Urinary System Introduction Lecture PDF

University of Baghdad College of Medicine 2023-2024 Title: introduction to urinary imaging Grade: fourth grade Module: surgical module Speaker: Assist. Prof. Dr. Hiba Mohammed Abdulwahid Date: 30 January 2024 Gross Anatomy Gross Anatomy Anatomy of kidney 151 Techniques that used for urinary system a...

University of Baghdad College of Medicine 2023-2024 Title: introduction to urinary imaging Grade: fourth grade Module: surgical module Speaker: Assist. Prof. Dr. Hiba Mohammed Abdulwahid Date: 30 January 2024 Gross Anatomy Gross Anatomy Anatomy of kidney 151 Techniques that used for urinary system assessment Ultrasound Intravenous pyelography (intravenous urography Retrograde & antegrade pyelography Voiding cystourethrography CT & MRI What are the indication of Ultrasound in Urinary system ? Ultrasound can provide anatomical and morphological information but cannot provide information about the renal function 1. 2. 3. 4. 5. 6. 7. First investigation in suspected UT pathology. Follow up for renal size in CRF , scarring in children with UTI, transplanted kidney & possible complication Assess the presence & the cause, if possible, of hydronephrosis in non-functioning kidney. Evaluate tumors, cysts & abscess. Guide percutaneous procedures. Assess renal blood flow by Doppler US. Assess the bladder & prostate Normal renal Ultrasound kidneys Size (9-12 cm), there may be a difference between the two kidneys of < 1.5 cm. Smooth outlines Renal capsule appear echogenic Normal renal Ultrasound kidneys Central echogenic area (PCS, blood vessels & surrounding fat) : renal sinus echo The cortical echoes are less than that of liver & spleen Pyramids appear as triangular structures of low echo texture Normal renal Ultrasound Normal renal Ultrasound 4513h intra-venous pyelography (IVP) or intravenous Urography (IVU) IVP refer to visualization of the kidney parenchyma, calyces, and pelvis after intravenous injection of contrast Recently it is largely replaced by CT urography Indications: 1. 2. 3. 4. 5. When detailed demonstration of PC system & ureters is required. Suspected ureteric colic. Investigation of renal calculi. check for function of kidneys check for anatomical variants or congenital anomalies (e.g. horse-shoe kidney) and check the course of the ureters 6. Investigation of hematuria Contra-indications of IVU : 1. 2. 3. 4. 5. Contrast allergy Raised serum creatinine. Pregnancy. Thyrotoxicosis Hematological syndrome Procedure Plain film (KUB) : full length -Kidney, ureter, bladder (KUB)to assess radiopaque shadows overlying the renal, ureteric or vesical regions ,and to assess bone & soft tissue abnormalities After Injection of iodinated contrast media (watersoluble contrast; non-ionic contrast is preferred) 1 min (nephrogram) 1-5min film (pyelogram) of both kidneys 10-15 min (images of the upper collecting system and ureters ) (performed with compression) 20-30 min UB (Cystogram phase) Post-voiding film. Normal KUB How to distinguish KUB from plain abdominal radiograph ? Normal KUB Normal plain abdomen dye injection IV iodinated contrast media used Post-contrast film series What to see in IVP Renal size Renal outline Renal position. Calyces and renal pelvis Ureters UB IVU can provide anatomical and functional informations What to see in IVP The renal size The normal kidney measures 10-16 cm in length in IVU which is larger in size than renal size in US mainly due to radiographic magnification of the image A difference of 1.5 cm is acceptable between the two sides A kidney with bifid collecting system is usually 1-2 cm larger than normal What to see in IVP The renal position Rt. K.is lower than the Lt.K. The renal axis is parallel to the psoas muscle (abnormal axis in mal-rotation or displacement of the kidney ) Abnormal position (ectopic, displaced by mass, transplanted K.) LT RT What to see in IVP The renal outlines Renal parenchymal width should be symmetrical & uniform renal cortex measurement (1.5- 2 cm ) except at the poles Minor indentation as in Persistence of fetal lobulation What to see in IVP The renal outlines An important normal variant causing a bulge of the outline is the socalled ‘splenic hump’ (Dromedary) hump” What to see in IVP The calices 1.Normal calices are cup shape, evenly distributed & fairly symmetrical. 2.Dilated calyx is clubbed in shape Causes of dilatation a. obstruction b. papillary destruction (e.g.: TB, papillary necrosis) The renal pelvis: Should be funnel shaped Normal VS dilated calyces in IVP Cupped Clubbed What to see in IVP The ureters 1.Only portion of the ureter is seen due to peristalsis 2. Diameter =