Vous êtes sur la page 1sur 29

JOURNAL READING

What the Radiologist Needs to Know About Urolithiasis :


Part 1 Pathogenesis, Types, Assessment, and Variant Anatomy

AYU WULANDARI
162021222

Pembimbing :
dr. Novita Elyana, SpRad

KEPANITERAAN KLINIK DEPARTEMEN


FAKULTAS KEDOKTERAN UPN VETERAN JAKARTA
RSUD AMBARAWA
2017
SYSTEMA URINARIA
1.SYSTEMA URINARIA MASCULINA
1.1. ORGANAE URINARIAE : RENES DEXTRA ET
SINISTRA
1.2. TRACTUS URINARIUS :
1.2.1. URETER
1.2.2. VESICA URINARIA
1.2.3. URETHRA ( MASCULINA )
URETER
CONTINUATION OF PELVIS RENALIS TO VESICA URINARIA
RENES
FORM & SIZE :
25 34 C;
:1 MM 1 CM. URETER DEXTRA SHORTER.
URETER
PARTS
1. PARS ABDOMINALIS URETERIS:

2. PARS PELVINA URETERIS


VESICA URINARIA
VESICA URINARIA ( BLADDER )
A MUSCULO MEMBRANOUS SAC THAT FUNCTION AS RESERVOIR
URINE.
FULL : EXTEND CRANIOVENTRALLY INTO CAVUM ABDOMINALIS

FORM, SIZE & POSITION DEPEND ON ITS CONTENT.


CAPACITY : 500 CC ; 200 300 CC MICTIO
VESICA URINARIA
PARTS:
1. VERTEX VESICAE : THE TOP : APEX VESICAE:
LIG. VESICO UMBILICALE MEDIALE (URACHUS)
2. CORPUS VESICAE
3. FUNDUS VESICAE : CAUDODORSALLY,TOWARD RECTUM.
URETHRA

1. PARS PROSTATICA URETHRAE


3 CM, WIDEST , MOST DILATABLE
NEARLY VERTICAL WITH GLD. PROSTATAE.
2. PARS MEMBRANACEA URETHRAE
THE SHORTEST, SMALLEST POSSIBILITY FOR
DILATATION, FROM APEX PROSTATAE TO
BULBUS PENIS.
3. PARS SPONGIOSA URETHRAE
LENGTH 15CM, LOCATED IN CORPUS
CAVERNOSUM URETHRAE

LENGTH : 17,5 20 CM ; ORIFICIUM URETHRA


INTERNA - ORIFICIUM URETHRA EXTERNA.
INTRODUCTION

Urolithiasis is a common
clinical entity. Renal calculi
affect up to 6% of all
American women and 12% of
all American men during their
lifetimes. Overall, the
prevalence is increasing and is
higher in developed countries.

AJR : What the Radiologist Needs to Know About Urolithiasis


TYPES OF RENAL CALCULI
CALCIUM

MAGNESIUM
AMMONIUM
PHOSPATE
TYPES OF
RENAL
CALCULI
MEDICATION
& URIC ACID
METABOLITES

CYSTINE

AJR : What the Radiologist Needs to Know About Urolithiasis


CHARACTERISTICS OF DIFFERENT TYPES OF URINARY TRACT CALCULI

COMPOSITION (%) IMAGING PEARL CAUSATIVE FACTOR

Calcium 70-80 Wide range of densities and gross Numerous, including primary
morphologies hyperparathyroidism, chronic
diarrhea, and distal renal tubular
acidosis
Magnesium 15-20 Staghorn calculus refers to a struvite Infection
ammonium calculus involving the renal pelvis and
phosphate extending into at least two calyces
(struvite)
Uric acid 5-10 Pure uric acid stones are radiolucent on Gout, small-bowel disease, and
radiography high body mass index
Cystine 1-3 May contain low-attenuation foci Cystinuria
(voids)

Medications & 1 Indinavir can be radiolucent even on CT Prolonged or excessive use of some
their medications
metabolites

AJR : What the Radiologist Needs to Know About Urolithiasis


CLINICAL ASSASEMENT
SYMPTOMS LABORATORY EXAM :
Colic pain Blood and urine renal function
Renal pelvic or proximal ureteral and hematologic status.
obstruction flank pain Electrolyte, blood urea nitrogen,
Lower ureteral obstruction pain and creatinine levels reflect
radiating to the testicle or labium. renal and metabolic status.
Stones at the ureterovesical WBC count may be elevated
junction urgency and response to infection or stress
suprapubic discomfort Hemoglobin level can be
Nausea and vomiting may be depressed some cases of
present. chronic calculus disease.
Gross or microscopic hematuria Urinalysis detects hematuria
can be associated with renal or and pyuria and includes urine pH,
which can help guide
ureteral stones management.

AJR : What the Radiologist Needs to Know About Urolithiasis


IMAGING OF
UROLITHIASIS
RADIOGRAPHY
For decades, the kidney-ureter-bladder
radiograph was the initial examination of
choice in the evaluation of acute onset of flank
pain.

Unfortunately, radiography has been found to


be only about 60% sensitive overall in the
detection of urolithiasis because bowel
contents, overlying soft tissues, gas, and
osseous structures may obscure small
radiopaque calculi.

AJR : What the Radiologist Needs to Know About Urolithiasis


EXCRETORY UROGRAPHY
Excretory urography allows increased
delineation of renal anatomy compared with
the kidney-ureter-bladder radiograph and may
reveal the presence of a calculus causing
obstruction.

Unfortunately, these calculi can also be


obscured by contrast material.

Urinary obstruction may cause significant delay


in the excretion of contrast agent, thus
increasing the study time.

AJR : What the Radiologist Needs to Know About Urolithiasis


ULTRASOUND
Ultrasound is advantageous in the setting of the pediatric patient, pregnant
patient, or a patient with recurrent bouts of urolithiasis , because ultrasound does
not use ionizing radiation.

Ultrasound can also reveal secondary effects, such as obstruction, superimposed


infection, or abscess formation.

The direct visualization of ureteral calculi can be also difficult with ultrasound
because of overlying bowel gas and the relative depth of the ureter within the
pelvis. Ultrasound visualization may be further complicated in obese patients by
large amounts of intervening fat

AJR : What the Radiologist Needs to Know About Urolithiasis


MRI
ADVANTAGES DISADVANTAGES
MR urography is an excellent Unfortunately, as with
modality for the delineation of nearly any calcified
secondary effects of
urolithiasis such as infection or structure on MRI, the actual
obstruction calculus is often not well
Like ultrasound, MRI does not visualized
use ionizing radiation and can
be of value alone or in
combination with radiography
in the evaluation of the
pediatric, pregnant, or serially
imaged patient

AJR : What the Radiologist Needs to Know About Urolithiasis


CT
ADVANTAGES DISADVANTAGES
CT, both unenhanced and A significant drawback is
contrast enhanced, has quickly
become the modality of choice that CT utilizes ionizing
in the evaluation of suspected radiation.
urolithiasis
CT can measure stone
attenuation, evaluate
secondary effects of
obstruction, delineate
surgically relevant anatomy,
and detect other potential
sources of pain or pathologic
abnormality

AJR : What the Radiologist Needs to Know About Urolithiasis


MODALITIES IN THE EVALUATION OF UROLITHIASIS
MODALITY ADVANTAGES DISADVANTAGES PREFERRED UTILIZATION
Radiography Relatively low radiation dose with Only 60% sensitivity in detection Monitoring of calculus
respect to CT; 90% of calculi are of urinary calculi; patients source burden in patients known to
radiopaque of pain may not be urolithiasis have urolithiasis

Excretory Some delineation of renal and Exposure to contrast agent; CT now preferred over
urography collecting system anatomy length of examination; contrast excretory urography in most
agent can obscure calculi settings for evaluation of
renal and collecting system
anatomy

Ultrasound Lack of ionizing radiation; Operator dependent; deep Pregnant or pediatric


intermediate sensitivity for portions of ureter difficult to patients and recurrent stone
detection of renal calculi and image formers
hydronephrosis

MR urography Nonionizing radiation; imaging of Actual calculus difficult to Evaluation of urinary tract
secondary effects of urolithiasis visualize findings other than
and other genitourinary urolithiasis such as stricture
abnormalities, including
malignancy

Unenhanced CT Delineation of urinary tract and Radiation exposure especially in First-line imaging
nongenitourinary anatomy; rapid the recurrent stone former, investigation in the adult
acquisition and interpretation; young, or pregnant patient with flank pain
highlights procedurally relevant
anatomy
COMPLEX OR VARIANT GENITOURINARY ANATOMY
A horseshoe kidney results from renal fusion and subsequent ascent failure at the
level of the inferior mesenteric artery. Collecting system drainage of a horseshoe
kidney is impaired because of malrotation and a high ureteral insertion. Up to
20% of horseshoe kidneys can present with calculi, most of which consist of
calcium oxalate

AJR : What the Radiologist Needs to Know About Urolithiasis