contrast radiography of bladder and urethra by dr. pavulraj. s

CONTRAST RADIOGRAPHY OF

BLADDER AND URETHRA

Dr. Pavulraj.S

M.V.Sc., (Veterinary Pathologist)

Research fellow

National Research Centre of Equines, India

Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist, Research Fellow, NRCE, India

CONTRAST RADIOGRAPHY OF

BLADDER • It is a simple, fast, inexpensive

technique

• Provide valuable diagnostic and prognostic information about bladder disease

• Clinical indications - dysuria, pollakiuria, haematuria

Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,

Research Fellow, NRCE, India

Dog



Cat



Cystographic technique • Withheld food for 24 hrs

• Enema given preceding cystography

• All catheters should be sterilized

• Bladder is catheterized



Contrast media

• Negative contrast media – CO2, Nitrous oxide

• Positive contrast media – water soluble organic iodides 20% - 10 ml per Kg body weight.



Views • Lateral

• Ventral left dorsal right

• Ventral right dorsal left



Procedure

• Positive contrast cytography is performed by

injecting 20% organic iodides solution in to bladder by urethral catheter

• Double contrast cytography is performed by injecting a small volume of undiluted +ve contrast medium in to a empty bladder

Dose – 1 ml for cat, 3 ml for dog. Followed by bladder distention with –ve contrast medium

• Positive and double contrast procedure is useful than negative contrast cytography

• Double contrast cytography is superior for assessing bladder wall lesions and intraluminal filling defects.



Radiographic signs

• Irregular mucosal border

• Intramural thickening filling defects

• Extravasation patterns



Mucosal changes

• Metaplastic, neoplastic, non-neoplastic proliferations.

• Appears as a irregular outline along inside of bladder surface. Ulcers can be identified with a double contrast cystography



Bladder wall thickening

• Normal thickness – 1 mm • Can use double contrast cytography • Thickening may be due to Cellular infiltrations Fibrous tissue proliferation Hemorrhage Trauma Neoplasia



Filling defects

• Any thing occupying space with in the bladder alter normal filling. Defect area appear as radiolucent surrounded by +ve contrast medium.

• Size, shape, border, position with in the bladder and attachment to the bladder should be examined.



• Free luminal filling defect Air bubbles Calculi Blood clots • Attached luminal filling defect Neoplasia Polyps Blood clots Haemotoma Adherent calculi



Contrast extravasation patterns from the urinary

bladder

• Traumatic bladder diverticula's

• Urachal anomalies – urachal diverticulum's

• Extravasations to peritoneal cavity



Pitfalls with cystographic interpretation

• Changes mimic actual pathologic changes • Artifacts – created during cystographic procedures Air bubbles Small -calculi or small luminal filling defects Large – bladder wall thickening Multiple – honey comb appearance • Pseudo filling defects Mistaken as bladder neoplasia It may due to inadequate bladder distension and

external pressure from abdominal structures.



Contrast radiography of urethra

• Conduit for urine from bladder

• Female - shorter and wider

• Dog – 3 parts

• Cat - 2 parts

• Contrast radiography used in all urethral diseases



Contrast urethrography

• Water soluble organic iodides 15 % used.

• Balloon tipped catheter used. It is inserted and balloon inflated to prevent reflux of contrast medium

• 10 – 15 ml in dogs. 5-10 ml in cats

• Radiographic exposure should be done at the last 2-3 ml of contrast medium injection



Views • Lateral

• Right and left ventro-dorsal oblique



Female animals

• Difficult • Balloon tipped catheter inserted into

urethra then balloon inflated and contrast injected then exposure made during injection

Vaginocystourethrography Balloon tipped catheter placed in

vestibule and inflated to occlude the outflow. +ve contrast medium is injected. Vagina fills first and then urethra fills. But it need general anesthesia



Radiographic signs Filling defects

1. Intraluminal

Air bubbles – round, smooth margin

Urethral calculi – irregular margin, blurred margin

Blood clots – irregular, poorly defined margin



2. Intramural filling defects

Due to neoplasm, inflammation

Irregularity of mucosal surface

Widening or narrowing of lumen



Extramural filling defects

• Due to compression by masses surround the urethra

• Prostate hyperplasia

• Neoplasm

Mucosal surface will be smooth



Extra vasation of contrast medium

• Urethral rent near bladder neck – peritoneal cavity

• Urethrocavernous reflux – systemic venous circulation

• Os penis fracture

• Poor catheter manipulation



Dr.Pavulraj. S., M.V.Sc.,

Veterinary Pathologist, Research

Fellow, NRCE, India

contrast radiography of bladder and urethra by dr. pavulraj. s

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