Radiology Department of Hasan Sadikin Hospital

Medical Faculty of Padjadjaran University

 ANATOMY
Genitourinary System
• Urinary System
– Kidney
– Ureter
– Bladder
– Urethra
ANATOMY
 ANATOMY
Genitourinary System
• Genital/Reproductive
– Male – Female
• Testis • Uterus
• Epidydimis • Salphynx
• Vas deferen • Ovaries
• Ejaculatory duct • Cervix
• Prostate • Vagina
• Seminal vesicle
• Penis
 ANATOMY
Male Reproductive System
 ANATOMY
Female Reproductive System
 ANATOMY
KIDNEY
• Bean shaped (convex laterally & concave medially)
• Length: ±11,5cm or 31/2 vertebral body)
• Width: ±5-8cm
• Thickness: ±3cm
• Retroperitoneal
• Between Th12- L3
• Right kidney is lower ± 1cm than left kidney
 ANATOMY
KIDNEY
 ANATOMY
KIDNEY
 ANATOMY
URETER
• Diameter 1mm-1cm
• Length: 25-30cm
• Retroperitoneal
• Three normal narrowing area
– Pelvoureter junction (PUJ)
– Pelvic brim where the iliac vessels cross the ureter
– Vesicoureter junction (VUJ)
 ANATOMY
URETER
 ANATOMY
BLADDER
• Urine reservoir
• Posterosuperior to the pubic bone
• Position:
– Empty: In the pelvic cavity
– Full: Extend to the abdominal cavity
• Capacity
– Adult: 350-500 cc
– Children: (Age [in year] + 2) x 30 cc
 ANATOMY
BLADDER
 ANATOMY
URETHRA
• Length:
– Male: 17,5-20cm
– Female: 4cm
• Male urethra divided by inferior aspect of urogenital
diaphragm into:
– Anterior part
• Cavernous/Penile part
• Bulbar part
– Posterior part
• Membranous part
• Prostatic part
 ANATOMY
URETHRA
ANATOMY
 IMAGING MODALITIES
– Plain abdominal x ray
– BNO-IVP
– Retrograde & antegrade pyelography
– Retrograde uretrography/cystography/urethrocystography
– Bipolar Urethrocystography
– Voiding Cystourethrography
– Ultrasonography
– CT Scan
– MRI
– Nuclear Imaging
– Hysterosalphingography
 PLAIN ABDOMINAL X-RAY
• Routine
• Good quality films will show the kidney outlines
– Enlargement (mass/hydronephrosis) can be
recognized
• Calcification
– Opaque calculi in the kidney, ureter or bladder
– Nephrocalcinosis : calcification in the renal
parenchym.
• Air distribution in the bowel
– Sentinel loop
NORMAL
ENLARGEMENT OF THE KIDNEYS
KIDNEY STONE
KIDNEY STONE
URETERAL STONE
BLADDER STONE
 BNO-IVP
• Blass = Urinary bladder, Nier = Kidney,
Overzicht = Examination
• Synonim:
– Intravenous urography
– Excretory urography
– Intravenous pyelography
 BNO-IVP
• Use contrast media intravenously
• Anatomic function:
– Depict the minor calyx, major calyx, renal pelvis,
ureter, urinary bladder.
• Physiologic function:
– Assess the kidney function in contrast media
filtration and excretion.
 BNO-IVP
• Indication
– Evaluate mass or cyst
– Urolithiasis (calculi in the kidney or urinary tract)
– Pyelonephritis
– Glomerulonephritis
– Hydronephrosis
– Trauma
– Renal hypertension
 BNO-IVP
• Contraindication
– Allergy
– Asthma
– Anuria
– Renal failure
– Cardiovascular disease
– Severe liver function abnormality
– Diabetes mellitus
– Sickle cell disease
– Multiple myeloma
– Pheochromocytoma
– Pregnancy
 BNO-IVP
• Contraindication
– Allergy
– Asthma
– Anuria
– Renal failure
– Cardiovascular disease
– Severe liver function abnormality
– Diabetes mellitus
– Sickle cell disease
– Multiple myeloma
– Pheochromocytoma
– Pregnancy
 BNO-IVP
Procedure
• 1-3minute : Nephrogram phase (not
• Ureteral compression
• 5 minute : Excretory function
• 15 minute : Pelvocalyceal system
• Compression can be released if the pelvocalyceal system has
been seen adequately
• 30 minute : After the compression was released to
see the urinary tract from the kidney
to the bladder
• 45-60 minute : fullbladder
• Post voiding : passage of contrast agent
 BNO-IVP
Contraindication of compression :
• Suspected stone
• Acute abdomen
• Following abdominal surgery
• Large abdominal mass
• Aortic aneurysm

 Use trendelenburg position instead

BNO IVP
1-3 Minute
5 Minute
15 Minute
30 Minute
Full Blast
Post Voiding
HYDRONEPHROSIS
CAUSED BY URETERIC
STONE (Black arrow
 Antegrade & Retrograde Pyelography
• Assess the urinary tract anatomically
• Nonfunctional  different from intravenous
pyelography
• Inject the contrast media through:
– Ureter catheter (retrograde)
– Nephrostomy catheter (antegrade)
 Antegrade & Retrograde Pyelography
Indication
• Depict the location, length and lower margin
(retrograde) or upper margin (antegrade) of
obstruction
• To predict the etiology of the obstruction
• Depict the pelvocalyceal system if it can not
be done by intravenous urography
– Renal failure
– Allergy
 Antegrade & Retrograde Pyelography
Contraindication
• Acute urinary tract infection
• Contrast media allergy (although the reaction
is less severe than intravenous)
• Pregnancy
• Hemorrhagic diathesis and hydatid cyst
(contraindication to nephrostomy)
 Antegrade & Retrograde Pyelography

Retrograde pyelography
shows extravasation of
contrast media
 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
 Retrograde Urethrography
Indication
• Urethral rupture
• Urethral stricture
• Congenital anomaly
• Urethral fistule
• Urethral diverticle
• Urethral obstruction
• Hematuria
• Recurrent urinary tract infection
• Slow urinary flow
• Urinary mass
 Retrograde Urethrography
Contraindication
• Acute urinary tract infection
 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
• 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 Cystourethrography
• Syn: micturating cystourethrography
• To assess the vesicoureter valve
 Voiding Cystourethrography
Indication
• Suspicion of vesicoureter reflux
• Recurrent urinary tract infection in children
• Stress incontinentia
• Hydronephrosis
Contraindication
• Urinary tract infection
 Voiding Cystourethrography
International reflux system
 Voiding Cystourethrography
Grade I vesicoureter reflux
 Voiding Cystourethrography
Grade IV vesicoureter reflux
 Ultrasonography
• The kidneys are well shown by ultrasound
– Mass
– Cyst (simple or polycystic)
– Hydronephrosis
– Stone
– Nephrostomy guiding
 Ultrasonography
Renal Mass
 Ultrasonography
Simple cyst
 Ultrasonography
Hydronephrosis
 Ultrasonography
Kidney stone
 Ultrasonography
• The distended urinary bladder is also well
shown by abdominal ultrasound
– Mass
– Stone
– Inflammation
– Infection
– Diverticle
 Ultrasonography
Urinary Bladder Mass
 Ultrasonography
Urinary bladder stone
 CT scan
• Mass, cyst and various lesion of the kidneys
are all well shown
• Gold standard in urinary tract stone
• Staging in tumour
 CT scan

Ureteric stone with

hydronephrosis
 MRI
• Staging in tumour
• Superior to CT in staging the bladder and
prostatic tumour
• Good contrast resolution
 MRI

Renal mass
 Hysterosalpingography
• Primarily demonstrate the uterus and the
salpynx (fallopian tube)
 Hysterosalpingography
Indication
• Infertility assessment
– Obstruction (can be therapeutic)
– Anatomic anomaly (e.g.uterine bicornis)
• Intrauterine pathology
– Endometrial polyps
– Uterine fibroids
– Intrauterine adhesion
• Post operative assessment after tubal ligation or
reconstructive surgery
 Hysterosalpingography
Contraindication
• Pregnancy (performed 7-10 days after the
onset of menstruation)
• Acute pelvic inflammatory disease
• Active uterine bleeding
Hysterosalpingography
Left Hydrosalpynx
Uterus bicornis
Thank you for your attention