urinary system 1

Advance Radiographic Advance Radiographic TechniqueTechnique

Urinary tract investigationsUrinary tract investigations

11 / /I.V.UI.V.U

22 / /Retrograde pyelogramRetrograde pyelogram

33 / /AntegradeAntegrade

44 / /CystogramCystogram

55 / /UrethrogramUrethrogram

66 / /MCUGMCUG

77 / /AngiographyAngiography

Anatomy of the urinary Anatomy of the urinary systemsystem

11 / /two kidneystwo kidneys

22 / /two ureterstwo ureters

33 / /urinary bladder + urethraurinary bladder + urethra

Anatomy of the urinary Anatomy of the urinary systemsystem

Anatomy of the urinary Anatomy of the urinary systemsystem

Intravenous urography (IVU)Intravenous urography (IVU)

Contrast examination for urinary tractContrast examination for urinary tract

IndicationsIndications

a. Congenitala. Congenital

b. Acquiredb. Acquired

Contra indicationContra indication

a. Absolute contra indicationa. Absolute contra indication

b. Relative contra indicationb. Relative contra indication

Contrast mediaContrast media

11 / /UrographinUrographin

22 / /OmnipaqueOmnipaque

33 / /OthersOthers

Patient preparationPatient preparation

11 / /Caster oilCaster oil

22 / /DisflytealDisflyteal

33 / /EucarbonEucarbon

44 / /light dietlight diet

55 / /patient fasting at least 4hrs before patient fasting at least 4hrs before the procedurethe procedure

Before to start the Before to start the procedureprocedure

11 / /Check the Check the ultrasound reportultrasound report

22 / /Check the blood Check the blood ureaurea

Before to start the Before to start the procedureprocedure

The patient should void just before the The patient should void just before the examination for the following two examination for the following two reasonsreasons::

11 / /a bladder that is too full could a bladder that is too full could rupture, especially if compression is rupture, especially if compression is applied early in the examapplied early in the exam..

22 / /urine already present in the bladder urine already present in the bladder dilutes the contrast mediumdilutes the contrast medium..

Procedure of routine normal Procedure of routine normal IVUIVU::

11 / /plain filmplain film

Procedure of routine normal Procedure of routine normal IVUIVU::

* *Insertion of butter Insertion of butter flyfly

* *Injection of contrast Injection of contrast mediamedia

Procedure of routine normal Procedure of routine normal IVUIVU::

22 / /Immediate film Immediate film (nephrogram film)(nephrogram film)

Procedure of routine normal Procedure of routine normal IVUIVU::

33 / /Early excretion Early excretion film (5 min)film (5 min)

Procedure of routine normal Procedure of routine normal IVUIVU::

* *CompressionCompression

Procedure of routine normal Procedure of routine normal IVUIVU::

Compression is contraindicatedCompression is contraindicated::

. .After recent abdominal surgeryAfter recent abdominal surgery

. .After renal traumaAfter renal trauma

. .If there is a large abdominal massIf there is a large abdominal mass

. .When the 5 min film shows already When the 5 min film shows already distended calycesdistended calyces

. .Patient with IVC filterPatient with IVC filter

Procedure of routine normal Procedure of routine normal IVUIVU::

44 / /1010 min film for min film for p.c.s & upper p.c.s & upper ureterureter

Procedure of routine normal Procedure of routine normal IVUIVU::

55 / /Release film to Release film to show the whole show the whole urinary tract urinary tract including the full including the full bladderbladder

Procedure of routine normal Procedure of routine normal IVUIVU::

66 / /full bladder filmfull bladder film

Procedure of routine normal Procedure of routine normal IVUIVU::

77 / /post micturition post micturition filmfilm

IVU with less films which IVU with less films which means less radiationmeans less radiation

11 / /IVU in pregnancy (not early IVU in pregnancy (not early pregnancy)pregnancy)

22 / /IVU in follow upIVU in follow up

33 / /IVU in emergencyIVU in emergency

Some time in childrenSome time in children

IVU with less films which IVU with less films which means less radiationmeans less radiation

* *Plain filmPlain film

* *1515 –– 2020 min filmmin film

. .No compressionNo compression

. .No compression and no preparation in No compression and no preparation in pregnancy and emergencypregnancy and emergency..

Extra films/ extra radiationExtra films/ extra radiation

11 / /IVU in renal hypertensionIVU in renal hypertension..22 / /obstruction or stricture ( we take delayed obstruction or stricture ( we take delayed

films) afterfilms) after: : 1/2hr1/2hr

1hr1hr 2hrs2hrs 6hrs6hrs

12hrs12hrsIf no function we take retrograde If no function we take retrograde pyelographypyelography . .

Retrograde pyelograpgyRetrograde pyelograpgy

If the IVU fails to show P.C.S and upper If the IVU fails to show P.C.S and upper ureterureter..

Retrograde pyelograpgyRetrograde pyelograpgy

Contra indicationContra indication

11 . .Infection of the lower UTInfection of the lower UT..

22 . .Large vesical or urethral stoneLarge vesical or urethral stone..

Retrograde pyelograpgyRetrograde pyelograpgy

Contrast mediaContrast media

Diluted water soluble CMDiluted water soluble CM

Retrograde pyelograpgyRetrograde pyelograpgy

ProcedureProcedure The Pt comes with catheterThe Pt comes with catheter::

11 . .Plain KUB to show the position of the Plain KUB to show the position of the catheter and radiopaque calcificationcatheter and radiopaque calcification..

**injection of the CM (under screening)injection of the CM (under screening)22 . .Pt supine head down to fill the PCSPt supine head down to fill the PCS..33 . .Raised Pt head and take radiograph Raised Pt head and take radiograph

for ureter and pulling the catheter outfor ureter and pulling the catheter out..

Retrograde pyelograpgyRetrograde pyelograpgy

Retrograde pyelograpgyRetrograde pyelograpgy

CASESCASES