1. Urinary Tract
Dr. Nasr A. Mohammed FIBMS

2. Imaging techniques Basic examinations -Ultrasound.
-Intravenous Urography IVU.
-Computed Tomography CT.
-Radionuclide examination.

3. Other investigations investigations limited to selected patients
Magnetic Resonance Imaging MRI.
Arteriography.
Direct puncture of collecting system
Catheterization.

4. Type of information they provide
-Anatomical US CT
MRI
-Functional
Radionuclide
-both
IVU .

5. ULTRASOUND Is the first line investigation
Non invasive , no radiation, no contarst…..
The main uses of ultrasound :
renal symptoms
renal size
hydronephrosis
renal masses
bladder and prostate

6. Normal renal Ultrasound
Outline …….smooth
Renal paranchyma
Renal sinus ..cental part
Renal pyramids
Size …… difference <1.5 cm

7. Small kindeys Unilateral but may be bilateral :
chronic infection ( including TB)
obstructive atrophy
RAS
Hypoplastic
Always bilateral :
Chronic glomerulonephritis
Hypertensive nephropathy
DM,
collagen vascular disease

8. Enlarged kidneys Always unilateral …….compensatory hypertophy
May be unilateral or bilateral :
bifid collecting system
renal mass
hydronephrosis
lymphoma ( masses or just enlargement)
renal vein thromboses
Always bilateral :
PCK (polycystic disease)
AGN (acute glomerulonephritis)
amyloidosis

9. Ureters ……..usually not visualized
Urinary bladder
examined in distended state ….thin walls
following micturition….. For residual vol.

10. Urography Use of IV iodinated contrast IVU CT Urography
Details of PCS Renal calculi detection (all types)
Ureteric injury Hematuria
Acute ureteric colic Renal mass
Staging and follow up of CA
Renal vascular anatomy
renal trauma

12. Intravenous urogram Plain film ; identify calcification: -stone
-diffuse or focal nephroclacinosis
After contrast injection :
-Kidneys
position ( mormally left higher than Right)
outline :
indentation : fetal lobulation , scar
bulge : mass or cyst
renal length …… cm

13. - Calices : distribution (distributed and symmetrical ) shape : normal …. Cupped dilatation…….clubbed ( from obstruction or destruction )

14. Renal plevis and ureters : shape : funnel shaped dilatation : -obstruction filling defect : calculi, blood clot , tumor …. stricture : PUJ, tumor , infection compression : LN pelvic mass - reflux - normal variant

15. Bladder Outline : central and smooth Indentation
( smooth indentation by prostate or uterus )
after voiding should be empty .

16. CT urography Contrast : early …. Cortical phase then …..nephrogram
CT KUB : before contrast
for detection of calcification
Contrast :
early …. Cortical phase
then …..nephrogram
delay… urographic phase

18. MRI Indication : for selected patient as :- renal artery stenosis
tumor extension to IVC
Disadvantage :
calcification is not visible on MRI

21. Radionuclide examination
Renogram ( DTPA )
Renal morphology (DMSA scan)
Voiding cystography

22. Special techniques Retrograde and antegrade pyelography
Micturating cystogram
Urethrography
Renal arteriography

23. Questions?