I maging in Genitourinary S ystem

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 • Testis • Epidydimis • Vas deferen • Ejaculatory duct • Prostate • Seminal vesicle • Penis • Female • Uterus • Salphynx • Ovaries • Cervix • Vagina

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: 350-500 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 : Nephrogramphase • 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