The document describes the anatomy and radiographic evaluation of the urethra. It discusses the male and female urethra anatomy in detail. Retrograde urethrography and voiding cystourethrography are described as the main modalities for urethral imaging. Retrograde urethrography is used to evaluate traumatic injuries, strictures, and fistulas in men. Voiding cystourethrography is useful to assess the urethra during micturition and to detect vesicoureteric reflux in children.
A presentation about Intravenous Urography (Also known as Intravenous Pyeography).
The presentation contains 41 slides, and is divided into 4 parts :
1 - Introduction.
2 - The procedure.
3 - Examples for abnormal findings.
4 - Studies comparing IVU accuracy with KUB & USG with CT Scan.
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
A presentation about Intravenous Urography (Also known as Intravenous Pyeography).
The presentation contains 41 slides, and is divided into 4 parts :
1 - Introduction.
2 - The procedure.
3 - Examples for abnormal findings.
4 - Studies comparing IVU accuracy with KUB & USG with CT Scan.
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
A presentation about Imaging the urinary tract using contrast.
contains 45 slides, and covers the following methods :
1 - Antegrade urography
2 - Retrograde urography
3 - Retrograde cystography
4 - Voiding cystography
5 - Retrograde Urethrography
Intravenous urography is covered in a separate presentation, that you can read and download from here :
http://www.slideshare.net/abdallamutwakil/intravenous-urography-ivu-35107052
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
This presentation include biliary anatomy ,indication, contraindication post op care of percutaneus transhepatic biliary drainage with important technique. and advantage and disadvantage of different technique. This is important for radiologist, radiographers, intervention radiologist radiology resident. Thanks
Learn Barium Meal & Follow Through for the beginners from a Radiology Resident.For some image description please go through the text book "David Sutton" because i have described these image during my presentation Verbally..There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
A presentation about Imaging the urinary tract using contrast.
contains 45 slides, and covers the following methods :
1 - Antegrade urography
2 - Retrograde urography
3 - Retrograde cystography
4 - Voiding cystography
5 - Retrograde Urethrography
Intravenous urography is covered in a separate presentation, that you can read and download from here :
http://www.slideshare.net/abdallamutwakil/intravenous-urography-ivu-35107052
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
This presentation include biliary anatomy ,indication, contraindication post op care of percutaneus transhepatic biliary drainage with important technique. and advantage and disadvantage of different technique. This is important for radiologist, radiographers, intervention radiologist radiology resident. Thanks
Learn Barium Meal & Follow Through for the beginners from a Radiology Resident.For some image description please go through the text book "David Sutton" because i have described these image during my presentation Verbally..There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
2. INTRODUCTION
Retrograde urethrography and voiding cystourethrography -
modalities of choice for imaging the urethra.
RGU-Primary imaging modality for evaluating traumatic
injuries, inflammatory and stricture diseases of male urethra.
VCUG frequently used to evaluate urethral diverticula in women
USG, MRI and CT-useful for evaluating periurethral structures.
MR imaging is also accurate in the local staging of urethral
tumors.
3. MALE URETHRA
Length-17.5 to 20 cm.
Consists of
-Anterior portion
-Posterior portion
Each portion is
subdivided in two parts.
4. ANTERIOR URETHRA
Anterior urethra - from external urethral
meatus to inferior edge of the urogenital
diaphragm, coursing through the corpus
spongiosum.
The anterior urethra is conventionally divided
into
- Penile (or pendulous)
- Bulbous parts(at the penoscrotal junction)
5. The penile portion terminates in the glans
penis to form the fossa navicularis, which is
1–1.5 cm long.
The proximal portion of the bulbous
urethra is dilated called “sump” .
Just proximal to the sump, the bulbous
urethra assumes a conical shape at the
bulbomembranous junction called “cone.”
6. POSTERIOR URETHRA
Divided into
-Prostatic urethra
-Membranous urethra
PROSTATIC URETHRA
Approx. 3.5 cm long.
Passes through the prostate slightly anterior to the
midline.
Urethral crest-longitudinal ridge of smooth muscle
that extends from bladder neck to membranous urethra
on posterior wall .
7. Prostatic utricle- small saccular depression which is
remnant of mullerian duct opens over urethral crest at
the centre of Verumontanum.
Just distal & lateral to utricle are the orifices of the
paired ejaculatory ducts.
MEMBRANOUS URETHRA
1-1.5 cm long
perforate UG diaphragm
Surrounded by muscles fibers (sphincter urethrae) of
UG diaphragm( ext. sphincter)
8. GLANDS & DUCTS
Periurethral Littre´ glands –in ant. Urethra & are more
numerous at the dorsal aspect.
Cowper glands - lie within the urogenital diaphragm
on either side of the membranous urethra. The ducts of
the Cowper gland empty into the bulbous urethral sump.
Ejaculatory duct-on either side of orifice of prostatic
utricle.
Prostatic glands-opens directly in prostatic urethra via
multiple small openings aound the verumontanum.
9.
10. Radiologic anatomy of the urethra prostatic urethra (p), membranous urethra (m),
bulbous urethra (b), penile urethra (pe)
11.
12. FEMALE URETHRA
Length- 4 cm
Extends from the bladder neck at the urethrovesical
junction to the vestibule which runs downwards and
forwards embedded in the ant.wall of vagina, traverse
UG diaphragm and ends at external urethral orifice of
vestibule.
Many small periurethral glands open into the urethra.
Distally, these glands group together on either side of
the urethra(Skene glands) and empty through two
small ducts to either side of the external meatus.
13.
14. Retrograde urethrogram
Retrograde urethrography -Best initial study for
urethral and periurethral imaging in men and is
indicated in the evaluation of urethral injuries,
strictures and fistulas.
Straight forward, readily available, cost-effective
examination
16. Contrast media
HOCM or LOCM 200-300, 2w0 ml
Pre-warming the contrast media will help
reduce the incidence of spasm of the external
sphincter.
Equipment
Tilting radiography table with flouroscopy
unit & spot film device.
Foley’s catheter 8F.
17. Patient preparation
Empty urinary bladder
Allergic to x-ray contrast material
Consent
Preliminary film
Coned supine PA view of bladder base &
urethra
18. Technique
The pt. lies supine on x-ray table.
Using aseptic technique the tip of the catheter is
inserted so that the balloon lies in the fossa
navicularis. Lubrication is not recommended.
The patient should be reassured about the
discomfort that is experienced during balloon
inflation.
Balloon is inflated with 1-2 ml of saline.
The patient is placed in a supine oblique position.
The penis should be placed laterally over the
proximal thigh with moderate traction.
19. Then, 20–30 ml of contrast material is injected
under fluoroscopic guidance to fill ant urethra.
Commonly spasm of the external urethral
sphincter will be encountered, which prevents
filling of the deep bulbar, membranous, and
prostatic urethras.
Slow, gentle pressure is usually needed to
overcome this resistance.
20. Retrograde urethrogram : resistance to passage of cm at the region of ext.sphincter
resulting in dilatation of the anterior urethra d/t pressure of injection
21. Films
1) 30 degrees LAO, with right leg abducted &
knee flexed.
2) Supine PA
3) 30 degrees RAO, with left leg abducted &
knee flexed.
Retrograde urethrography should be followed
by micturating cystourethrography to
demonstrate the proximal urethra .
22. Reflux of contrast medium into dilated prostatic ducts is
also better seen during micturition.
The verumontanum is seen as an ovoid filling defect in
the posterior part of the prostatic urethra.
The distal end of the verumontanum marks the
proximal boundary of the membranous urethra. This is
also the region of the external sphincter of the urethra.
The distal boundary of the membranous urethra is the
cone of the bulbar urethra.
23. Identification of bulbomembranous jn.
The identification of bulbomembranous junction on RGU is very
important for assessing patients with urethral disease and for
planning urologic procedures.
When the posterior urethra is optimally opacified and the
verumontanum visible, the bulbomembranous junction can be
identified 1–1.5 cm distal to the inferior margin of the
verumontanum.
When the posterior urethra is suboptimally opacified, the
bulbomembranous junction can be arbitrarily localized where an
imaginary line connecting the inferior margins of the obturator
foramina intersects the urethra.
24. The anterior urethra extends from its origin at the end of the
membranous urethra to the urethral meatus.
There is usually mild angulation of the urethra where the
pedulous & bulbar segments join at the penoscrotal junction.
Contraction or spasm of the constrictor nudae muscle, a deep
musculotendinous sling of the bulbocavernous muscle, may cause
circumferential indentation of the proximal bulbous urethra. It
should not be confused with urethral stricture
The membranous urethra should not be confused with stricture.
Narrowing elsewhere in the urethra will be clearly defined as
separate from the membranous urethra and, therefore,
representative of a pathologic stricture.
25.
26. If the patient is not positioned sufficiently oblique,
the bulbous urethra will appear foreshortened and
will therefore not be adequately evaluated .
27.
28. Filling of the Cowper ducts should not be
misinterpreted as extravasation .
Opacification of the prostatic ducts, Cowper
ducts, and periurethral Littre´glands is often, but
not necessarily, associated with urethral
inflammatory and stricture disease.
If the integrity of the urethral mucosal lining is
disrupted by increased pressure during contrast
material injection, intravasation of contrast
material with opacification of the corpora and
draining veins may occur.
29. After care
None
Complications
Due to contrast medium
Rare
Due to technique
Acute UTI
Urethral trauma
Intravasation of contrast medium,esp. if excessive
presure is used to overcome stricture.
30. Antegrade Urethrogram
Definition: Filling the bladder with contrast
media through urethral catheter or by
percutaneous needling of bladder
suprapubically for examination of bladder and
the urethra( during voiding)- Voiding
cystourethrography (VCUG) or micturating
cystourethrography (MCU).
31. Excretory micturition cystourethrography
(EMCU): variation of antegrade method,
the urethra is studied after opacification of
bladder by I.V urography.
Often inadequate for study of the urethra
because of insufficient radiodensity of
bladder urine after IVU; however result can
be improved by having the patient void
against resistance e.g compress penis
between fingers during voiding.
32. Indications
Vesicoureteric reflux
Study of urethra during micturition
Abnormalities of bladder
Stress incontinence
Contraindication
Acute UTI
Hypersensitivity to contrast media
Fever within the past 24 hours
33. Contrast medium
HOCM or LOCM
Water soluble contrast media (150 mg/ml iodine) are
used, which are diluted with normal saline in 1: 3 ratio.
Equipment
Flouroscopy unit with spot film device & tilting table.
Video recorder
foley catheter
In infants 5-7 F feeding tube is adequate.
Patient preparation:
Pt. micturates prior to the examination.
Preliminary films
Coned view of the bladder.
34. Technique
To demonstrate vesico-ureteric reflux
Indicated almost exclusively in children
Pt. lies supine on x-ray table.
Using aseptic technique ,a catheter lubricated with
sterile gel containing LA & antiseptic is
introduced in bladder.
Residual urine is drained.
Contrast material is slowly dripped in & bladder
filling is observed by intermittent flouroscopy
35. Initial filling should be monitered by flouroscopy
as catheter may be in ureter(mimick vesico-
ureteric reflux) or vagina.
Any reflux is recorded on spot films.
The catheter should not be removed until the
radiologist is convinced that the patient will
micturate or until no more contrast media will
drip into the bladder.
36. Older children & adults are given urine
receiver while small children are allowed to
micturate onto absorbent pads on which
they lie.
Children can lie on table but adults will find
it easier to micturate while standing erect.
37. In pt. of neuropathic bladder ,micturition can be
accomplished by surapubic pressure.
Spot films are taken during micturition & any reflux
recorded.
Lower ureter is best seen in anterior oblique position of
that side.
Finally a full length view of the abdomen is taken to
demonstrate any reflux of contrast medium that might
have occurred unnoticed into the kidneys & to record
post micturition volume.
39. To demonstrate stress incontinence
Same procedure but catheter is left in situ until the
pt. is in erect position
Films
It should include sacrum & symphysis pubis b’coz
bony landmarks are used to assess bladder neck
descent.
1. Lateral bladder
2. Lateral bladder,straining
The catheter is then removed.
3. Lateral bladder during micturition.
40. Normal antegrade urethrogram . The mild areas of narrowing and dilation are
normal. On an antegrade study, unlike a retrograde examination, the proximal
urethral is distended and readily assessed. No evidence of stricture or
extravasation is seen.
41.
42. Normal female VCUG. Note the smooth contour
of the urinary bladder and the short, conical
appearing urethra.
43. Aftercare
Pt. & parents of children should be warned that
dysuria, possibly leading to retention of urine
may rarely occur. In such cases analgesic should
be given & children may be helped by allowing
them to micturite in warm bath.
If reflux is present, antibiotics should be
prescribed.
44. Complications
Due to contrast medium
Contrast medium induced cystitis.
Due to the technique
Acute UTI
Catheter trauma-dysuria, increased frequency of
micturation, hematuria & urinary retention.
Complication of bladder filling-perforation from
overdistention, prevented by using non-retaining catheter
eg. Jaques
Retention of a foley cathter.
50. Narrowest and least distensible part of the
urethra is ?
a. prostratic urethra
b. membranous urethra
c. bulbous urethra
d. pendulous urethra
51. which of the following are incorrect regarding ducts
that open into urethra;
A. Glands of littre: penile urethra
B. Ejaculatory duct: prostatic urethra
C. Skene glands: female urethra
D. Cowper’s duct: membranous urethra