Transcript Imaging in Genitourinary System

dr. Harry Galuh Nugraha, Sp.Rad
ANATOMY
Genitourinary System
• Urinary System
– Kidney
– Ureter
– Bladder
– Urethra
ANATOMY
ANATOMY
Genitourinary System
• Genital/Reproductive
– Male
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Testis
Epidydimis
Vas deferen
Ejaculatory duct
Prostate
Seminal vesicle
Penis
– Female
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Uterus
Salphynx
Ovaries
Cervix
Vagina
ANATOMY
Male Reproductive System
ANATOMY
Female Reproductive System
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
ANATOMY
KIDNEY
ANATOMY
KIDNEY
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)
ANATOMY
URETER
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
ANATOMY
BLADDER
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
ANATOMY
URETHRA
ANATOMY
IMAGING MODALITIES
– Plain abdominal x ray
– BNO-IVP
– Retrograde
uretrography/cystography/urethrocystography
– Bipolar Urethrocystography
– Voiding Cystourethrography
– Ultrasonography
– CT Scan
– MRI
– Nuclear Imaging
– Hysterosalphingography
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
NORMAL
KIDNEY STONE
KIDNEY STONE
URETERAL STONE
BLADDER STONE
IMAGING MODALITIES
– Plain abdominal x ray
– BNO-IVP
– Retrograde
uretrography/cystography/urethrocystography
– Bipolar Urethrocystography
– Voiding Cystourethrography
– Ultrasonography
– CT Scan
– MRI
– Nuclear Imaging
– Hysterosalphingography
BNO-IVP
• Blass = Urinary bladder, Nier = Kidney,
Overzicht = Examination
• Synonim:
– Intravenous urography
– Excretory urography
– Intravenous pyelography
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.
BNO-IVP
• Indication
– Evaluate mass or cyst
– Urolithiasis (calculi in the kidney or urinary tract)
– Pyelonephritis
– Glomerulonephritis
– Hydronephrosis
– Trauma
– Renal hypertension
BNO-IVP
• Contraindication
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Allergy
Asthma
Anuria
Renal failure
Cardiovascular disease
Severe liver function abnormality
Diabetes mellitus
Sickle cell disease
Multiple myeloma
Pheochromocytoma
Pregnancy
BNO-IVP
• Contraindication
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Allergy
Asthma
Anuria
Renal failure
Cardiovascular disease
Severe liver function abnormality
Diabetes mellitus
Sickle cell disease
Multiple myeloma
Pheochromocytoma
Pregnancy
BNO-IVP
Procedure
• 1-3minute
: Nephrogram phase
• 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
BNO-IVP
Contraindication of compression :
• Suspected stone
• Acute abdomen
• Following abdominal surgery
• Large abdominal mass
• Aortic aneurysm
 Use trendelenburg position instead
BNO IVP
1-3 Minute
5 Minute
15 Minute
30 Minute
Full Blast
Post Voiding
HYDRONEPHROSIS
CAUSED BY URETERIC
STONE (Black arrow
IMAGING MODALITIES
– Plain abdominal x ray
– BNO-IVP
– Retrograde
uretrography/cystography/urethrocystography
– Bipolar Urethrocystography
– Voiding Cystourethrography
– Ultrasonography
– CT Scan
– MRI
– Hysterosalphingography
Retrograde Urethrography
• To assess the urethra
• The contrast media is injected from the distal
to the proximal part of the urethra (retrograde
or ascending)
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
Retrograde Urethrography
Contraindication
• Acute urinary tract infection
Retrograde Urethrography
Retrograde Urethrography
Urethral rupture
Retrograde Urethrography
Urethral stricture with periurethral abscess
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
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
Retrograde Cystography
Contraindication
• Pregnancy
• Urethral rupture (contraindication to the
urinary catheter insertion)
Retrograde Cystography
Retrograde Urethrocystography
• To assess the urinary bladder and the urethra.
• Combination of the retrograde urethrography
and cystography.
• The contrast media is injected through the
external urethral orificium to fill the urethra
and then the urinary bladder.
IMAGING MODALITIES
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Plain abdominal x ray
BNO-IVP
Retrograde & antegrade pyelography
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Voiding Cystourethrography
Ultrasonography
CT Scan
MRI
Hysterosalphingography
Bipolar Urethrocystography
• To assess the urethra from the proximal and
distal aspects.
• Retrograde from the distal urethra
• Antegrade from the cystostomy catheter
• Patient is asked to void so that the contrast
media will fill the proximal part of the urethra.
Bipolar Urethrocystography
Indication
• Assess the proximal and distal margin of
obstruction (stricture, stone, mass) in the
urethra
Contraindication
• Allergy to contrast media
IMAGING MODALITIES
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Plain abdominal x ray
BNO-IVP
Retrograde & antegrade pyelography
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Ultrasonography
CT Scan
MRI
Hysterosalphingography
Ultrasonography
• The kidneys are well shown by ultrasound
– Mass
– Cyst (simple or polycystic)
– Hydronephrosis
– Stone
– Nephrostomy guiding
Ultrasonography
Renal Mass
Ultrasonography
Simple cyst
Ultrasonography
Hydronephrosis
Ultrasonography
Kidney stone
Ultrasonography
• The distended urinary bladder is also well
shown by abdominal ultrasound
– Mass
– Stone
– Inflammation
– Infection
– Diverticle
Ultrasonography
Urinary Bladder Mass
Ultrasonography
Urinary bladder stone
IMAGING MODALITIES
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Plain abdominal x ray
BNO-IVP
Retrograde & antegrade pyelography
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Ultrasonography
CT Scan
MRI
Hysterosalphingography
CT scan
• Mass, cyst and various lesion of the kidneys
are all well shown
• Gold standard in urinary tract stone
• Staging in tumour
CT scan
Ureteric stone with
hydronephrosis
IMAGING MODALITIES
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Plain abdominal x ray
BNO-IVP
Retrograde & antegrade pyelography
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Ultrasonography
CT Scan
MRI
Hysterosalphingography
MRI
• Staging in tumour
• Superior to CT in staging the bladder and
prostatic tumour
• Good contrast resolution
MRI
Renal mass
IMAGING MODALITIES
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Plain abdominal x ray
BNO-IVP
Retrograde & antegrade pyelography
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Ultrasonography
CT Scan
MRI
Hysterosalphingography
Hysterosalpingography
• Primarily demonstrate the uterus and the
salpynx (fallopian tube)
Hysterosalpingography
Indication
• Infertility assessment
– Obstruction (can be therapeutic)
– Anatomic anomaly (e.g.uterine bicornis)
• Intrauterine pathology
– Endometrial polyps
– Uterine fibroids
– Intrauterine adhesion
• Post operative assessment after tubal ligation or
reconstructive surgery
Hysterosalpingography
Contraindication
• Pregnancy (performed 7-10 days after the
onset of menstruation)
• Acute pelvic inflammatory disease
• Active uterine bleeding
Hysterosalpingography
Left Hydrosalpynx
Uterus bicornis
Thank you for your attention