(8) urinary tract

7/26/2019 (8) Urinary Tract

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Urinary Tract


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PLEASEPLEASETURN ALL CELL

PHONES TO SILENTMODE


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33

Text book of radiographic positioning and related anatomy; Kenneth

L.Bontrager,5th, 6theditionMerrills !tlas of "adiographic #ositions and "adiologic #roced$res,

#.%. Ballinger, &.'. (rank"adiographic #roced$res) by *tephen +hapman

References


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Urinary System

Structure :Consists of

Two kidneys

Two ureters

Urinary bladderUrethra


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The KidneysThe Kidneys

Located behind peritoneum on posteriorLocated behind peritoneum on posteriorabdominal wall on either side ofabdominal wall on either side ofvertebral column.vertebral column.

Location


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Adrenal glands rest onAdrenal glands rest ontoptop

Lumbar vertebrae andLumbar vertebrae andrib cage partiallyrib cage partiallyprotectprotect

Right kidney slightlyRight kidney slightlylower than leftlower than left

Location


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Each kidney encasedEach kidney encasedin fibrous connectivein fibrous connectivetissue covered withtissue covered withfatfat

A layer of connectiveA layer of connectivetissue supports andtissue supports andanchors each kidneyanchors each kidney

Location


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Ureters , Bladder & UrethraUreters , Bladder & Urethra

UretersTubes through which urineflows from kidneys tourinary bladder.

Urinary bladderStores urine

UrethraTransports urine from bladder to outside of body

Difference in length between males and females


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Methods of imagingMethods of imaging UltrasoundUltrasound !lain film !lain film

E"ecretion Urography #$%U& E"ecretion Urography #$%U&

Micturiating cystourethrography Micturiating cystourethrography

Ascending urethrography Ascending urethrography

Retrograde pyelography Retrograde pyelography

Antegrade pyelography Antegrade pyelography

computeri'ed tomography #(T&computeri'ed tomography #(T&

magnetic resonance imaging #MR$& magnetic resonance imaging #MR$&

Radionuclide imaging Radionuclide imaging

Urinary Tract


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Ultrasoundultrasound is one of themost valuable investigationsof the urinary tract its is

effective in evaluating renalsi!egrowthmassesrenalobstruction bladder residualvolumes and "rostatic si!e

Diagnosing Processes

Radiological Procedures

Ultrasound of the prostate


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)ormal *ray of the Abdomen)ormal *ray of the Abdomen

+U, !UT+U, !UT


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(alcifications(alcifications


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Contrast #$aminations%ntravenous Urography &%.'.U(%'U is one of the most valuable investigations

of the urinary tract its is effective inevaluating

renal function.

)fter in*ection of contrast medium&+,-,,ml(the contrast rapidly reaches the kidneys ande$creted by glomerular filtration.

Through a se/uence of films &+,+ min( thefunction of the kidneys can be detected inaddition to other abnormalities till the contrast

reaches the urinary bladder.

Radiological Procedures

IVU- Non visualization of theleft idney


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Hrseshe Kidney D!"le# Kidney Pel$i%Kidney


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$ndication$ndication %esicoureteric reflu" %esicoureteric reflu"

-tudy of urethra during Micturition -tudy of urethra during Micturition

bladder abnormalities bladder abnormalities

-tress incontinence -tress incontinence

(ontraindications(ontraindications

Acute urinary tract infection Acute urinary tract infection

(ysto urography


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EuipmentEuipment fluoroscopic unit with spot film fluoroscopic unit with spot film

/tilting table/tilting table

video recorder video recorder

0oley catheter 0oley catheter

(ontrast medium(ontrast medium

12(M 2R L2(M 34512(M 2R L2(M 345

(ysto urography


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!atient preparation!atient preparationMicturition prior to the e"amMicturition prior to the e"am

!lain # preliminary film&!lain # preliminary film&

coned view of the bladderconed view of the bladder

0ilms0ilms Lateral bladderLateral bladder

obliue obliue

removal of the catheter removal of the catheter

lateral bladder during micturition lateral bladder during micturition

(ysto urography


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After careAfter care in cases of 6ysuria analgesic is helpful in cases of 6ysuria analgesic is helpful

antibiotics if reflu" is indicated antibiotics if reflu" is indicated (omplications(omplications

6ue to contrast medium6ue to contrast medium

adverse reaction due to absorption of contrastadverse reaction due to absorption of contrastmedium by the bladder mucosamedium by the bladder mucosa

cystitis cystitis

6ue to Techniue6ue to Techniue

Acute urinary tract infectionAcute urinary tract infection

(atheter trauma (atheter trauma !erforation due to bladder over distension !erforation due to bladder over distension

(ysto urography


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TechniueTechniue%esicoureteric reflu"%esicoureteric reflu"

this indicated commonly for childrenthis indicated commonly for children

with patient supine the catheter is introduced with patient supine the catheter is introduced

into the bladder # using aseptic techniue&into the bladder # using aseptic techniue&

contrast medium is slowly in7ected and filling of contrast medium is slowly in7ected and filling of

bladder is monitored by fluoroscopybladder is monitored by fluoroscopy

Any reflu" is recorded on spot films Any reflu" is recorded on spot films -pot films are taken during micturition-pot films are taken during micturition

The lower ureter is best seen in the anterior The lower ureter is best seen in the anterior

obliue positionobliue position

finally a full length view of the abdomen is taken to finally a full length view of the abdomen is taken to

demonstrate any reflu" of contrast into the kidneysdemonstrate any reflu" of contrast into the kidneys

$n case of vesico vaginal or recto vesical fistula films are taken $n case of vesico vaginal or recto vesical fistula films are taken

in the lateral positionin the lateral position to demonstrate stress incontinence the catheter is left in site until to demonstrate stress incontinence the catheter is left in site until

patient is in the erect positionpatient is in the erect position

(ysto urography


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Cy%tra' sh(inBladder Di$erti%!la Urethrra' sh(in

M!lti"le Stri%t!resNr'al Urethrra'


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$ndication$ndication 6emonstration of the site8 length8 and the 6emonstration of the site8 length8 and the

nature of obstructive lesionnature of obstructive lesion

demonstration of the pelvicalyceal demonstration of the pelvicalyceal

system after unsatisfactory $%Usystem after unsatisfactory $%U

(ontraindications(ontraindications

Acute urinary tract infection Acute urinary tract infection

(ontrast medium(ontrast medium

12(M or L2(M 35 ml not dense to obscure small12(M or L2(M 35 ml not dense to obscure small

lesionslesions

Retrograde pyelography


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!atient preparation!atient preparation

As for surgeryAs for surgery !lain # preliminary film&!lain # preliminary film&

full length supine abdomenfull length supine abdomen TechniueTechniue

$n the theatre$n the theatrecatheteri'ation of the ureter viacatheteri'ation of the ureter via

cystoscopecystoscope

$n the "ray department$n the "ray department

Urine is aspirated under fluoroscopic control Urine is aspirated under fluoroscopic control contrast medium is in7ected slowly #94 ml are contrast medium is in7ected slowly #94 ml are

usually enough to fill the pelvisusually enough to fill the pelvis

if there is a pelviureteric 7unction obstruction the contrast if there is a pelviureteric 7unction obstruction the contrast

in the pelvis is aspiratedin the pelvis is aspirated

films are taken and then the catheter is withdrawn 8first to 35 cm films are taken and then the catheter is withdrawn 8first to 35 cm

below the renal pelvis8 and then 7ust above the ureteric orificebelow the renal pelvis8 and then 7ust above the ureteric orifice

about : ml of contrast is in7ected at each of these levels and films taken about : ml of contrast is in7ected at each of these levels and films taken films include supine / and both 94 anterior obliueof the ureters films include supine / and both 94 anterior obliueof the ureters



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After careAfter care !ost anesthetic observations !ost anesthetic observations

antibiotics may be used antibiotics may be used (omplications(omplications

6ue to contrast medium6ue to contrast medium

adverse reaction due to absorption from pelvisadverse reaction due to absorption from pelvis

6ue to Techniue6ue to Techniue

$ntroducing of infection$ntroducing of infection

Mucosal damage to the ureter Mucosal damage to the ureter

!erforation of the ureter or pelvis by the !erforation of the ureter or pelvis by thecathetercatheter



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$ndicated$ndicated$f retrograde is not possible.$f retrograde is not possible. The patient lies in a prone position.The patient lies in a prone position.

A fine needle8is inserted into the pelvicalycealA fine needle8is inserted into the pelvicalyceal

system under local anaesthesia and fluoroscopicsystem under local anaesthesia and fluoroscopic

control and with the aid of ultrasound alsocontrol and with the aid of ultrasound also

The contrast is in7ected to visuali'e the calyces8The contrast is in7ected to visuali'e the calyces8

pelvis8 and uretrspelvis8 and uretrs

(ontrast medium is inroduced until the level of(ontrast medium is inroduced until the level of

obstruction is outlined.obstruction is outlined.

Antegrade pyelography


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(8) urinary tract

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