprapubic catheter, showing a posterior urethral disruption with extravasation of contrast dye from the transected urethra.
Cystogram with dumbbell shaped urinary bladder in a sliding inguinal hernia

33. Voiding Cystourethrography
Purpose: Functional study of the bladder and urethra
Performed after routine cystogram
Catheter removed and imaged while voiding
Female—AP
Male—30° RPO

34. Bead Chain Cystogram
This is a special kind of voiding cystourethrogram on females with a diagnosis of stress incontinence or involuntary loss of urine.
The purpose is to determine anatomical relationship of the bladder and the urethra