RADIOLOGY IMAGING

Semi Cluster Bedah (RSST-FK UGM)

URINARY TRACT IMAGING

INTRA VENOUS PYELOGRAPHY

ULTRASONOGRAPHY
ANTEGRAGE PYELOGRAPHY
RETROGRADE PYELOGRAPHY
MCU, URETHROGRAPHY
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
RENOGRAPHY

DEFINITION IVP
A type of x-ray examination specifically
designed to study the kidneys, ureters and
bladder, using contrast material (x-ray dye).

INDICATION AND CONTRA INDICATION

Suspected of urologic
disease:
infections
acute genitourinary
pain
hematuria (microscopic
or gross)
trauma
suspected neoplasm
renal transplantation
neurogenic bladder
congenital anomalies
investigation of
complications following
a surgical procedure

combined
renal
and liver failure
multiple myeloma
pregnancy
previous reactions
to contrast media
history of allergy
infancy
thyroid disease
renal failure
diabetes mellitus

THE CONTRAST
Consists of iodine atoms.
Following injection, their distribution in the
body and routes of excretion are identical,
and their visualization in the kidneys is equal.
Assuming normal renal function, their route of
excretion is greater than 99% by glomerular
filtration.

INTERPRETATION
Abnormalities in the appearance of the
kidneys or ureters, distribution of contrast
within a kidney, asymmetry in the amount of
contrast in each kidney, or defects in the
collecting systems can be identified and are
suggestive of particular diseases and
conditions.

PATIENT PREPARATION
Dehydration INCREASE OF UROGRAPHIC
IMAGING AND AVOID EMESIS
Bladder voiding
Bowel preparation ELIMINATING GAS AND FECES
Psychological preparation
Anxiety appears to be a factor in the so-called
idiosyncratic reactions (nausea and vomiting,
urticaria) following contrast injection.

Informed consent

previous alergic reaction,

sensation during and following contrast

injection
7

PROCEDURES
Plain film of the abdomen

Contrast administration
Film sequencing

Urinary tract, KUB (kidneys, ureters and bladder),

Sequencing IVP
plain

15

30

45

PV

Normal bolus injection urographic

nephrogram

A. One minute after contrast injection. the cortex and cortical columns
are opacified; the medullary pyramids remain relatively lucent.
B. Four minutes later, the cortex and medulla are equally opacified.
Note excellent filling of the collecting system and ureter.
(Newhouse JH, Pfister RC: The nephrogram. Radiol Clin North Am,
17:213, 1979)

15

Obstructive nephrogram

Contrast material had

been administered
intravenously 45
minutes before this
radiograph was obtained
in a patient with acute
unilateral ureteral
obstruction.
The kidney is enlarged;
the nephrogram was
slow to develop, but the
kidney is now much
denser than normal and
contains faint radial
striations
16

Normal excretory urogram.

An anterior calyx points

laterally (large arrow); the
paired posterior calyx (small
arrow) directly posterior,
mimicking a filling defect.

17

Ten-minute film from urogram

with compression cuff in place.

The upper ureters and

collecting system are well
distended, allowing confident
diagnostic evaluation. Note that
the balloons are well inflated
and the upper margin parallel
the illiac crest.
18

Minimal right ureteral obstruction

The fornices of the

left kidney appear
normal. Those on the
right are slightly but
definitely blunted
19

Moderate ureteral obstruction

There is partial effacement

of the fornices and
generalized caliceal
dilatation.

20

Proximal right
ureteral obstruction

The collecting system is

dilated and there is
diminished
concentration of
contrast within it.

21

Distal right ureteral obstruction

The right ureter is filled as a

continuous column; serial
radiographs revealed no
change in its configuration.

22

Bilateral chronic ureteral obstruction.

On the right, the

nephrogram of the
remaining parenchyma
surrounds the dilated
nonopacified calices,
producing a "negative
pyelogram." On the left,
the obstruction is less
severe: the dilated
proximal ureter and
collecting system are
faintly opacified.
23

Uric acid calculus

Intravenous urogram
(IVU) shows an
extensive branched
filling defect in the lower
pole collecting system.

24

Partially obstructing distal

ureteral
An opaque calculus just
distal to the inferior aspect
calculus
of the left sacroiliac joint is

producing several of the

urographic changes
associated with an
obstructing ureteral
calculus:
ureteropyelocaliectasis, a
continuous column of
contrast-laden urine from
the renal pelvis to the
calculus, and narrowing of
the ureter (arrow) just
distal to the stone. These
were persistent findings on
several films whereas the
contrast-filled left
juxtavesical ureter
appeared collapsed on
other films. The right
collecting system has
partially emptied of
contrast at the time of this
1-hour film.
25

Ultrasound of the urinary tract :

USG of kidney and bladder
USG of the male genitalia
USG of the prostat

Fig.29.8 Normal renal; note the

relatively hypoechoic pyramids and
markedly
Hyperechoic fat containing sinus
(centrally) compared to the cortex.

Mild and Moderate Hydronephrosis

Severe Hydronephrosis

 This ultrasound image demonstrates dilated renal

calyces indicative of hydronephrosis. Chronic
reflux uropathy can lead to hydronephrosis which
can result in renal dysfunction as the calyces
dilate and compress the renal parenchyma.
Black arrow = renal capsule
Black arrowhead = sinus fat
White arrow = dilated calyx
White arrowhead = renal cortex

Fig. 29.9 Normal bladder ultrasound; note the thin smooth wall and the shape
Approximating to rounded-off square in the transverse view (A)
and a rounded-off triangle in the sagital view (B)

Antegrad pyelography
Simple procedure
Evaluate the cause and level of
ureteric obstr
First step : Nephrostomy or Whitaker
procedur
The patient is positioned
approximately 45 semiprone and
the pelvicalyceal system cannulated
with a fine (22 gauge) needle

Antegrad pyelography
Directed through the parenchyme renal calyx
pelvis ren

Confirmation of cannulation of the collecting

system is obtained by aspirating urine
150 strength contrast is infused into the
system
a series of spot films of the ureter down to
the level of the obstruction is taken

Antegrade pyelography.
The dilated pelvicalyceal system has been cannulated with a 22
gauge needle and opacified with 150 strength contrast (A). The
ureter is dilated, shows marked medial displacement distally and
tapers to a complete occlusion (B)

Sample

Pic. A partial obstruction

in the distal ureter is
caused by a small
calculus (seen as a
filling defect)
followed by a
stricture.

MCU
male - oblique

Verumontanum ( filling defect

in the posterior urethra

Female - supine