1. Urinary System
Prefinals

2. Urinary System
Is the production of urine and its elimination from the body.
Functions:
Remove nitrogenous wastes
Regulate water levels in the body.
Regulate acid-base balance and electrolyte levels of the blood.

6. Procedures: Urography Ivu or excretory urography Hypertensive IVU
Percutaneous renal puncture
Retrograde urography
Retrograde cystography
Voiding cystourethrography
Retrograde urethrography

7. Urography
General term for radiologic investigations of the renal drainage. Or collecting system are performed by various procedures.

8. Excretory, or Intravenous Urography Retrograde Pyelography
2 – methods routinely employed of filling the urinary canals with contrast medium
Excretory, or Intravenous Urography
Retrograde Pyelography

9. Excretory, or Intravenous Urography
most frequently employed method, in which the contrast agent is routinely administered intravenously.

10. Retrograde Pyelography
contrast medium is introduced directly into the canals by means of catheterization – ureteral catherterization for contrast filling of the upper urinary tracts.

11. Percutaneous Antegrade Urography
Contrast solution is introduced directly into pelvicalyceal system by means of puncture of the renal pelvis.
It is seldom used method of introducing contrast media to the kidney

12. Preparation of Patient
General Use:
Low-residue diet for 1 – 2 days to prevent gas  formation caused by excessive fermentation of the intestinal contents.
A light evening meal
Costive bowel action, a non-gas forming laxative the evening before the examination.
NPO after midnight on the day of examination.
For retrograge urography, patient is often requested to force water(4-5 glassfuls) for severe hours before examination.

13. IVU or Excretory Urography (commonly known as IVP)
most common radiographic examination of urinary system.
Visualizes the minor and major calyces, renal pelves, ureters and urinary bladder – following an intravenous injection of contrast medium.

14. Purpose: Visualize the collecting portion of the U.S.
Assess the functional ability of the kidneys.

15. Clinical Indications Abdominal or pelvic mass
Renal or ureteral calculi
Kidney trauma
Flank pain
Hematuria or blood in the urine
Hypertension
Renal failure
Urinary tract infections

16. Contraindications Hypersensitivity to contrast media
Anuria (non passage of urine)
multiple myeloma
diabetes
severe hepatic or renal disease
congestive heart failure
Pheochromocytoma (rare tumor that arise outside the adrenal gland)
sickle cell anemia (another type of anemia)

17. IVU – basic routine
scout radiograph & 15mins test dose before injection
injection of contrast media
basic filming routine
1 – min.(nephrogram or nephrotomogram)
5 – min. AP supine L2)
10mins RPO & LPO positions
15 – min. AP supine or PA prone (to provide compression in the abdomen
20 – min posterior obliques (alternatives)
Full bladder (10x12” pelvis 1” below ASIS)
post-void ( prone or erect)

18. 1-5mins

19. 5-10 mins

20. 10 mins

21. Prone 15 mins

22. Full Bladder

23. Post Void

24. Ureteric Compression
Method utilized to enhance filling of the pelvicalyceal system and proximal ureters.
It allows the renal collecting system to retain the contrast medium longer for more complete study.

26. Ureteral Compression
The Ureteral Compression Device is used in excretory urography.
The belt fits around the waist of the patient so that he may be repositioned quickly for studies at any angle

27. Contraindications: Possible ureteric stones Abdominal mass
Aortic abdominal aneurysm
Recent abdominal surgery
Severe abdominal pain
Acute abdominal trauma

28. Hypertensive IVU one special type of IVU.
This is done on patients with high blood pressure to determine if the kidneys are the caused of the hypertension.
 Procedure: (sequence)
1 min
2 min
3 min
30 seconds additional radiographs

29. A hypertensive IVU was commonly requested to screen for Renovascular Hypertension.
This consisted of 30-second and 1-, 2-, 3-, and 5-minute radiographs at the beginning of IVU, which were frequently referred to as “minute-sequence films.”
The rationale for this study was that physiologic changes caused by the renal arterial stenosis would be demonstrated on early-phase excretion radiographs.

30. Percutaneous Renal Puncture
Radiologic procedure for the investigation of renal masses.
It is used to differentiate cysts and tumors of the renal parenchyma.
Introduced by Lindblom
It is replaced by the advent of ultrasounography.

31. Retrograde Urography
Is a nonfunctional radiographic examination of the urinary system which contrast medium is introduced directly into pelvicalyceal system via catheterization.

32. Procedure: Modified Lithotomy Position
knees are flexed over stirrups of the adjustable leg supports.

33. * 3 – routine radiographs*
Preliminary radiographs ( showing the ureteral catheters in position)
The pyelogram
The ureterogram

34. Positioning Routine Additional AP for Ureteral Catheters 14x17 film
AP for pyelogram 14x17 film
AP for Urography film
Additional
RPO
LPO
Lateral – for demonstration of anterior displacement of kidneys or ureters
Cross table – for demonstrating of ureteropelvic region with hydronephrosis patients.

41. Retrograde Cystography
Another nonfunctional urinary system examination.
Radiographic examination of the urinary bladder following installation of an iodinated contrast medium via a urethral catheter.

42. Procedure:
contrast material is allowed to flow in by “gravity only” – using an asepto syringe or drip infusion.
150 – 500 cc’s of contrast media to be instilled into the bladder.

43. AP with 15 degrees caudal angulation Both posterior obliques
Routine positions:
AP with 15 degrees caudal angulation
Both posterior obliques

44. Positioning
AP projections of the bladder and proximal part of the urethra with 15 degrees caudal angle.
Oblique projections of degrees, with perpendicular CR, or a 10 degrees angulations if needed.
AP projections with degree cephalic angulation to demonstrate, the shadow of the prostate above that of the pubic bones.
Lateral positions, to demonstrate the anterior and posterior bladder walls and base of the bladder.

45. Chassard-Lapine method or “Squat shot”, is used to obtain an axial image of the posterior surface of the bladder and the lower end of the ureters.
AP projections, with a degrees tilt of the table to allow the filled bladders to stretch superiorly, where it will not superimpose the ureters.

49. Voiding Cystourethrography
Study of the urethra and evaluate the patients ability to urinate.
Trauma or involuntary loss of urine are common clinical indiactions.

50. Retrograde Urethrography
Perform on the male patient to demonstrate the full length of the urethra.
Contrast medium is injected into distal urethra until the entire urethra is filled in retrograde fashion.

51. Procedure:
Brodney clamp – special device for injection of the c+ medium w/c is attached to distal penis.
30 degs RPO – is the position of choice.

55. Summary Ivu or excretory urography Hypertensive IVU
Percutaneous renal puncture
Retrograde urography
Retrograde cystography
Voiding cystourethrography
Retrograde urethrography