RADIOLOGY OF THE

UROGENITAL SYSTEM

Dr Richard Bullock
Consultant Radiologist
UHWI
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 Imaging Evaluation Of Urinary
Tract
 Structural Assessment
 Renal parenchyma
 Collecting System-pelvicalyceal
system,ureter and bladder

 Functional Assessment
 Renal perfusion
 Renal excretion

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 Urinary Tract Modalities
 Plain Radiographs- KUB

 Ultrasound

 Computed Tomography(CT)

 Magnetic Resonance Imaging(MRI)

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 Urinary Tract Modalities
 Contrast studies-
 Intravenous Pyelogram(IVP)

 Retrograde pyelogram

 Micturating Cystourethrogram(MCUG)

 Nuclear Scintigraphy

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 KUB
 Readily available
 Affordable($1000-1500)
 X-radiation
 Limited soft tissue detail
 Useful findings-
 Calcification-calculi,nephrocalcinosis
 Air- renal infections,trauma

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 KUB

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 KUB

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 Ultrasound
Based on sound waves, no ionizing
radiation is used
No adverse effects recorded
Equipment widely available
Most procedures average $3000- $4000

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 Ultrasound
Sound is generated through a transducer
applied to the skin.
Gel applied to the skin allows good contact and
movement across the skin
Dynamic real time images acquired. Still images
or a video can be recorded from the
equipment.

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 Ultrasound
The images are represented as a gray scale
image.
This is generated from the echoes returned
from the tissues.
The pattern of gray dots is called the
echopattern and each organ has a distinctive
echopattern

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 Ultrasound

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 Ultrasound

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 Ultrasound
 Good anatomic detail
 Renal cortex-outline,thickness,echogenicity
 Renal medulla- collecting system
 Bladder-volume, wall thickness
 Ureter-not seen unless dilated

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 Ultrasound Normal Kidney

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 Ultrasound Normal Bladder

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 ULTRASOUND
 Renal size-large/small
 Renal cortical loss eg scars
 Hydronephrosis/obstruction
 Renal masses-
 Cysts,masses,calculi
 Bladder
 Masses,calculi
 Trabeculation,diverticula

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 Ultrasound Of Renal Calculus

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 IVP
 Contrast examination of kidney,ureter
and bladder
 NPO morning of exam
 Consent for IV injection of iodinated
contrast
 Renal uptake and excretion
 Plain radiographs taken at intervals
during uptake and excretion

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 IVP
 Contrast mediated anaphylaxis
 Contrast induced nephrotoxicity eg
diabetics, sickler
 Uses restricted due to above risks
 Primarily used to assess causes of
obstruction

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 IVP

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 IVP

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 IVP

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 Retrograde Pyelogram
 Ureteric catheter placed via cystoscope
 Contrast injected via catheter
 Used to delineate lower limit of
obstructive lesion, or where poor renal
function makes IVP unacceptable

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 MCUG
 Used to evaluate
 urethral obstruction-strictures, posterior
urethral valves
 Vesicoureteric reflux
 Structural abnormalities of the bladder

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 MCUG
 Urethral catheter placed in bladder
 Bladder filled with contrast
 Catheter withdrawn
 Films taken during voiding

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 MCUG

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 Posterior Urethral Valve

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 Vesicoureteric Reflux(VUR)

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 Computed Tomography
 Special application of xrays involving a
rotating xray tube
 Patient lies on a moving table that carries
them through the rotating beam
 Rotating beam housed in gantry
 Generates cross sectional images at different
levels eg through kidneys,ureter,bladder
 The levels are selected by the operator
 Gives good anatomic depiction of structures

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 Computed Tomography
 Cost - $20,000
 Depicts difference in density of the tissues
 Normal pattern of tissue density for each
organ.
 In order of density from the lowest to the
highest are air, fat, fluid, soft tissue, bone,
contrast and metal
 Abnormal tissues are referred to as hyper or
hypodense relative to the normal tissues

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 Computed Tomography

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 Computed Tomography

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 CT
 Calculi detected without contrast
 Further evaluation of urinary tract
masses

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 CT of Calculi

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 MRI
 Expensive
 Limited role

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 Renal Scintigraphy
 Best method for assessing renal
function
 Renal perfusion/excretion+diuretic
 Split function
 Detects scarring,obstruction,poor
function

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 Female Genital Tract
 Uterus
 Ovaries
 Fallopian tubes

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 Pelvic Ultrasound
 Transabdominal- full bladder used as a
window to view uterus and ovaries
 Transvaginal-
 excellent detail of uterus and ovaries
 Does not require bladder distension

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 Pelvic Ultrasound
 Uterus
 Gravid vs non gravid
 Position-ante or retroverted
 Myometrium-fibroid
 Endometrium- thickening
 Ovaries
 Volume
 Follicular size/distibution
 Cysts/solid masses

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 Normal Pelvic Ultrasound

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 Pelvic Ultrasound-Fibroid

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 Pelvic Ultrasound-Ovarian Cyst

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 Hysterosalpingography(HSG)
 Contrast study of uterine cavity and
Fallopian tubes
 Speculum examination of cervix
 Cervix cannulated with small Foley
catheter
 Contrast injected

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 HSG
 Primarily done to assess causes of
infertility
 Done 10 days from beginning of LMP
 Pregnancy test -ve
 Patient may experience pain or bleeding

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 Normal HSG

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 HSG-TUBAL OBSTRUCTION

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 HSG -Fibroid

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 Male Genital System
 Scrotal evaluation
 Ultrasound
 MRI
 Prostatic evaluation
 US
 CT/MRI

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 Scrotal Ultrasound
 Testicular size- masses
 Testicular position-cryptorchidism
 Testicular blood flow-orchitis; torsion
 Epididymal size-epididymitis
 Pampiniform plexus- varicocele

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 Prostatic Ultrasound
 Transabdominal-
 Volume- BPH,prostatic carcinoma,
 Nodularity
 2°effects- bladder
obstruction,hydronephrosis
 Transrectal
 Guide biopsy of enlarged/nodular gland

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 Further prostatic evaluation
 For local staging of prostatic carcinoma
 Computed tomography
 Magnetic resonance imaging

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