Endoscopy and Radiology for Lower Urinary Tract Dysfunction

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Endoscopy and Radiology for Lower Urinary Tract
Dysfunction

• Hann-Chorng Kuo
• Department of Urology
• Buddhist Tzu Chi General Hospital

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Lower Urinary Tract

• Urinary bladder
• Ureteral orifices
• Trigone
• Bladder neck
• Prostate and prostatic urethra
• Urethral sphincter
• Urethra (posterior, bulbous, anterior)

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Bladder wall in Cystoscopy

• Smooth bladder wall
• Trabeculated bladder wall
• Diverticulum
• Pseudodiverticulum
• Bladder tumor
• External compression

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Smooth Bladder Wall
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Trabeculation of Bladder Wall
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Bladder Tumor
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Bladder mucosa

• Normal mucosa and vasculature
• Hyperemia
• Ischemia
• Hemorrhagic cystitis
• Cystitis cystica
• Pseudomembranous trigonitis
• Granulomatous cystitis

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Normal Mucosal Vasculature
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Hyperemia and Inflammation
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Hemorrhagic cystitis
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Cystitis Cystica
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Pseudomembranous Trigonitis
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Granulomatous Cystitis
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Tuberculosis Cystitis
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Prostatic enlargement

• Benign prostatic enlargement
• Prostatic cancer

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Bladder Neck Obstruction
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Urethral Stricture

• Bladder neck contracture
• Membranous urethral stricture
• Anterior urethral stricture
• Anterior urethral valve
• Meatal stenosis

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Urethral Stricture
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Ureteral Orifice

• Normal cone shape
• Horseshoe shape
• Stadium shape
• Golf hole shape
• Short submucosal ureteral tunnel

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Ureteral Orifice
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Chronic Inflammation of Female Bladder Neck
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Female Urethral Incompetence

• Bladder neck incompetence
• Urethral incompetence

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Interstitial Cystitis
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Painful Bladder Syndrome
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Bladder Stone
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Bladder musculature
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Uroradiology in Lower Urinary Tract Dysfunction

• Intravenous pyelography (IVP)
• Retrograde pyelography
• Cystography
• Voiding cystourethrography
• Retrograde urethrography
• Beaded chain cystourethrograph
• Magnetic resonance image (MRI)

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Intravenous pyelography inBenign Prostatic
Hyperplasia
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Inravenous Pyelography in High Grade Cystocele
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Retrograde Pyelography inUreteral stricture
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Voiding Cystourethrography

• Bladder neck dysfunction
• Prostatic obstruction
• Urethral stricture
• Anterior urethral valve
• Vesicoureteral reflux
• Bladder diverticulum

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Cystography on Straining
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Urethral Incompetence
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Bladder Base IndentationProstate Enlargement
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Voiding CystourethrographyProstatic Obstruction
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Voiding Cystourethrography inDESD and after
Sphincterotomy
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Voiding CystourethrographyAnterior urethral valve
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Voiding CystourethrographyDysfunctional voiding
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Voiding CystourethrographyUrethral meatal
stricture
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Transrectal sonography

• Prostatic configuration
• Urethral stricture
• Bladder neck incompetence
• Bladder base hypermobility
• Intravesical pathology

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Prostate Configuration

• Prostatic urethra
• Transition zone of prostate
• Seminal vesicle
• Ejaculatory duct
• Peripheral zone of prostate
• Bladder neck

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Transrectal sonography of the Prostate, Seminal
vesicle, Urethra
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Prostatic Enlargement
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Transition Zone Index (TZI)

• Transition zone vol/ total prostate vol
• A TZI of lt0.3 indicates low possibility of
  prostatic obstruction, a TZI of gt0.5 indicates
  highly suspicious prostatic obstruction
• TZI correlates poorly with total prostatic volume

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Measurement of TZI
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Female Urethral Structure
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Female Urethra in SUI
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Hypermobility of Bladder Base
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Beaded-Chain Cystourethrography
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MRI of Cystocele
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MRI of Large Cystocele Enterocele
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MRI of Rectocele
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MRI of Uterine Prolapse