Urinary System
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Transcript Urinary System
Prefinals
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.
Procedures:
Urography
Ivu or excretory urography
Hypertensive IVU
Percutaneous renal puncture
Retrograde urography
Retrograde cystography
Voiding cystourethrography
Retrograde urethrography
Urography
General term for radiologic
investigations of the renal drainage. Or
collecting system are performed by
various procedures.
2 – methods routinely employed of filling
the urinary canals with contrast medium
1. Excretory, or
Intravenous Urography
2.Retrograde
Pyelography
Excretory, or Intravenous Urography
most frequently employed
method, in which the
contrast agent is routinely
administered
intravenously.
Retrograde Pyelography
contrast medium is introduced
directly into the canals by
means of catheterization –
ureteral catherterization for
contrast filling of the upper
urinary tracts.
Percutaneous Antegrade Urography
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
Preparation of Patient
General Use:
1.
2.
3.
4.
5.
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 retrograge urography, patient is often
requested to force water(4-5 glassfuls) for
severe hours before examination.
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.
Purpose:
Visualize the collecting
portion of the U.S.
Assess the functional
ability of the kidneys.
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
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)
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)
1-5mins
5-10 mins
10 mins
Prone 15 mins
Full Bladder
Post Void
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.
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
Contraindications:
Possible ureteric stones
Abdominal mass
Aortic abdominal aneurysm
Recent abdominal surgery
Severe abdominal pain
Acute abdominal trauma
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
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.
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.
Retrograde Urography
Is a nonfunctional radiographic
examination of the urinary
system which contrast medium
is introduced directly into
pelvicalyceal system via
catheterization.
Procedure:
Modified Lithotomy
Position
knees are flexed over
stirrups of the adjustable
leg supports.
* 3 – routine radiographs*
Preliminary radiographs (
showing the ureteral
catheters in position)
The pyelogram
The ureterogram
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.
Retrograde Cystography
Another nonfunctional urinary
system examination.
Radiographic examination of
the urinary bladder following
installation of an iodinated
contrast medium via a urethral
catheter.
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.
Routine positions:
AP with 15 degrees
caudal angulation
Both posterior
obliques
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.
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.
Voiding Cystourethrography
Study of the urethra and
evaluate the patients ability
to urinate.
Trauma or involuntary loss of
urine are common clinical
indiactions.
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.
Procedure:
Brodney clamp – special
device for injection of the c+
medium w/c is attached to
distal penis.
30 degs RPO – is the position
of choice.
Summary
Urography
Ivu or excretory urography
Hypertensive IVU
Percutaneous renal puncture
Retrograde urography
Retrograde cystography
Voiding cystourethrography
Retrograde urethrography