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Radiology course UROGENITAL Anatomy.

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Presentation on theme: "Radiology course UROGENITAL Anatomy."— Presentation transcript:

1 Radiology course UROGENITAL Anatomy

2 Kidney-ureter-bladder
Case courtesy of Dr Ian Bickle, Radiopaedia.org

3 Kidney-ureter-bladder

4 Kidney-ureter-bladder
Uro-MRI

5

6

7 Horseshoe-kidney Horseshoe kidneys are the most common type of renal fusion anomaly. They render the kidneys susceptible to trauma and are an independent risk factor for the development of renal calculi and transitional cell carcinoma of the renal pelvis. Horseshoe kidneys are found in approximately 1 in adults and are more frequently encountered in males (M:F 2:1) 

8 Ectopic Kidney Pelvic kidney (sometimes known as sacral kidney) is a kidney that is seen fixed in the bony pelvis or across the spine .  Pelvic ectopia is seen in 1 in autopsies. It is considered the most common form of renal ectopia .

9 Kidneys The kidneys are paired retroperitoneal organs that lie at the level of the T12 to L3 vertebral bodies. Each kidney is normally cm in length, 3-5 cm in width and weighs g.  The left kidney is usually slightly larger than the right. The kidneys are located on the posterior abdominal wall, with one on either side of the vertebral column. The long axis of the kidney is parallel to the lateral border of the psoas muscle. The kidney itself can be divided into renal parenchyma, consisting of renal cortex and medulla, and the renal sinus containing renal pelvis, calyces, renal vessels, nerves, lymphatics and perirenal fat.

10 Kidneys

11 Kidneys Case courtesy of Dr Ian Bickle, Radiopaedia.org

12 CT Arterious phase Venous phase Equilibrium phase

13 MR, basal sequences

14 MR, basal sequences

15 MR T2-wighted MR

16 MR T1 weighed, arterious phase T1 weighed, without MdC
T1 weighet, portal phase T1 weighet, equilibrium phase

17 Kidneys Ecografia Eco-Doppler

18 Ureters The ureter begins its descent to the bladder by running along the medial aspect of the psoas muscle. Here, the ureter lies anteriorly and slightly medial to the tips of the L2-L5 transverse processes.  It enters the pelvis anteriorly to the sacroiliac joint at the bifurcation of the common iliac vessels and then courses anteriorly to the internal iliac artery down the lateral pelvic sidewall.  At the level of the ischial spine it turns forward and medially to enter the posterolateral wall of the bladder, where it runs an oblique 1-2cm course, before opening into the bladder at the internal ureteric orifice

19 Ureters

20 Bladder The bladder has a triangular shape with a posterior base, an anterior apex and an inferior neck with two inferolateral surfaces The trigone is a triangular area of smooth mucosa found on the internal surface of the base. The superolateral angles are formed by the ureteric orifices and the inferior angle is formed by the internal urethral orifice. The urethra arises from the neck of the bladder and is surrounded by the internal urethral sphincter.

21 Bladder

22  Voiding Cystourethrogram (VCUG), also Micturating Cystourethrogram (MCUG), is a technique for visualizing a person's urethra and urinary bladder while the person urinates (voids). Under fluoroscopy (real time x-rays) the radiologist watches the contrast enter the bladder , by a urinary catheter, and looks at the anatomy of the patient. If the contrast moves into the ureters and back into the kidneys, the radiologist makes the diagnosis of vesicoureteral reflux, and gives the degree of severity a score. The exam ends when the person voids while the radiologist is watching under fluoroscopy. It is important to watch the contrast during voiding, because this is when the bladder has the most pressure, and it is most likely this is when reflux will occur.  post voiding image is obtained to see how much urine is left within the bladder (residual urine), which is useful to evaluate bladder contraction dysfunction

23 Micturating Cystourethrogram

24 Micturating Cystourethrogram

25 Micturating Cystourethrogram

26 Micturating Cystourethrogram

27 Micturating Cystourethrogram

28 Micturating Cystourethrogram

29 Bladder

30 Bladder

31 Female Urethra The female urethra is a simple tube that extends from the internal urethral orifice of the bladder to the external urethral orifice in the vestibule of the vagina. It has a much simpler course, structure and less lose prone to disease than the male urethra.  Gross anatomy The female urethra measures approximately 4cm in length. It is embedded in the anterior vaginal wall and runs with the vagina through the urogenital hiatus.  The female urethra begins at the internal urethral meatus at the bladder neck and opens in the vestibule of the vagina, 2.5cm below the clitoris. Paraurethral glands line the urethra at the external urethral meatus.

32 Male Urethra The male urethra measures, on average, 18-20cm in length.
It commences at the internal urethral orifice in the trigone of the bladder and opens in the navicular fossa of the glans penis at the external urethral meatus, which is the narrowest part of the urethra. The male urethra can be divided into anterior and posterior portions. The anterior urethra is composed of the penile and bulbar urethra to the level of the urogenital diaphragm. The posterior urethra is composed of the membranous and prostatic urethra.

33 Male urethra

34 Gynaecology System

35 Uterus The uterus is a hollow, thick-walled, muscular organ that lies in the lesser pelvis. The uterus has an inverted pear shape. In the adult, it measures about 7.5 cm in length, 5 cm wide at its upper part, and nearly 2.5 cm in thickness. The uterus is divisible into two portions: body and cervix. About midway between the apex and base, is a slight constriction known as the isthmus. The portion above the isthmus is termed the body, and that below, the cervix. The part of the body which lies above a plane passing through the points of entrance of the uterine tubes is known as the fundus.

36 Isterography

37 Uterus

38 Uterus

39 Uterus

40 Ovaries The ovaries are paired organs of the female reproductive and endocrine systems. They lie within the ovarian fossa on the posterior wall of the true pelvis.  The ovaries are ovoid in shape and measure approximately x x cm. The suspensory ligament of the ovary runs from the side wall of the pelvis to the ovary. The ovarian vessels run in this ligament. Each ovary is attached to the back of the broad ligament by the mesovarium, which is continuous with its outer coat. Despite all its attachments, the ovary is very mobile. it is frequently found behind the uterus in the pouch of Douglas and have a variable relationship with the uterus

41 Ovaries

42 Ovaries

43 Ovaries

44 Ovaries

45 Male Reproductive System
The prostate gland is the largest male accessory gland and provides approximately 30% of the volume of seminal fluid. It typically weighs between 20-40  grams with an average size of 3 x 4 x 2cm. The prostate is comprised of 70% glandular tissue and 30% fibromuscular or stromal tissue. The prostate gland is an inverted pyramid that surrounds the proximal urethra, which traverses the prostate close to its anterior surface. The base of the prostate is in continuity with the bladder. It ends at the apex at the urogenital diaphragm .

46 Male Reproductive System

47 Male Reproductive System

48 Prostate The prostate is comprised of three distinct zones with different embryologic origins: peripheral zone central zone - transition zone

49 Central zone (CG) and Peripheral zones (PZ)
Prostate Central zone (CG) and Peripheral zones (PZ)

50 Seminal Vesicles The seminal vesicles are paired accessory sex glands of the male reproductive system. The seminal vesicle produces over two-thirds of the ejaculate and is very high in fructose.  The seminal vesicle is actually a 10-15cm long tubular structure but is coiled tightly so it only meaures 4-5cm in length. It is located superiorly and posteriorly to the prostate. The excretory duct of the seminal vesicle unites with the vas deferens to form the ejaculatory duct. 

51 Seminal Vesicles

52 Testicle The testes (sing. "testis" or "testicle") are the main male genital organs, and are contained within a sac called the scrotum. The testes are responsible for production of sperm and testosterone.

53 Testicle The normal testes have a homogenous, moderately echogenic pattern. A testicle is surrounded by a thin echogenic fibrous band, which represents the visceral component of the tunica vaginalis and the tunica albuginea.

54 Radiology course UROGENITAL Anatomy

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