Urinary System

Urinary SystemPrefinalsUrinary SystemIs the production of urine and its elimination from the body.Functions:Remove nitrogenous wastesRegulate water levels in the body.Regulate acid-base balance and electrolyte levels of the blood.

Procedures:UrographyIvu or excretory urographyHypertensive IVU Percutaneous renal punctureRetrograde urographyRetrograde cystographyVoiding cystourethrographyRetrograde urethrography

UrographyGeneral term for radiologic investigations of the renal drainage. Or collecting system are performed by various procedures.

2 methods routinely employed of filling the urinary canals with contrast mediumExcretory, or Intravenous UrographyRetrograde Pyelography

Excretory, or Intravenous Urographymost frequently employed method, in which the contrast agent is routinely administered intravenously.Retrograde Pyelographycontrast medium is introduced directly into the canals by means of catheterization ureteral catherterization for contrast filling of the upper urinary tracts.Percutaneous Antegrade UrographyContrast solution is introduced directly into pelvicalyceal system by means of puncture of the renal pelvis.It is seldom used method of introducing contrast media to the kidney

Preparation of PatientGeneral Use:Low-residue diet for 1 2 days to prevent gas formation caused by excessive fermentation of the intestinal contents.A light evening mealCostive bowel action, a non-gas forming laxative the evening before the examination.NPO after midnight on the day of examination.For retrograge urography, patient is often requested to force water(4-5 glassfuls) for severe hours before examination.

IVU or Excretory Urography (commonly known as IVP)most common radiographic examination of urinary system.Visualizes the minor and major calyces, renal pelves, ureters and urinary bladder following an intravenous injection of contrast medium.

Purpose:Visualize the collecting portion of the U.S.Assess the functional ability of the kidneys.

Clinical IndicationsAbdominal or pelvic massRenal or ureteral calculiKidney traumaFlank painHematuria or blood in the urineHypertensionRenal failureUrinary tract infections

ContraindicationsHypersensitivity to contrast mediaAnuria (non passage of urine)multiple myelomadiabetessevere hepatic or renal diseasecongestive heart failurePheochromocytoma (rare tumor that arise outside the adrenal gland)sickle cell anemia (another type of anemia)IVU basic routinescout radiograph & 15mins test dose before injectioninjection of contrast mediabasic filming routine1 min.(nephrogram or nephrotomogram)5 min. AP supine (10x12Film @ L2)10mins RPO & LPO positions15 min. AP supine or PA prone (to provide compression in the abdomen20 min posterior obliques (alternatives)Full bladder (10x12 pelvis 1 below ASIS)post-void ( prone or erect)

1-5mins

5-10 mins

10 mins

Prone 15 mins

Full Bladder

Post VoidUreteric CompressionMethod utilized to enhance filling of the pelvicalyceal system and proximal ureters.It allows the renal collecting system to retain the contrast medium longer for more complete study.

Ureteral Compression The Ureteral Compression Device is used in excretory urography. The belt fits around the waist of the patient so that he may be repositioned quickly for studies at any angleContraindications:Possible ureteric stonesAbdominal massAortic abdominal aneurysmRecent abdominal surgerySevere abdominal painAcute abdominal trauma

Hypertensive IVUone special type of IVU.This is done on patients with high blood pressure to determine if the kidneys are the caused of the hypertension.Procedure: (sequence)1 min2 min3 min30 seconds additional radiographs

A hypertensive IVU was commonly requested to screen for Renovascular Hypertension.This consisted of 30-second and 1-, 2-, 3-, and 5-minute radiographs at the beginning of IVU, which were frequently referred to as minute-sequence films. The rationale for this study was that physiologic changes caused by the renal arterial stenosis would be demonstrated on early-phase excretion radiographs.29Percutaneous Renal PunctureRadiologic procedure for the investigation of renal masses.It is used to differentiate cysts and tumors of the renal parenchyma.Introduced by LindblomIt is replaced by the advent of ultrasounography.

Retrograde UrographyIs a nonfunctional radiographic examination of the urinary system which contrast medium is introduced directly into pelvicalyceal system via catheterization.

Procedure:Modified Lithotomy Positionknees are flexed over stirrups of the adjustable leg supports.

* 3 routine radiographs*Preliminary radiographs ( showing the ureteral catheters in position)The pyelogramThe ureterogram

Positioning RoutineAP for Ureteral Catheters 14x17 filmAP for pyelogram 14x17 filmAP for Urography filmAdditional RPO LPOLateral for demonstration of anterior displacement of kidneys or uretersCross table for demonstrating of ureteropelvic region with hydronephrosis patients.

Retrograde CystographyAnother nonfunctional urinary system examination.Radiographic examination of the urinary bladder following installation of an iodinated contrast medium via a urethral catheter.

Procedure:contrast material is allowed to flow in by gravity only using an asepto syringe or drip infusion.150 500 ccs of contrast media to be instilled into the bladder.

Routine positions:

AP with 15 degrees caudal angulationBoth posterior obliques

PositioningAP projections of the bladder and proximal part of the urethra with 15 degrees caudal angle.Oblique projections of 40-60 degrees, with perpendicular CR, or a 10 degrees angulations if needed.AP projections with 20-25 degree cephalic angulation to demonstrate, the shadow of the prostate above that of the pubic bones.Lateral positions, to demonstrate the anterior and posterior bladder walls and base of the bladder.Chassard-Lapine method or Squat shot, is used to obtain an axial image of the posterior surface of the bladder and the lower end of the ureters.AP projections, with a 15-20 degrees tilt of the table to allow the filled bladders to stretch superiorly, where it will not superimpose the ureters.

Voiding CystourethrographyStudy of the urethra and evaluate the patients ability to urinate.Trauma or involuntary loss of urine are common clinical indiactions.

Retrograde Urethrography

Perform on the male patient to demonstrate the full length of the urethra.Contrast medium is injected into distal urethra until the entire urethra is filled in retrograde fashion.Procedure:Brodney clamp special device for injection of the c+ medium w/c is attached to distal penis.30 degs RPO is the position of choice.

Summary UrographyIvu or excretory urographyHypertensive IVU Percutaneous renal punctureRetrograde urographyRetrograde cystographyVoiding cystourethrographyRetrograde urethrography