Urinary Tract

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Urinary Tract

• Dr. Nasr A. Mohammed
• FIBMS

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Imaging techniques

• Basic examinations
• -Ultrasound.
• -Intravenous Urography IVU.
• -Computed Tomography CT.
• -Radionuclide examination.

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Other investigations

• investigations limited to selected
  patients
• Magnetic Resonance Imaging MRI.
• Arteriography.
• Direct puncture of collecting system
• Catheterization.

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Type of information they provide

• -Anatomical
• US
• CT
• MRI
• -Functional
• Radionuclide
• -both
• IVU

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ULTRASOUND

• Is the first line investigation
• Non invasive , no radiation, no contarst..
• The main uses of ultrasound
• renal symptoms
• renal size
• hydronephrosis
• renal masses
• bladder and prostate

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Normal renal Ultrasound

• Outline .smooth
• Renal paranchyma
• Renal sinus ..cental part
• Renal pyramids
• Size difference lt1.5 cm

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Small kindeys

• Unilateral but may be bilateral
• chronic infection ( including TB)
• obstructive atrophy
• RAS
• Hypoplastic
• Always bilateral
• Chronic glomerulonephritis
• Hypertensive nephropathy
• DM,
• collagen vascular disease

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Enlarged kidneys

• Always unilateral .compensatory hypertophy

• May be unilateral or bilateral
• bifid collecting system
• renal mass
• hydronephrosis
• lymphoma ( masses or just enlargement)
• renal vein thromboses

• Always bilateral
• PCK (polycystic disease)
• AGN (acute glomerulonephritis)
• amyloidosis

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• Ureters ..usually not visualized

• Urinary bladder
• examined in distended state .thin walls
• following micturition.. For residual vol.
  

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Urography

• Use of IV iodinated contrast

IVU CT
Urography Details of PCS Renal
calculi detection (all types) Ureteric injury
Hematuria Acute ureteric colic
Renal mass
Staging and follow up of CA
Renal vascular anatomy
renal trauma
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Intravenous urogram

• Plain film
• identify calcification
• -stone
• -diffuse or focal nephroclacinosis
• After contrast injection
• -Kidneys
• position ( mormally left higher than
  Right)
• outline
• indentation fetal lobulation ,
  scar
• bulge mass or cyst
• renal length 10-16 cm

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• - Calices
• distribution (distributed and symmetrical
  )
• shape
• normal . Cupped
• dilatation.clubbed ( from
  obstruction
• 
  or destruction )

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• Renal plevis and ureters
• shape funnel shaped
• dilatation
• -obstruction
• filling defect calculi, blood clot
  , tumor .
• stricture PUJ, tumor , infection
• compression
• LN
• pelvic mass
• - reflux
• - normal variant

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Bladder

• Outline central and smooth
• Indentation
• ( smooth indentation by prostate or
  uterus )
• after voiding should be empty .

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CT urography

• CT KUB before contrast
• for detection of calcification

• Contrast
• early . Cortical phase
• then ..nephrogram
• delay urographic phase

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MRI

• Indication
• for selected patient as -
• renal artery stenosis
• tumor extension to IVC
• Disadvantage
• calcification is not visible on MRI

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Radionuclide examination

• Renogram ( DTPA )
• Renal morphology (DMSA scan)
• Voiding cystography

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Special techniques

• Retrograde and antegrade pyelography
• Micturating cystogram
• Urethrography
• Renal arteriography

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Questions?