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1. RADIOLOGICAL METHODS OF STUDY OF THE URINARY SYSTEM,
CHARACTERISTICS OF DIFFERENT DISEASES OF KIDNEYS AND URINARY
TRACT. RADIOLOGICAL DIAGNOSIS OF EMERGENCY CONDITIONS.
M.KURTANIDZE

2. • Uroradiology remains a discipline that utilizes all imaging techniques to provide answers to specific clinical
questions. The required information can be obtained most rapidly and efficiently by using the correct test or
tests performed in the correct order
1.A plain radiograph of the abdomen should be obtained before any contrast examination because calcification
may later be masked by the contrast medium
.The full-length radiograph should include the bladder base and, in male patients, the prostatic urethra,
particularly when there are lower tract symptoms, in order not to miss a urethral calculus.
.The change in position of the kidneys at these different phases of respiration will show whether a calcification is
intrarenal because its position is constantly related to the kidney, or separate from the kidney

3. Bilateral renal calculi
Ureteric calculi

6. INTRAVENOUS UROGRAM
The number of intravenous urograms (IVUs) performed over the last 15 years has decreased as the use of
other imaging techniques, particularly US and CT, has increased. The IVU is still a valuable procedure for
examination of the urinary tract. It gives excellent anatomical images of the pelvicalyceal systems and, to
some extent, an indication of renal function.
.The quantity of contrast medium administered should be related to the weight of the patient, If the
patient is well hydrated the dose may be increased.
. The contrast medium should be injected rapidly so that a bolus reaches the kidneys.
.An image at 5 min coned to the renal area will show early filling of the pelvicalyceal system and the
relationship of the calyces to the renal outline
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7. • Patient preparation
• overnight fasting prior to the date of examination; a laxative would help to achieve a good preparation
• on the day of the procedure take a scout/pilot film to check patient preparation and also for radiopaque
calculi
• check serum creatinine level to be within the normal range (as per hospital guidelines)
• take a history of the patient for any known drug allergies followed by written informed consent for the
procedure

8. Indications
check for normal function of kidneys
check for anatomical variants or congenital
anomalies (e.g. horse-shoe kidney)
check the course of the ureters
detect and localize a ureteric obstruction
(urolithiasis)
assess for synchronous upper tract disease in those
with bladder transitional cell carcinoma (TCC)

9. Duplicated collecting system

10. CT urography (CTU) has become so refined that some centres have now abandoned the IVU, particularly in
patients with macroscopic haematuria, as CT has high sensitivity for detection of small renal cell carcinoma,
urinary tract stones and transitional cell carcinoma

11. ULTRASOUND
Ultrasound (US) is an exceedingly useful technique for examination of the urinary tract. The advantages of
using a noninvasive test, which is painless and does not involve irradiation to either patient or operator, are
obvious
. When a renal mass is found at IVU, then an ultrasound examination will easily and rapidly differentiate a
tumour from a cyst.
. provides information about renal length which is used to estimate renal mass and the presence or
absence of hydronephrosis. The normal length in the adult ranges between 11 and 14 cm

13. Ultrasound
uncomplicated renal cyst
-well-marginated anechoic lesion with thin walls
-a few thin septa may be present (5% of cysts)
-the back wall should be visible
-posterior acoustic enhancement may be present, although this finding is non-specific and also may
not be seen with smaller cysts
-a small amount of intracystic hemorrhage/debris may be present and may require further
evaluation (5% of cysts)

14. Hydronephrosis

15. MAGNETIC RESONANCE IMAGING
• Magnetic resonance imaging (MRI), like CT, provides images of the urinary tract and surrounding
structures. Unlike CT, MRI does not involve exposure to ionizing radiation. MRI can be used to provide
images of blood vessels (called magnetic resonance angiography, or MRA). For some disorders, MRI
provides more detail than CT. However, MRI does not provide much useful information about stones in
the urinary tract. Use of paramagnetic contrast agents given by vein makes MRI images clearer. This
contrast agent is very different from the agent used in CT scans. However, paramagnetic contrast often
cannot be used in people with poor kidney function because in those people the contrast agent rarely
causes a serious and irreversible disorder called nephrogenic systemic fibrosis, which affects the skin
and other organs.

16. MR UROGRAPHY
• The unique advantage of MR urography (MRU) is the absence of ionizing radiation

17. MR ANGIOGRAPHY
• Gadolinium-enhanced MR angiography may be
used for assessment of renal artery stenosis.
• It also has a role in the diagnosis of
arteriovenous malformations

18. RETROGRADE UROGRAPHY
• In retrograde urography, a radiopaque contrast agent is introduced directly into the ureters or the collecting
tubules of the kidney through the bladder. This procedure is usually done during cystoscopy or another routine
urologic procedure such as ureteroscopy (insertion of a catheter into the ureters) or placement of a stent in the
ureter or kidney. The urinary tract can be examined, including the parts of the kidney through which urine
drains. Retrograde urography can be done to diagnose scarring, tumors, or abnormal connections between
parts of the urinary tract and other structures (fistulas). Retrograde urography can be done if a radiopaque
contrast agent cannot be given (for example, if kidney function is poor).

19. PERCUTANEOUS ANTEGRADE UROGRAPHY
• In percutaneous antegrade urography, a radiopaque contrast agent is introduced directly into the parts of the kidney
through which urine drains through an opening in the back (called a nephrostomy opening). This test may be done if
retrograde urography cannot be done (for example, if the instrument's insertion path is blocked) or if a person
already has a nephrostomy tube used to treat a disorder such as a tumor or stone that blocks the urinary tract.

20. CYSTOGRAPHY AND CYSTOURETHROGRAPHY
• Cystography is any test that provides bladder images after a radiopaque contrast agent is introduced into the
bladder (for example, through a cystoscope or a catheter in the urethra)
• In cystourethrography (sometimes called retrograde cystourethrography), a radiopaque contrast agent is
injected through the urethra into the bladder

21. UROLOGIC EMERGENCIES
• Obstructive Uropathy:Acute urinary retention (AUR), or the involuntary inability to pass urine from the
bladder, is the most common reason for emergent urologic care.
• Obstructed urine flow may result from any blockage of the bladder neck, urethra, or meatus, including
stones, tumors, blood clots, prostate enlargement, local edema, or phimosis.
• Imaging, including bedside ultrasound, can also confirm the presence of a large volume of urine in the
bladder.

23. URETERAL OBSTRUCTION
• Ureteral obstruction, in which the antegrade flow of urine from the kidney to the bladder is blocked,
can occur in either or both renal units
• Causes of ureteral obstruction may be:
• Stones
• ureteropelvic junction obstruction
• ureteral polyps or tumors
• blood clots
• ureteroceles

25. TESTICULAR TORSION:
Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced
blood flow causes sudden and often severe pain and swelling. Testicular torsion is most common between ages 12 and 18, but
it can occur at any age, even before birth.
Ultrasound features:
• increase in the size of the testis and epididymis
• homogeneous echotexture
• early finding, before necrosis
• heterogeneous echotexture
• a late finding (after 24 hours), implies necrosis
• hypoechoic regions represent necrosis
• hyperechoic regions represent hemorrhage

26. The left testis is diffusely hypoechoic without any mass lesions. There is no flow on
the Power Doppler imaging. The left spermatic cord shows twisting.
The right testis shows a normal echopattern and vascularity.
There is no hydrocele on either side. Both hemiscrotal wall thickness is normal.

27. BLADDER RUPTURE:
• Leakage of urine may occur into the peritoneum or the extraperitoneal space. Both intra- and
extraperitoneal leakage of urine may have iatrogenic causes (e.g. perforation of the bladder during a
transurethral resection of a bladder tumor)

28. Pelvic free fluid with a hypoechoic disruption of the urinary bladder wall.

29. RENAL TRAUMA
• Renal trauma occurs more frequently in male patients and can occur in up to 10% of abdominal
traumas.
• Blunt traumas occur in the setting of motor vehicle accidents, motorcycle accidents, falls, and some
sports. Penetrating trauma occurs often in the setting of a gunshot or stab wound.

30. Active hemorrhage in a 20-year-old man who sustained blunt trauma during
soccer practice. Oblique coronal portal venous phase ct image shows a
heterogeneous right retroperitoneal hematoma

31. Urinary extravasation in a 75-year-old woman with known
left ureterohydronephrosis who sustained blunt trauma in
a fall from a height of 1 m
Portal venous phase CT scan shows a left
subcapsular hematoma

32. Renal agenesis

33. Excretory urography (EU) shows left floating kidney. Figure 1.3, EU of supine image (Fig. 1.3a) and standing image
(Fig. 1.3b) shows caudal movement of the left kidney from supine to standing positioning for more than two
vertebral heights.