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Imaging in

Genitourinary System

ANATOMY

ANATOMY

Male Reproductive System

ANATOMY

IMAGING MODALITIES
Plain abdominal x ray
BNO-IVP

Retrograde

uretrography/cystography/urethrocystog
raphy
Bipolar Urethrocystography
Voiding Cystourethrography

Ultrasonography
CT Scan
MRI
Nuclear Imaging
Hysterosalphingography

Retrograde
uretrography/cystogr
aphy/urethrocystogra
phy

Retrograde Urethrography

To assess the urethra


The contrast media is injected from the
distal to the proximal part of the
urethra (retrograde or ascending)

Retrograde Urethrography
Indication
Urethral rupture
Urethral stricture
Congenital anomaly
Urethral fistule
Urethral diverticle

Contraindication

Acute urinary tract


infection

Urethral obstruction
Hematuria
Recurrent urinary
tract infection
Slow urinary flow
Urinary mass

Retrograde Urethrography

IMAGING IN RGU

Pre-contrast AP Film

Right-anterior Oblique

Left-anterior Oblique

Retrograde Urethrography: Urethral


rupture

Retrograde Urethrography: Urethral


stricture with periurethral abscess

Retrograde Cystography

To assess the urinary bladder


The contrast media is injected through
the urinary catheter into the urinary
bladder
Retrograde to the urinary flow

Retrograde Cystography
Indication

Recurrent urinary
tract infection
Suspicion of urinary
bladder rupture
Stone
Mass
Inflammation
Diverticle
Fistule

Incontinentia
Hematuria
Measure the urinary
volume post
micturition
Assess the integrity
of the anastomosis
or suture post
operative

Retrograde Cystography
Contraindication

Pregnancy
Urethral rupture (contraindication to
the urinary catheter insertion)

Retrograde Cystography

Retrograde
Urethrocystography

To assess the urinary bladder and the


urethra.
Combination of the retrograde
urethrography and cystography.
The contrast media is injected through
the external urethral orificium to fill the
urethra and then the urinary bladder.

Bipolar
Urethrocystography

Bipolar Urethrocystography

To assess the urethra from the proximal


and distal aspects.
Retrograde from the distal urethra
Antegrade from the cystostomy
catheter
Patient is asked to void so that the
contrast media will fill the proximal
part of the urethra.

Bipolar Urethrocystography
Indication

Assess the proximal and distal margin


of obstruction (stricture, stone, mass)
in the urethra

Contraindication

Allergy to contrast media

Voiding
Cystourethrogram
(VCUG)

Voiding Cystourethrogram
(VCUG)

To demonstrates the
lower urinary tract
helps to detect the
existence of any
vesico-ureteral reflux
to detect bladder
pathology
to detect congenital
or acquired
anomalies of bladder
outflow tract

passing a catheter through the


urethra into the bladder filling
the bladder with contrast
material taking radiographs
while the patient voids.

Ind
icat
ion
s
VC
UG

Chil
dre
n

Adu
lts

Urinary tract infection Usually done


after some weeks of acute stage or may
be done under antibiotic converge.
voiding difficulties : dysuria , thin
stream dribbling, frequency, urgency,
vesico ureteric reflux, trauma.
Baseline study prior to lower UT surgery.

Trauma to urethra, urethral stricture,


urethral diverticula ,UTI,
Reflux nephropathy prior to renal
transplant of one/both kidneys.

PROCEDURE

Under aseptic conditions, catheterize the urinary


bladder with patient in supine position.
Push the diluted contrast medium slowly under
fluoroscopic guidance
Ask the patient to inform you when he has urge to
micturate.
Ask the patient to micturate in a urine receiver in an
erect oblique position.
Spot images are taken during micturition in right and
left oblique projections and any reflux is recorded.
Finally, a full-length view of the abdomen is taken to
demonstrate any undetected reflux of the contrast
medium that might have occurred in the kidneys and to
record the post micturition residue.

Voiding Cystourethrogram
(VCUG)

Adult Male:
The voiding study can be modified by

getting the patient to void against


resistance by using a penile clamp or
compression of distilled part of penis,
which enhances visualization of urethra by
the artificial distension.
This is known as choke

cystourethrography

Scout Film

The first image is a


KUB called the scout
film.
On this film one can
evaluate the spine
and pelvis (injury or
congenital anomaly
such as spina bifida)
and the soft tissues
(calcifications,
foreign bodies, etc.).

Filli
ng
Ph
ase

Several seconds after the contrast material begins to


flow, the minimally filled bladder is imaged in the
anteroposterior projection.
A ureterocele or bladder tumor that is well seen during
early filling may become obscured as more contrast
material enters the bladder.
On complete filling ,the bladder should appear smooth
and regular and there should be no filling defects. The
edges of the bladder image should be smooth.

Voiding Phase

Images captured during voiding will


demonstrate the urethra (strictures
or obstruction) and the bladder, and
they will document the presence or
absence of vesicoureteral reflux.

Voiding Phase

This film shows


a normal male
urethra; there is
no obstruction.
The variation
seen in the
diameter of the
urethra is
normal.
Indentation at the urethral
sphincter (normal)

Post-void Film

The post-void image


may demonstrate
reflux (contrast
seen in the ureter or
kidney) or
extravasation of
urine from the
bladder or
urethra (such as
from a traumatic
rupture).

Normal post-void film

Vesicoureteral reflux
(VUR)

Vesicoureteral reflux (VUR)

Vesicoureteric reflux (VUR) abnormal


flow of urine from the bladder into the
upper urinary tract young children.
As such the diagnosis is first suspected
after a urinary tract infection in a
young child.

Vesicoureteral reflux (VUR)

MCUG The primary diagnostic


procedure for evaluation of
vesicoureteric reflux is a voiding
cystourethrogram (VCUG)
whether reflux occurs during
micturition or during bladder filling

Vesicoureteral reflux (VUR)

Grade I: reflux to ureter but not to kidney


Grade II: reflux into ureter, pelvis, and
calyces without dilatations
Grade III: reflux to calyces with mild
dilatation,blunted fornices
Grade IV: to calyces with moderate
dilatation,obliteration of fornices
Grade V: gross dilatation, tortuous
ureters.

Vesicoureteral reflux (VUR)

VCUG
demonstrating
bilateral Grade III
vesicoureteral
reflux

Vesicoureteral reflux (VUR)

Pre-void contrast filled


bladder demonstrated
bilateral vesicoureteral reflux with
mildly tortuous and
moderately dilated
ureters, with contrast
reaching blunted
dilated calyces.
Findings are keeping
with bilateral type 4
vesico-ureteral
reflux.

Vesicoureteral reflux (VUR)

Voiding
cystourethrogram
demonstrates reflux into
both kidneys, with
dilatation of the ureters
and renal collecting
system.
The calyxes are
distended and blunted.
This case illustrates
typical bilateral grade
V vesicoureteric
reflux

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