Imaging in urology: part 2 other conventional imaging by Ahmad Al-Sabbagh & revised by M.A. Wadood for more resources: uronotes2012.blogspot.com

3. 1. Evaluation of congenital & acquired ureteral obstruction.
2. Elucidation of filling defects and deformities of the ureters or
intrarenal collecting systems.
3. Opacification or distention of collecting system to assist
percutaneous access.
4. In conjunction with ureteroscopy or stent placement.
5. Evaluation of hematuria.
6. Surveillance of transitional cell carcinoma.
7. In the evaluation of traumatic or iatrogenic injury to the ureter
or collecting system.

4. • Usually done in the dorsal lithotomy position.
• A KUB film is taken to confirm correct positioning, and exposes
kidney stones or bladder stones.
• Cystoscopy is performed and a catheter is inserted in the ureteral
orifice through which the contrast medium is injected
• Documentary still images or “spot films” may be saved for evaluation
during peristalsis & for future comparison

5. 1. Urinary tract infections
2. Patients who cannot or should not be cystoscoped (e.g. patients
recover ing from recent bladder or urethral surger y).

6. 1. Difficult identification of the orifice in case of inflammatory or
neoplastic bladder changes (Helped by IV injection of Methylin Blue)
2. Changes associated with Bladder outlet obstruction causes
angulation of the intramural part of the ureter which may result in
trauma during canulation of the orifice

7. Backflow of contrast which may cause upward introduction of Infection
& absorption of contrast.
A. Pyelotubular Backflow: C. Pyelovenous Backflow:
B. Pyelosinus Backflow:
Injection under pressure → contrast enters the venous
Calyceal tear → leakage
Opacification of medullary system → visualization
to the renal sinus
pyramids. of the renal vein
D. Pyelolymphatic Backflow:
contrast enters the lymphatics
in the renal hilum

10. Historically the term “loopogram” has been associated with ileal conduit
diversion but may be used in reference to any bowel segment serving as
a urinary conduit (Pouch-o-gram is a more accurate discription)
1. Evaluation of infection, hematuria, renal insufficiency, or pain after
urinary diversion
2. Surveillance of upper urinary tract for obstruction
3. Surveillance of upper urinary tract for urothelial neoplasia
4. Evaluation of the integrity of the intestinal segment or reservoir

11. • Supine position.
• A KUB film is taken to confirm correct positioning, and exposes
kidney stones or bladder stones.
• A small-gauge catheter is inserted into the ostomy of the loop,
advancing it just proximal to the abdominal wall fascia. The balloon
can then be inflated to 5 to 10 mL of sterile water.

14. 1. Evaluation of ureteral stricture disease (anterior)
2. Assessment for foreign bodies
3. Evaluation of penile or urethral penetrating trauma
4. Evaluation of traumatic gross hematuria
VCUG is the diagnostic study for anterior urethral stricture

15. • The patient is usually positioned slightly obliquely (45o) and dependent
gip flexed to allow evaluation of the full length of urethra.
• A KUB film is taken to confirm correct positioning, and exposes kidney
stones or bladder stones.
• The penis is placed on slight tension.
• A small catheter may be inserted into the fossa navicularis with the
balloon inflated to 1 - 2 mL .
• Contrast is then introduced via catheter-tipped syringe.
• Alternatively, a penile clamp may be used to occlude the urethra
around the catheter.

18. Urethral trauma- urethral stretch
©

19. Urethral trauma- rupture above pelvic
diaphragm
©

20. Urethral trauma- rupture above pelvic
diaphragm
©

21. Urethral trauma- rupture below pelvic
diaphragm
©

22. Bladder trauma- anterior urethra
©

24. 1. Evaluation of intravesical pathology
2. Evaluation of bladder diverticula
3. Evaluation of inguinal hernia involving the bladder
4. Evaluation of colovesical or vesico-vaginal fistulae
5. Evaluation of bladder or anastomotic integrity after surgical
procedure (urine leakage after bladder surgery)
6. Evaluation of blunt or penetrating trauma to the bladder

25. • The patient is usually positioned in supine position
• A KUB film is taken to confirm correct positioning, and exposes kidney
stones or bladder stones.
• The bladder is filled with 200 to 400 mL of contrast depending on
bladder size and patient comfort.
• Oblique films should be obtained because posterior diverticula or
fistulae may be obscured by the full bladder.
• A postdrainage film completes the study.

30. 1. Evaluation of structural and functional bladder outlet obstruction
(post. ureth. Strict. and PUV).
2. Evaluation of reflux.
3. Evaluation of the urethra in males and females.
VCUG is the diagnostic study for posterior urethral stricture and PUV

31. • The patient is usually positioned in supine position
• A KUB film is taken to confirm correct positioning, and exposes kidney
stones or bladder stones.
• Filling film: The bladder is filled with 200 to 400 mL of contrast (for
bladder pathology & early reflux).
• in ped <12 ys, volume (mL) = (age [years] + 2) × 30 (vary widely based on
patient comfort)
• Voiding film: (for reflux and urethral abnormalities).
• AP and oblique films are obtained.
 Oblique films should because posterior diverticula or fistulae may
be obscured by the full bladder in addition determination of the
grade of reflux (grade I may be hidden in AP film)
• Post-drainage (post-void) film: completes the study.