1. Radiology of urinary system
Dr. Sameer Abdul Lateef

2. LEARNING OBJECTIVES
*Revision of different radiological investigations of urinary system.
*Revision of radiological anatomy of the renal tract on KUB, IVU and US
*Applications of KUB,IVU, CT and US examinations of the renal tract .
*Recognize radiological features of common urological conditions .

3. URINARY TRACT Plain abdomen (KUB) Preparation
Methods of examination:
Plain abdomen (KUB)
Preparation
Pt should follow low residue diet for 1-2 days prior to examination.
laxative taken day before
NPO after midnight
Psoas muscle

4. KUB

5. IVU- Intravenous Urogram !
Formerly erroneously known as IVP- Intravenous pyelogram!
pyelo refers to renal pelvis and calyces only
study also shows ureters, bladder, and sometimes urethra

6. Indications For Urography
Demonstrate physiologic function and structure of urinary system
Evaluate abd. Masses, renal cysts and tumors
Urolithiasis (stones)
Pyelonephritis (Inflammation of kidney)
Hydronephrosis (distension of renal pelvis and calyces with urine)
Effects of trauma
Pre-op evaluation
Renal hypertension

7. IVU ( Intra Venous Urography) Contrast examination for demonstrating urinary tract and testing renal function
Stages of IVU:
Preparation.
1--Plain (KUB)
Contrast : should be water soluble e.g. urographine , conray , hypaque.& omnipaque
2 min)) 2--Nephrogram
Few min 5 – 10 ) ) 3--Pyelogram
Compression.
4-– Release stage.
After min 5--Cystogram stage.

8. Compression

9. Contrast Media and Adverse Reactions
Crucial not to leave pt alone for first 5 minutes after injection!
Mild reactions
warmth
flushing
hives, Nausea/Vomiting, respiratory edema (accumulation of fluid in lungs)
Severe reactions
Anaphylactic shock (sudden allergic response associated with a sudden drop in blood pressure and difficulty breathing). Can lead to death in a matter of minutes)

10. Contrast Media
Excretory urography (IVU) generally uses a 50 to 70% iodine solution
Lower concentrations for bladder studies due to large amount required to fill bladder (30%)
Non-ionic contrast is generally used
More expensive, but-
Patients less likely to have reactions with nonionic

11. Kidneys 2 bean shaped bodies situated behind peritoneum
Asymmetrical - left is slightly longer and narrower than right
How come Rt kidney slightly lower than Lt kidney?
Liver
Lie in an oblique plane (opposite si jt direction)
Normally extend from T-12 to L3

12. Nephrogram

13. pyelogram

14. AP Projection- IVU (cont’d)
Must include entire KUB region
Should include prostatic region on older males

15. And cystogram stage Release stage

16. Ascending pylogram Descending pylogram Ascending cystogram

17. Cystography Radiologic exam of urinary bladder
Contrast administration usually performed retrograde (against normal flow of urine)

18. Cystography Indicated for:
Vesicoureteral reflux (backward flow of urine into ureters)
Recurrent lower urinary tract infection
Neurogenic bladder: (dysfunction due to disease of central nervous system or peripheral nerves)

19. Cystography indications cont’d
Bladder trauma
Prostate enlargement
Lower urinary tract fistulae
Urethral stricture
Posterior urethral valves (obstructive congenital defect of the male urethra)

20. Ultrasound
Procedure of choice for people who should avoid radiation including pregnant women Very sensitive for diagnosis of obstruction, stones and can detect radiolucent stones missed on KUB. However, may miss small stones and ureteral stones.

21. Ultrasound Procedure of choice Procedure of choice for people who should avoid radiation including pregnant women Very sensitive for diagnosis of obstruction, stones and can detect radiolucent stones missed on KUB. However, may miss small stones and ureteral stones. for people who should aoideral stones

22. CT scan