1. Imaging in Genitourinary System
dr. Harry Galuh Nugraha, Sp.Rad

2. ANATOMY Genitourinary System Urinary System Kidney Ureter Bladder
Urethra

3. ANATOMY

4. ANATOMY Genitourinary System Genital/Reproductive Male Female Testis
Uterus
Epidydimis
Salphynx
Vas deferen
Ovaries
Ejaculatory duct
Cervix
Prostate
Vagina
Seminal vesicle
Penis

5. ANATOMY
Male Reproductive System

6. ANATOMY
Female Reproductive System

7. ANATOMY KIDNEY Bean shaped (convex laterally & concave medially)
Length: ±11,5cm or 31/2 vertebral body)
Width: ±5-8cm
Thickness: ±3cm
Retroperitoneal
Between Th12- L3
Right kidney is lower ± 1cm than left kidney

8. ANATOMY
KIDNEY

9. ANATOMY
KIDNEY

10. ANATOMY URETER Diameter 1mm-1cm Length: 25-30cm Retroperitoneal
Three normal narrowing area
Pelvoureter junction (PUJ)
Pelvic brim where the iliac vessels cross the ureter
Vesicoureter junction (VUJ)

11. ANATOMY
URETER

12. ANATOMY BLADDER Urine reservoir Posterosuperior to the pubic bone
Position:
Empty: In the pelvic cavity
Full: Extend to the abdominal cavity
Capacity
Adult: cc
Children: (Age [in year] + 2) x 30 cc

13. ANATOMY
BLADDER

14. ANATOMY URETHRA Length:
Male: 17,5-20cm
Female: 4cm
Male urethra divided by inferior aspect of urogenital diaphragm into:
Anterior part
Cavernous/Penile part
Bulbar part
Posterior part
Membranous part
Prostatic part

15. ANATOMY
URETHRA

16. ANATOMY

17. IMAGING MODALITIES Plain abdominal x ray BNO-IVP
Retrograde uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Voiding Cystourethrography
Ultrasonography
CT Scan
MRI
Nuclear Imaging
Hysterosalphingography

18. PLAIN ABDOMINAL X-RAY Routine
Good quality films will show the kidney outlines
Enlargement (mass/hydronephrosis) can be recognized
Calcification
Opaque calculi in the kidney, ureter or bladder
Nephrocalcinosis : calcification in the renal parenchym.
Air distribution in the bowel
Sentinel loop

19. NORMAL

20. KIDNEY STONE

21. KIDNEY STONE

22. URETERAL STONE

23. BLADDER STONE

24. IMAGING MODALITIES Plain abdominal x ray BNO-IVP
Retrograde uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Voiding Cystourethrography
Ultrasonography
CT Scan
MRI
Nuclear Imaging
Hysterosalphingography

25. BNO-IVP
Blass = Urinary bladder, Nier = Kidney, Overzicht = Examination
Synonim:
Intravenous urography
Excretory urography
Intravenous pyelography

26. BNO-IVP Use contrast media intravenously Anatomic function:
Depict the minor calyx, major calyx, renal pelvis, ureter, urinary bladder.
Physiologic function:
Assess the kidney function in contrast media filtration and excretion.

27. BNO-IVP Indication Evaluate mass or cyst
Urolithiasis (calculi in the kidney or urinary tract)
Pyelonephritis
Glomerulonephritis
Hydronephrosis
Trauma
Renal hypertension

28. BNO-IVP Contraindication Allergy Asthma Anuria Renal failure
Cardiovascular disease
Severe liver function abnormality
Diabetes mellitus
Sickle cell disease
Multiple myeloma
Pheochromocytoma
Pregnancy

29. BNO-IVP Contraindication Allergy Asthma Anuria Renal failure
Cardiovascular disease
Severe liver function abnormality
Diabetes mellitus
Sickle cell disease
Multiple myeloma
Pheochromocytoma
Pregnancy

30. BNO-IVP Procedure 1-3minute : Nephrogram phase Ureteral compression
5 minute : Excretory function
15 minute : Pelvocalyceal system
Compression can be released if the pelvocalyceal system has been seen adequately
30 minute : After the compression was released to
see the urinary tract from the kidney to the bladder
45-60 minute : fullbladder
Post voiding : passage of contrast agent

31. BNO-IVP Contraindication of compression : Suspected stone
Acute abdomen
Following abdominal surgery
Large abdominal mass
Aortic aneurysm
 Use trendelenburg position instead

32. BNO IVP

33. 1-3 Minute

34. 5 Minute

35. 15 Minute

36. 30 Minute

37. Full Blast

38. Post Voiding

39. HYDRONEPHROSIS CAUSED BY URETERIC STONE (Black arrow

40. IMAGING MODALITIES Plain abdominal x ray BNO-IVP
Retrograde uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Voiding Cystourethrography
Ultrasonography
CT Scan
MRI
Hysterosalphingography

41. Retrograde Urethrography
To assess the urethra
The contrast media is injected from the distal to the proximal part of the urethra (retrograde or ascending)

42. Retrograde Urethrography
Indication
Urethral rupture
Urethral stricture
Congenital anomaly
Urethral fistule
Urethral diverticle
Urethral obstruction
Hematuria
Recurrent urinary tract infection
Slow urinary flow
Urinary mass

43. Retrograde Urethrography
Contraindication
Acute urinary tract infection

44. Retrograde Urethrography

45. Retrograde Urethrography
Urethral rupture

46. Retrograde Urethrography
Urethral stricture with periurethral abscess

47. Retrograde Cystography
To assess the urinary bladder
The contrast media is injected through the urinary catheter into the urinary bladder
Retrograde to the urinary flow

48. Retrograde Cystography
Indication
Recurrent urinary tract infection
Suspicion of urinary bladder rupture
Stone
Mass
Inflammation
Diverticle
Fistule
Incontinentia
Hematuria
Measure the urinary volume post micturition
Assess the integrity of the anastomosis or suture post operative

49. Retrograde Cystography
Contraindication
Pregnancy
Urethral rupture (contraindication to the urinary catheter insertion)

50. Retrograde Cystography

51. Retrograde Urethrocystography
To assess the urinary bladder and the urethra.
Combination of the retrograde urethrography and cystography.
The contrast media is injected through the external urethral orificium to fill the urethra and then the urinary bladder.

52. IMAGING MODALITIES Plain abdominal x ray BNO-IVP
Retrograde & antegrade pyelography
Retrograde uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Voiding Cystourethrography
Ultrasonography
CT Scan
MRI
Hysterosalphingography

53. Bipolar Urethrocystography
To assess the urethra from the proximal and distal aspects.
Retrograde from the distal urethra
Antegrade from the cystostomy catheter
Patient is asked to void so that the contrast media will fill the proximal part of the urethra.

54. Bipolar Urethrocystography
Indication
Assess the proximal and distal margin of obstruction (stricture, stone, mass) in the urethra
Contraindication
Allergy to contrast media

55. IMAGING MODALITIES Plain abdominal x ray BNO-IVP
Retrograde & antegrade pyelography
Retrograde uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Ultrasonography
CT Scan
MRI
Hysterosalphingography

56. Ultrasonography The kidneys are well shown by ultrasound Mass
Cyst (simple or polycystic)
Hydronephrosis
Stone
Nephrostomy guiding

57. Ultrasonography
Renal Mass

58. Ultrasonography
Simple cyst

59. Ultrasonography
Hydronephrosis

60. Ultrasonography
Kidney stone

61. Ultrasonography
The distended urinary bladder is also well shown by abdominal ultrasound
Mass
Stone
Inflammation
Infection
Diverticle

62. Ultrasonography
Urinary Bladder Mass

63. Ultrasonography
Urinary bladder stone

64. IMAGING MODALITIES Plain abdominal x ray BNO-IVP
Retrograde & antegrade pyelography
Retrograde uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Ultrasonography
CT Scan
MRI
Hysterosalphingography

65. CT scan
Mass, cyst and various lesion of the kidneys are all well shown
Gold standard in urinary tract stone
Staging in tumour

66. CT scan
Ureteric stone with hydronephrosis

67. IMAGING MODALITIES Plain abdominal x ray BNO-IVP
Retrograde & antegrade pyelography
Retrograde uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Ultrasonography
CT Scan
MRI
Hysterosalphingography

68. MRI
Staging in tumour
Superior to CT in staging the bladder and prostatic tumour
Good contrast resolution

69. MRI
Renal mass

70. IMAGING MODALITIES Plain abdominal x ray BNO-IVP
Retrograde & antegrade pyelography
Retrograde uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Ultrasonography
CT Scan
MRI
Hysterosalphingography

71. Hysterosalpingography
Primarily demonstrate the uterus and the salpynx (fallopian tube)

72. Hysterosalpingography
Indication
Infertility assessment
Obstruction (can be therapeutic)
Anatomic anomaly (e.g.uterine bicornis)
Intrauterine pathology
Endometrial polyps
Uterine fibroids
Intrauterine adhesion
Post operative assessment after tubal ligation or reconstructive surgery

73. Hysterosalpingography
Contraindication
Pregnancy (performed 7-10 days after the onset of menstruation)
Acute pelvic inflammatory disease
Active uterine bleeding

74. Hysterosalpingography

75. Left Hydrosalpynx

76. Uterus bicornis

77. Thank you for your attention