Urinary System

1. Urinary System Prefinals

2. Urinary System • Is the production of urine and its elimination from the body. • Functions: • Remove nitrogenous wastes • Regulate water levels in the body. • Regulate acid-base balance and electrolyte levels of the blood.

6.  Procedures: • Urography • Ivu or excretory urography • Hypertensive IVU • Percutaneous renal puncture • Retrograde urography • Retrograde cystography • Voiding cystourethrography • Retrograde urethrography

7. Urography • General term for radiologic investigations of the renal drainage. Or collecting system are performed by various procedures.

8. 2 – methods routinely employed of filling the urinary canals with contrast medium • Excretory, or Intravenous Urography • Retrograde Pyelography

9. Excretory, or Intravenous Urography • most frequently employed method, in which the contrast agent is routinely administered intravenously.

10. Retrograde Pyelography • contrast medium is introduced directly into the canals by means of catheterization – ureteralcatherterization for contrast filling of the upper urinary tracts.

11. PercutaneousAntegradeUrography • Contrast solution is introduced directly into pelvicalyceal system by means of puncture of the renal pelvis. • It is seldom used method of introducing contrast media to the kidney

12. Preparation of Patient • General Use: • Low-residue diet for 1 – 2 days to prevent gas  formation caused by excessive fermentation of the intestinal contents. • A light evening meal • Costive bowel action, a non-gas forming laxative the evening before the examination. • NPO after midnight on the day of examination. • For retrogrageurography, patient is often requested to force water(4-5 glassfuls) for severe hours before examination.

13. IVU or Excretory Urography (commonly known as IVP) • most common radiographic examination of urinary system. • Visualizes the minor and major calyces, renal pelves, ureters and urinary bladder – following an intravenous injection of contrast medium.

14. Purpose: • Visualize the collecting portion of the U.S. • Assess the functional ability of the kidneys.

15. Clinical Indications • Abdominal or pelvic mass • Renal or ureteral calculi • Kidney trauma • Flank pain • Hematuria or blood in the urine • Hypertension • Renal failure • Urinary tract infections

16. Contraindications • Hypersensitivity to contrast media • Anuria (non passage of urine) • multiple myeloma • diabetes • severe hepatic or renal disease • congestive heart failure • Pheochromocytoma (rare tumor that arise outside the adrenal gland) • sickle cell anemia (another type of anemia)

17. IVU – basic routine • scout radiograph & 15mins test dose before injection • injection of contrast media • basic filming routine • 1 – min.(nephrogram or nephrotomogram) • 5 – min. AP supine (10x12”Film @ L2) • 10mins RPO & LPO positions • 15 – min. AP supine or PA prone (to provide compression in the abdomen • 20 – min posterior obliques (alternatives) • Full bladder (10x12” pelvis 1” below ASIS) • post-void ( prone or erect)

18. 1-5mins

19. 5-10 mins

20. 10 mins

21. Prone 15 mins

22. Full Bladder

23. Post Void

24. Ureteric Compression • Method utilized to enhance filling of the pelvicalyceal system and proximal ureters. • It allows the renal collecting system to retain the contrast medium longer for more complete study.

26. Ureteral Compression • The Ureteral Compression Device is used in excretory urography. • The belt fits around the waist of the patient so that he may be repositioned quickly for studies at any angle

27. Contraindications: • Possible ureteric stones • Abdominal mass • Aortic abdominal aneurysm • Recent abdominal surgery • Severe abdominal pain • Acute abdominal trauma

28. Hypertensive IVU • one special type of IVU. • This is done on patients with high blood pressure to determine if the kidneys are the caused of the hypertension. • Procedure: (sequence) • 1 min • 2 min • 3 min • 30 seconds additional radiographs

29. A hypertensive IVU was commonly requested to screen for Renovascular Hypertension. • This consisted of 30-second and 1-, 2-, 3-, and 5-minute radiographs at the beginning of IVU, which were frequently referred to as “minute-sequence films.” • The rationale for this study was that physiologic changes caused by the renal arterial stenosis would be demonstrated on early-phase excretion radiographs.

30. Percutaneous Renal Puncture • Radiologic procedure for the investigation of renal masses. • It is used to differentiate cysts and tumors of the renal parenchyma. • Introduced by Lindblom • It is replaced by the advent of ultrasounography.

31. Retrograde Urography • Is a nonfunctional radiographic examination of the urinary system which contrast medium is introduced directly into pelvicalyceal system via catheterization.

32. Procedure: • Modified Lithotomy Position • knees are flexed over stirrups of the adjustable leg supports.

33. * 3 – routine radiographs* • Preliminary radiographs ( showing the ureteral catheters in position) • The pyelogram • The ureterogram

34. Positioning • Routine • AP for Ureteral Catheters 14x17 film • AP for pyelogram 14x17 film • AP for Urography film • Additional • RPO • LPO • Lateral – for demonstration of anterior displacement of kidneys or ureters • Cross table – for demonstrating of ureteropelvic region with hydronephrosis patients.

41. Retrograde Cystography • Another nonfunctional urinary system examination. • Radiographic examination of the urinary bladder following installation of an iodinated contrast medium via a urethral catheter.

42. Procedure: • contrast material is allowed to flow in by “gravity only” – using an asepto syringe or drip infusion. • 150 – 500 cc’s of contrast media to be instilled into the bladder.

43. Routine positions: • AP with 15 degrees caudal angulation • Both posterior obliques

44. Positioning • AP projections of the bladder and proximal part of the urethra with 15 degrees caudal angle. • Oblique projections of 40-60 degrees, with perpendicular CR, or a 10 degrees angulations if needed. • AP projections with 20-25 degree cephalic angulation to demonstrate, the shadow of the prostate above that of the pubic bones. • Lateral positions, to demonstrate the anterior and posterior bladder walls and base of the bladder.

45. Chassard-Lapine method or “Squat shot”, is used to obtain an axial image of the posterior surface of the bladder and the lower end of the ureters. • AP projections, with a 15-20 degrees tilt of the table to allow the filled bladders to stretch superiorly, where it will not superimpose the ureters.

49. Voiding Cystourethrography • Study of the urethra and evaluate the patients ability to urinate. • Trauma or involuntary loss of urine are common clinical indiactions.

50. Retrograde Urethrography • Perform on the male patient to demonstrate the full length of the urethra. • Contrast medium is injected into distal urethra until the entire urethra is filled in retrograde fashion.