This document provides information on various conventional urinary imaging techniques, including intravenous urography (IVP), micturating cystourethrogram (MCU), and retrograde urethrography (RGU). It discusses the history, indications, contraindications, procedures, and grading of these techniques. IVP involves injecting contrast medium intravenously to visualize the kidneys and urinary tract. MCU involves catheterizing the bladder and filling it with contrast to image the bladder and urethra during voiding. Both techniques can detect abnormalities and evaluate renal function, but have been supplemented by ultrasound, CT, MRI and nuclear medicine due to improved sensitivity, specificity and safety.
INTRAVENOUS UROGRAM OR INTRAVENOUS PYELOGRAMThis presentation covers in detail about the anatomy, patient preparation, procedure and pathologies.
It contains lots of images and timings for imaging.
you can look into this presentation for more ideas about IVU/ IVP.
-THANK YOU-
INTRAVENOUS UROGRAM OR INTRAVENOUS PYELOGRAMThis presentation covers in detail about the anatomy, patient preparation, procedure and pathologies.
It contains lots of images and timings for imaging.
you can look into this presentation for more ideas about IVU/ IVP.
-THANK YOU-
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.
Ivu is a radiological investigation for visualization and assessment of the urinary tract.This presentation covers brief anatomy of urinary tract, indication and contraindication,contrast media dose and administration, routine and modified ivu procedure,its complication,ctivu and some abnormalities in the urinary tract.
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.
HELLO GUYS, THIS PRESENTATION IS ABOUT CONVENTIONAL CONTRAST STUDY USED IN RADIOGRAPHY FOR EXAMINING LOWER URINARY TRACT AND TO CHECK VARIOUS PATHOLOGIES OR VESICO URETRO REFLUX. CONTRAST MEDIA IS USED TO VISUALIZE THE TRACT. M.C.U. is also known as Voiding Cystourography.
IVU is the radiographic examination of urinary tract including renal parenchyma, calyces and pelvis after intravenous injection of contrast media. Study was carried out at UCMS, Bhairawa, Nepal.
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.
Ivu is a radiological investigation for visualization and assessment of the urinary tract.This presentation covers brief anatomy of urinary tract, indication and contraindication,contrast media dose and administration, routine and modified ivu procedure,its complication,ctivu and some abnormalities in the urinary tract.
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.
HELLO GUYS, THIS PRESENTATION IS ABOUT CONVENTIONAL CONTRAST STUDY USED IN RADIOGRAPHY FOR EXAMINING LOWER URINARY TRACT AND TO CHECK VARIOUS PATHOLOGIES OR VESICO URETRO REFLUX. CONTRAST MEDIA IS USED TO VISUALIZE THE TRACT. M.C.U. is also known as Voiding Cystourography.
IVU is the radiographic examination of urinary tract including renal parenchyma, calyces and pelvis after intravenous injection of contrast media. Study was carried out at UCMS, Bhairawa, Nepal.
An IVU (Intravenous Urography) is an x-ray of your urinary tract (consisting of kidneys, ureters and bladder) following an injection of a clear dye called contrast into a vein in your arm.
The pictures produced are called intravenous urograms (IVU) or intravenous pyelograms (IVP).
A series of x-rays are taken of the abdomen at various time intervals. This usually takes up to an hour, but occasionally it may be necessary to take additional delayed images, which may continue for several hours.
Routine IVP[edit]
This procedure is most common for patients who have unexplained microscopic or macroscopic hematuria. It is used to ascertain the presence of a tumour or similar anatomy-altering disorders. The sequence of images is roughly as follows:
plain or Control KUB image;
immediate X-ray of just the renal area;
5 minute X-ray of just the renal area.
15 minute X-ray of just the renal area.
At this point, compression may or may not be applied (this is contraindicated in cases of obstruction).
In pyelography, compression involves pressing on the lower abdominal area, which results in distension of the upper urinary tract.[1]
If compression is applied: a 10 minutes post-injection X-ray of the renal area is taken, followed by a KUB on release of the compression.
If compression is not given: a standard KUB is taken to show the ureters emptying. This may sometimes be done with the patient lying in a prone position.
A post-micturition X-ray is taken afterwards. This is usually a coned bladder view.
Image Assessment[edit]
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
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In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
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Growing Prevalence of Lifestyle Diseases
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CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...
IVP by Dr.Anil.ppt
1. DR. ANIL RAWAT
ASSISTANT PROFESSOR
Conventional techniques in urinary system imaging
(IVP, MCU, RGU)
2. History
In 1896, for first time, X-ray demonstration of renal calculi
in a patient was done.
Techniques of cystography, retrograde pyelography and
retrograde urethrography were described within 15 years
after that.
With introduction of RGP, renal PCS and ureters were made
available for X-ray study.
In 1929, Moses Swick invented uroselectan (5-iodo-2-
pyridone-N-acetic acid ) which led to revolutionary advent
of IVP.
3. Progressive improvement in the chemistry of contrast media
made IVP an excellent method for studying PCS and renal
parenchyma.
Subsequent development of better and safe contrast media like
iohexol, iopamidol etc. brought a current era of lower osmolality
radio-opaque contrast media.
Currently, the use of USG, CT, MRI and radionuclide scanning
has superseded older conventional techniques at many fronts in
the form of high sensitivity, specificity and better safety margins.
4. EXCRETORY UROGRAPHY
Excretory urography refers to visualization of the kidney
parenchyma, calyces and pelvis after iv. Injection of
contrast.
The excretory Urogram is the classic routine investigation
of Uroradiology.
Technically satisfactory IVU demonstrates clearly and
completely both the renal parenchyma & the collecting
system including the calyces, renal pelvis, ureters and the
urinary bladder and gives an indication of their function.
5. INDICATIONS:
Hematuria
Renal colic
Renal trauma
Persistent pyuria
Prior to percutaneous urological procedures to define renal
anatomy
Prior to surgery involving risk of significant ureteric injury
After surgery e.g. Ureteric surgery
Ureteric strictures or fistulas
Complex urinary tract infection (including tuberculosis)
Work up of live donor in renal transplant
To screen for renal anomalies in patient with multiple
congenital anomalies.
6. CONTRAINDICATIONS:
No absolute contraindication
Relative contraindications
• Previous reaction to contrast media
• Asthma
• Renal & hepatic failure
• Multiple myeloma
• Pregnancy
• H/o allergy to other drugs
• Thyroid disease
• Diabetes
• Sickle cell disease
7. PATIENT PREPARATION
Dehydration : Overhydration should be avoided but dehydration
is unecessary. It is a potentiating factor for contrast induced
nephrotoxicity.
Bowel preparation
2 tab charcol or gasex TDS X 2days prior to examination &
25 ml Castor oil or 2 tab Dulcolax at night X 2 days prior
Ambulatory for 2 hrs prior to examination to reduce bowel gas
A group of children in which we never perform bowel
preparation are those with myelomeningocele.
• Fasting on the morning of the study
8. EXPOSURE FACTORS
Kvp 65-75
mA Sufficiently high to allow short exposure
times(mA-600-1000 mA or 60 MAS),
Exposure time < 0.1 sec (approx 80 msec in adults, < 50
msec in children)
Film/Screen combination Medium speed
All exposures are to be made in suspended expiration to
minimize geometric distortion of renal image because deep
inspiration causes descent and ventral rotation of lower poles
of the kidneys
9. History taking
Clinical history of patient
Co-morbid illnesses eg. diabetes, hypertension,
cardiac disease, thyroid disease and other risk
factors
Renal function (S. creatinine)
LMP in females
Drugs
Written informed consent before contrast
administration
10. Technique
KUB radiograph, an indispensable part of sequence.
Appropriate technique (65–75 kVp, high mA, short
exposure time) to maximize inherent soft-tissue contrast
and optimize visualization of calcium-containing lesions
that are potentially of urinary tract origin.
Proper KUB may require additional images for evaluating
portions of urinary tract not seen on standard 14* 17-inch
image (area from suprarenal region to a level below
symphysis pubis).
Patient should void immediately prior to examination.
11. PROCEDURE
Plain film of the abdomen (Scout film)
Area to be included from the suprarenal region to
the level below the symphysis pubis.
The patient should void immediately prior to undergoing this
examination.
Center the rays at the level of the iliac crest in the midsagittal
plane.
Gonadal shields should be used routinely throughout the
examination.
12.
13.
14.
15. Things to look for in plain abdominal radiograph:
1. Calculus/ calcifications: Assessment of probable location
of calcifications in abdomen with respect to urinary tract
should be made prior to contrast injection, which can
obscure a calcification. Oblique radiographs helpful.
2. Skeletal abnormalities: spinal deformity, metabolic bone
changes, skeletal metastasis.
3.Intestinal gas pattern: Ileus, obstruction.
4.Abdominal masses: May be seen better on scout view.
5.Foreign bodies: Opaque foreign bodies or barium.
19. Indications for LOCM
Those at high risk of anaphylactoid reaction:
Previous reactors
Asthamatics
Atopics
allergy to other drugs
20. Those unable to tolerate a high osmotic load
Poor cardiac reserve
Infants and elderly patients
Sickle cell disease or trait
Pre-existing renal impairment
21. Contrast administration
Bolus infusion of 350-370 strength water-soluble
contrast is done with 18 gauge needle into
antecubital vein.
adult dose 50 ml
elderly and
obese patient
75 ml
small children 1.5 ml/kg
neonate 4ml/kg
22. Although modern contrast medium is exceptionally safe,
there is a small risk of serious reactions.
Most dangerous of these are anaphylactoid -type
hypersensitivity reactions. To minimise the risks of these a
routine inquiry about previous contrast exposure and
allergy is recommended.
Injection should be through some form of indwelling
cannula or needle that can he taped into place for duration
of investigation.
Most adverse events are likely to take place within first few
minutes after injection. Emergency drugs, oxygen and
resuscitation equipment should also be readily available.
23. Filming sequence
1 min –nephrogram (often omitted as renal outline are
adequately visualised on 5 min radiograph)
5 min- collecting system
Abdominal compression at 5 min
10 min - proximal ureters
15 min ‘release’ film- entire urinary tract
Full bladder film
Post micturation film
24.
25. In our department
Scout film
5 min film with compression for PCS
15min film with release of compression for ureter
20 min film in prone position (if lower ureter not visualized
in 15 min film)
full bladder
Empty bladder
All films are taken in suspended respiration at end-
expiration.
26. 1 min film (Nephrogram)
Nephrograms are produced
primarily by filtered contrast
material within the nephron,
with optimal visualization of
the renal parenchyma 1–3
minutes after bolus injection.
Features to be seen here are:
Size
Contour
position
Axis of kidney
27. 5 min film
Focused to the renal area
(to assess temporal symmetry
and progress of opacification).
28. Abdominal compression
Applied after 5 min film with compression pad placed
between ASISs (ureters are compressed against the
sacrum as the ureter traverses the sacral ala)
Produces partial ureteric obstruction
Distension of calyceal system
Improved calyceal detail
Reliable ureteric opapification
on release
29. Value of compression. (a) On a radiograph obtained 5 minutes after
administration of low- osmolar urographic contrast material, the
collecting system is bilaterally underfilled and poorly demonstrated.
(b) On a radiograph obtained 5 minutes after compression was applied,
distention of the collecting system is significantly improved (arrows).
30. Contraindications to compression
Urinary tract obstruction
Severe abdominal pain e.g.. Ureteric colic
Abdominal mass or abdominal aortic aneurysm
Recent trauma or abdominal surgery
IVC filter
Presence of urinary diversion e.g.. nephrostomy
Renal transplant
Severe hypertension
31. 15 min film Ureter -bladder images
Full film is taken immediately after release of compression
to visualise ureter and filling bladder
32. Bladder Films
Central ray is angulated by 15
degrees caudally and centered
in midline to a point 5 cm above
pubic symphysis or 2.5 cm
below ASIS.
Exposure is made on suspended
expiration.
33. Post micturation film
Residual urine
Diverticula
Bladder hernia
Bladder tumor
Obstructive urethral lesion
Distal ureteral process e.g.
Ureterocele
Primary mega ureter
34. Additional films
Oblique radiographs
Prone radiograph
Erect radiograph
Full length post- micturation radiograph
Fluoroscopy
35. Patient Aftercare
General psychological reassurance.
Needle wound site dressed and checked for
extravasation.
Tell to patient how to receive the report of
examination
Ensure patient has understood preparation
instructions are finished
36. Examination Effective dose (mSv) Equivalent no. of
chest x-rays
Limbs and joints (except
hip)
< 0.01 <0.5
Chest PA 0.02 1
Skull 0.06 3
Thoracic spine 0.7 35
Lumbar spine 1 50
Hip 0.4 20
Abdomen or Pelvis 0.7 35
IVU 2.4 120
Ba swallow 1.5 75
Ba meal 2.6 130
BMFT 3 150
Ba enema 7.2 360
CT head 2.0 100
CT chest 8.8 400
CT abdomen or pelvis 10 500
37. Micturiting Cystourethrogram/MCU/VCU
Commonly used examination for
UB and urethral evaluation in
both children and adult.
Preliminary abdominal imaging
precedes catheterization. If an
abdominal radiograph obtained
within past 3– 6 months , a scout
image may be unnecessary.
Abdominal radiograph may
reveal bone abnormalities,
calcifications, foreign bodies, or
other disease processes.
38. Indications for VCU in children
Main is UTI, esp. in girls <5 yrs age.
In neonate, MC indication is hydronephrosis detected on
prenatal USG.
To look for VUR (30 – 50% children with UTI have VUR)
For congenital lower urinary tract anomalies.
39. Indications for VCU in adults
Trauma
UTI
To document reflux nephropathy
Evaluation and follow up of in spinal cord injury or voiding
difficulties
Following renal transplantation to see for bladder capacity,
VUR or BOO.
In females to look for urethral diverticula.
40. For catheterization, a 5-F feeding tube is appropriate in
children under 3 months of age and an 8-F feeding tube in
all other children.
In female child, after cleansing intralabial region with
povidone iodine solution, a small drop of solution remains
pooled in midline, depressed, slightly oval meatus, which
thus becomes easily visible. It helps prevent vaginal
catheterization.
In boys, external sphincter is MC site of resistance to
catheter advancement. Gentle, steady pressure rather than
intermittent poking at this level permits advancement into
the bladder.
41. In older boys, retrograde injection of 2% lidocaine jelly into
urethra several minutes before catheterization may be used
to diminish sensation.
Once catheter has safely reached UB, filling with diluted
contrast material can begin.
During early filling, minimally filled bladder is imaged in
AP projection. A ureterocele or bladder tumor well seen
during early filling may become obscured as more contrast
material enters bladder.
42. Older children may indicate when voiding is imminent. In
younger children, as bladder capacity is reached, flow of
contrast material may slow, stop, or even reverse in tubing,
indicating an abrupt rise in intravesical pressure and
complete bladder filling.
At this stage steep oblique images of bladder centered on
UVJ should be obtained.
Bladder Capacity = (Age [Years] + 2) * 30
Volume of contrast instilled should be recorded.
43. URINARY BLADDER CAPACITY (in ml)
ACCORDING TO AGE :
For <2 years-
weight(kg)*7
For>2 to 12 years-
( age(years)+2)*30
For adults around 500ml
44. Male Urethra can also be divided into:
Anterior Urethra-
Penile urethra
Bulbar urethra
Posterior Urethra-
Membranous urethra
Prostatic urethra
45. VUR can be seen on oblique
radiographs obtained just before
voiding and can be graded after
voiding.
If reflux is observed during late
bladder filling, ipsilateral renal fossa
may be imaged in AP projection
prior to voiding.
Catheter may be removed as voiding
is initiated, but voiding around it is
recommended as it allows desired
cyclic voiding in neonates, repeat
filling if needed, and bladder
drainage when unable to empty
bladder completely.
46. Approximately 20% of reflux will be
missed if voiding does not occur.
Urethral disease is very rare in
girls, and one AP image of urethra
is usually sufficient. Voiding while
supine, especially with legs in close
apposition, can produce vaginal
reflux.
In boys, entire urethra must be
imaged in steep oblique position
because disease can occur
anywhere from the bladder base to
the urethral meatus.
After voiding, each renal fossa
should be imaged.
47. Causes of VUR:
Anatomical causes –
Posterior urethral valves(PUV’s)-most common anatomical
cause
Prostatomegaly
Ureteroceles
Ureteral duplication
Neurofunctional causes-
Neurogenic bladder
Dysfunctional voiding
Uninhibited bladder contractions-most common
urodynamic abnormality associated with reflux
48. GRADES OF VUR
GRADE 1-reflux limited to ureter
GRADE2-reflux upto the renal pelvis
GRADE 3-mild dilatation of ureter and pelvicalyceal system
GRADE4-tortuous ureter with moderate dilatation
blunting of fornices with preserved papillary impressions
GRADE5-tortuous ureter with severe dilatation of ureter and
pelvicalyceal system
loss of fornices and papillary impressions
51. GRADE 3-mild dilatation of ureter and pelvicalyceal
system
52. GRADE 4-tortuous ureter with moderate dilatation
blunting of fornices with preserved papillary
impressions
53. GRADE 5-tortuous ureter with severe dilatation of
ureter and pelvicalyceal system loss of fornices and
papillary impressions
54. Points to be assessed and reported by radiologist at end of
examinations:
1. status of spine and pelvis
2. presence of masses or opaque calculi
3. bladder capacity and contour and emptying capability
4. presence and grade of reflux and obstruction of a
refluxing segment
5. insertion site of a refluxing ureter
6. appearance of entire urethra
55. Retrograde urethrography (RGU)
Best initial study for urethral and
periurethral imaging in men, indicated
in evaluation of urethral injuries,
strictures, and fistulas.
Not a physiological examination.
External meatus prepared in standard
sterile fashion for placement of a
conventional 16- or 18-F Foley catheter.
Catheter, with both irrigating syringe
and inflating (saline solution) syringe
attached, should be flushed before use.
When balloon portion of catheter is
seated in fossa navicularis of penile
urethra, balloon is inflated with 1.0–1.5
mL of saline solution.
56. Lubrication not recommended, may prevent balloon
from remaining in place for optimal occlusion.
Patient placed in a supine 45° oblique position, penis
placed laterally over proximal thigh with moderate
traction.
20–30 mL of 60% iodinated contrast material is injected
so that anterior urethra is filled.
Commonly, spasm of external urethral sphincter will be
encountered preventing filling of deep bulbar,
membranous, and prostatic urethras. Slow, gentle
pressure is usually needed to overcome this resistance.
57. Contrast material can seen to jet through
bladder neck into bladder.
Verumontanum seen as ovoid filling defect
in posterior part of prostatic urethra.
Distal end of it marks proximal boundary
of membranous urethra
Identification of bulbomembranous
junction (1–1.5 cm distal to the inferior
margin of verumontanum) on a RGU is
important for assessing patients with
urethral disease as well as for planning
urologic procedures.
With poorly opacified posterior urethra ,
bulbomembranous junction can be
localized by an imaginary line connecting
inferior margins of obturator foramina
intersects urethra.
58. Filming:
Under fluoroscopic control, contrast medium is injected and spot films are
taken in the following positions-
30-degree right anterior oblique with left leg abducted and knee flexed
Supine AP
30-degree left anterior oblique with right leg abducted and knee flexed
59.
60. Anterior urethra extends from its
origin at end of membranous urethra
to urethral meatus, divided into bulbar
segment and penile segment. There is
usually mild angulation of the urethra
where these two segments join at
penoscrotal junction.
Contraction of constrictor nudae
muscle, a deep musculotendinous sling
of bulbocavernous muscle, may cause
anterior or circumferential indentation
of proximal bulbous urethra at RGU
(should not be confused with urethral
stricture)
If the membranous urethra can be
identified, it should not be confused
with a stricture.
61. Narrowing elsewhere in urethra will be
clearly defined as separate from
membranous urethra and, therefore,
representative of a pathologic stricture.
If the patient is not positioned sufficiently
oblique, the bulbous urethra will appear
foreshortened and will therefore not be
adequately evaluated.
Filling of Cowper ducts should not be
misinterpreted as extravasation.
If integrity of urethral mucosal lining is
disrupted by increased pressure during
contrast material injection, intravasation
of contrast material with opacification of
corpora and draining veins may occur.
62. Extravasation: Intramural extravasation
can occur in bladder esp. during voiding,
but is self limited and requires no
treatment.
Inadvertent catheterization of vagina or
ureter: If vagina is catheterized, tubular
shape with reflux into uterus , fallopian
tubes or peritoneal cavity may occur.
Catheter can also enter a ureter with an
ectopic ending, of a double collecting
system or one with a very dilated orifice.
Radiation effect
Autonomic dysreflexia
63. Complication of MCU/RGU
Infections: Bacteria may be introduced via the catheter
and high fever can develop after cystography.
Trauma: Dysuria, urinary retention and penetration of
bladder wall may develop following catheterization.
Reaction to contrast medium: Very rare, when contrast
can get absorbed through bladder wall or from the
ureteral or pyelocalyceal epithelium or intravasation
during RGU.
In children with ventriculoperitoneal shunt, nonionic
contrast is to be used.
Knotting of catheter within bladder
64. Urethral Trauma
Urethral injuries are divided into anterior and posterior
urethral injuries .
Causes:
Blunt Trauma-due to shearing/straddle injuries
posterior urethral injury is caused by a crushing force to
the pelvis and is associated with pelvic fractures and
bladder injury .
anterior urethral injury is usually caused by a straddle
injury and is an isolated injury
Penetrating trauma-due to stab wounds,gunshot wounds
more commonly affects anterior urethra
Iatrogenic-Catheterization,Cystoscopy
Post surgical(surgery for Benign Prostatic Hyperplasia)
65. Retrograde Urethrography is the modality of choice
to investigate the anterior part of urethra .It will
demonstrate extraluminal contrast which has
extravasated from the urethra at the site of injury.
VCUG is the most appropriate way to evaluate the
posterior part of male urethra and injuries to
female urethra.
66. Goldman system for Classification of urethral
injuries:
Type 1-
Stretching of prostatic urethra due to disruption of
puboprostatic ligaments but the urethra is intact.
Urethrographic appearance shows intact but stretched urethra
67. Type 2-
Posterior urethral injury above urogenital
diaphragm while the membranous segment
remains intact .
Urethrographic appearance shows contrast
material extravasation above urogenital
diaphragm only.
68. Type 3-(most common)
Injury to membranous urethra extending into proximal bulbous
urethra(with laceration of urogenital diaphragm).
Urethrographic appearance shows contrast material
extravasation below the urogenital diaphragm,possibly
extending into pelvis or peritoneum with intact bladder neck.
69. Type 4-
Bladder base injury involving bladder neck extending
into proximal urethra.Internal Sphincter is injured
hence incontinence can occur.
Extraperitoneal contrast agent extravasation,bladder
neck disruption
70. Type 4a-
Bladder base injury but not involving bladder
neck .
Cannot be differentiated from Type 4
radiologically.
Periurethral contrast material extravasation
,bladder base disruption.
71. Type 5-
Anterior urethral injury (isolated).
Contrast material extravasation below urogenital
diaphragm in and around penile soft tissue.
72. MCU VS RGU
MCU is performed to demonstrate posterior urethral
abnormalities ,in addition it shows bladder
pathologies and VUR also.
RGU is performed to demonstrate anterior urethral
abnormalities.
In cases of Trauma, RGU is performed before MCU to
avoid more injury while introducing Foley catheter
blindly into bladder.