Urological investigations

1. Urinary system
(Imaging)
Dr. Vipan Magotra
Professor
Department of Radiodiagnoisis

2. Imaging Techniques
 Plane urinary Tract film. Kidney, Ureters and
bladder(KUB).
 Intravenous urography. (IVU/EU).
 Ante grade and retrograde urethrography.
 Ultrasound.
 CT scan
 MRI
 Angiography

3. Principles of Radiography
The underlying physical principles of conventional
radiography involve
Emitting a stream of photons from x-ray source, strike
body tissue.
Photons with varying amount of energy exit the patient
body and fall on image receptor/film, thus produce an
image

4. X-ray KUB
Indications.
Stone diseases. Help in diagnosis and management
Abdominal pain
Gall bladder stones
Position and size of kidneys and bladder
Show the position of ureteric stent
Preliminary examination to contrast study

5. KIDNEYS
URETERS
URINARY
BLADDER
URETHRA
Good evaluation of radio-opaque stones

9. Preparation. We use laxative, the night
before the test to clear colon of solid
fecal material.
On good quality film psoas muscle should
be visible

10. INTRAVENOUS UROGRAPHY (IVU).
Shows anatomy and functions of the
kidneys. After injection of iv
contrast, it concentrate in the
kidneys. Excreted by kidneys and
pass via ureters in to the urinary
bladder. we take a series of films to
follow the passage of contrast from
kidneys to urinary bladder. Contrast
Shows renal parenchyma, collecting
system and ureters.
Evaluate urothelial
abnormalities,haematuria,urolithiasis
.
Scout film
+/- abd preparation.
Inject bolus of contrast
Nephrogenic phase in first minute
Pyelogenic phase after 5 minutes
Supine,oblique,prone upright and
post void film are taken
Prone films to see distal ureters

11. KUB IVU

13. Also called IVP (intravenous pyelogram)
Demonstrates both function and structure of the renal system
•Function --- Filtration
•Structure --- Contrast filled collecting system
Indications:
•Urolithiasis / calculus
•Pyelonephritis
•Hydronephrosis
•Trauma
•Tumour
•Renal hypertension
•Congenital abnormality
Contra-Indications: (relative)
•History of Allergy
•Asthma
•Cardiovascular disease
•Sickle cell disease
•Diabetes mellitus

14. Voiding/Micturating
cystourethrogram
Functional and anatomical evaluation of
bladder and urethra specially posterior
urethra.
Commonly for kids with recurrent UTI
Dx.reflux,urethralvalve,uretrocele,urethral
stricture and diverticula
Scout film
Pediatric 6-8F catheter
For adult standard catheter
Films during filling the bladder
Oblique films
Post void films
You can see normal bladder film

15. 8-16 F Foleys catheter.
Fill balloon with2cc of
contrast
Inject 50% of contrast in to
the bladder
Take films in oblique
position
Some resistance at the
membranous urethra and
sphincter.
Ascending urethgram
in female
Retrograde urethrogram

16. Now a days first line
investigation.
Grey scale and Doppler
Evaluate renal parenchyma,
adrenals, bladder and prostate.
Can differentiate between solid
and cystic, hydronephrosis,shows
all type of stone
Evaluate congenital anomalies.
Ultrasound

18. US
▶ + ve:
▶ Available
▶ No radiation
▶ Good anatomy
▶ - ve:
▶ Operator dependent
▶ Used for:
▶ Good for kidney stones
▶ Excellent for hydronephrosis
▶Excellent for focal lesion e.g.
cysts, masses

19. CT scan
Gold standard test.
With and with out contrast
Standard CT technique for renal
imaging.
5mm collimation is adequate to
demonstrate kidneys.
IV contrast differentiate
pathological process from normal.
Parenchyma,coricomedullary
differentiation max at 30 seconds
Nephrogenic phase is best seen at
70-100 seconds
Non contrast helical CT shows any
kind and small size of stone

20. ▶ Hyper-dense white
(stone/bone)
▶ Hypo-dense grey to
black (fat/fluid)

21. Venous = Parenchymal Excretion
Arterial = Cortical
Non-contrast

23. CT:
► + ve:
 Relatively available (more then MRI)
 Very good anatomy
► - ve:
 Radiation
 Some times need IV contrast (?
reaction)
► Used for:
 Excellent for kidney stones (the best)
 Excellent for hydronephrosis &
masses
 Excellent for kidney trauma

24. MRI

25. ▶ Hyper-intense (white)
▶ Hypo-intense (grey to
black)

26. MRI
▶ + ve:
▶ Excellent anatomy details
▶ No radiation
▶ - ve:
▶ Expensive
▶Long scanning time (30 to 60
min)
▶Not used to diagnosed kidney
stone
▶ Used for:
▶ Excellent for masses
▶ Good for hydronephrosis

27. ANGIOGRAPHY

28. Cross ectopic. Lower kidney is usually ectopic
one. In 90% of cases there is fusion of kidneys.
There are increase chances of calculus
formation.
Horse shoe kidney. Lower pole of both unite in
the middle. Prone to traume
Pelvic kidney. Kidney is located in the pelvis.
More prone to trauma.
Duplicate collecting system. Complete/part
Congenital anomalies

30. Anamolies