Urologic investigation

Types of investigations :

laboratory Imaging interventional

 Urine :  Plain x-ray  Retrodrade
 Urine analysis  Ivu ureterography
 Culture & sensitivity
 Ultrasonography  Antegrade
 cytology nephrostography
 Ct scan
 Blood  Renal angiography
 Mri
 semen  Urodynamic study
 Frozen section biopsy
 A-Urine analysis

• Colour :
normally amber yellow
colourless in diluted urine
deep yellow in concentrated urine
• Odour :
physical ammonia like in uria splitting bacteria
offensive in infection
fruity in ketones
• Aspect:
normally clear “ transparent “
turbid in : heamaturia - pyuria
• Specific gravity
normally 1015 : 1025
• Ph
normally 5 : 7 acidic
 • Glucose
It appears in urine when its blood level exceeds
the renal threshold as in diabetes mellitus. In other
cases, it can appear without increase in the blood

chemical level e.g. renal glycosuria.

• Protien
normal 150 : 300 mg/day
• Keton bodies
in dka
• Billirubin
in jaundice
• Nitrite
indicate uti
• Creatinine clearance
 •Rbcs
•Pus cells
•Epithelial cells
•Crystal & casts
microscopic •Bacteria &
parasites
B- culture and sensitivity :

 The bacterial microorganisms could be cultured and their sensitivity to

antibiotics is measured. It is done for :
1. Urine : In various types of urinary tract infections and suppuration.
2. Semen : As in cases of suspected tuberculosis.
3. Discharges : As urethral discharges.
4. Aspirates : As in cases of infected urinoma.
C- urine cytology

 To detect malignant cells

 BLOOD

2- tumour 3- routine
1- Renal investigations
markers 4- hormonal
function tests Random blood
Blood urea : Normal
- PSA for sugar. FSH
prostatic 5- karyotyping
value is 20-40 mg%.
Liver function tests. LH
Serum creatinine : cancer
Normal value is 0.7- - AFP for Complete blood testosterone
count.
1.2 mg%. testicular prolactine
Bleeding and
tumour coagulation profiles.
Semen analysis
Radiological investigations

 Plain x-ray
 IVU
 Ultrasonography
 Ct scan
 MRI
A- Plain x-ray

 Criteria for good kup film :

- the patient should be centralized
- well prepared : fasting 6 : 8 hs
- good extention : above the last 2 ribs
below 2 inches below symphysis pubis
 It shows
1- radio opaque shadows : stones – abnormal calcification – stent
2- soft tissue shadows : renal shadow – psoas muscle
3- bones : in the following conditions
the last rib is a landmark for lumbar incision in renal surgery
urological trauma
spine deformity
B- IVU

 It is a radiological study which visualize the anatomical features of the

urinary system through injection of iv dye

 The used dye may be :

LOCM HOCM “ urographin “

less complications high complications
Technique

 Preparation of the patient :

- renal function test
- bowel preparation by fasting at least 12 hours and enema
- sensitivity test
 KUB film should be taken before injecting the dye “ prelaminary film “
 Iv injection of the dye
 Serial x-ray films at :
- after 2 min it shows nephrogram
- after 10 min it shows pyelogram
- after 30 min it shows cystogram
- post voiding film for residual urine
 Vascular phase
It takes 20 : 40 seconds
 Nephrographic phase
Shape : appears as homogenous opacity
Size : 3 : 4 vertebrae
Site : from L1 : L3
 Pyelographic phase
Major calyx 2 : 3 in number
Minor calyx 8 : 12 “ each major has 2:3 minor “
 Renal papillae concave laterally
Renal pelvis triangular in shape
Ureter is segmented due to
peristalsis
 Cystographic phase
shape : homogenous opacity
appears as egg on sides
site : in centre of pelvis flushed on
symphysis pubis
borders : smoothly outlined
Indications of IVU :

 Urinary stones :The IVU is mandatory in both radio-opaque and radio-

luscent stones as the stone is included in the dye or appears as a filling
defect respectively.
 Urinary tumours :According to the site and the type of the tumour in the
different organs of the urinary tract, the IVU manifestations appear. For
example ; Bladder cancer appears as an irregular filling defect. The
corresponding kidney may be non-secreting or dilated, if secretion occurs.
 Obstructive disorders :
- Hydronephrosis : The kidneys are enlarged with dilated pelvi-calyceal
system with or without ureteral dilatation.
- Ureteral stricture
- BPH
 Congenital anomalies e.g.
Ectopic kidneys
Duplex system
Horse-show kidney
Polycystic kidney disease : Distorted distribution of the pelvicalyceal system
PUJ obstruction

 Heamaturia

 trauma
 Complications of IVU :
1- renal failure
2- anaphylaxis

 Contra indications :
1- hyper sensitivity
2- raised serum creat < 2 mg/dl
3- raised serum urea < 120
4- pregnancy
5- dm
6- thyrotoxicosis
C – ultra sonography

1. Abdominal us
2. Trans rectal us “ trus “
3. Duplex us renal
penile
scrotal
Abdominal us

Kidneys :
i. Site : In the normal or ectopic sites.
ii. Size : The kidney may be within normal diameters, enlarged as in hydronephrosis or small sized as in chronic
pyelonephritis and renal hypoplasia.

iii. Shape : Preserved normal kidney shape or disturbed due to a mass, hydronephrosis, …..
iv. Echogenicity :
v. Presence of stones or calcifications.
vi. Presence of obstruction and the cortical thickness measurement.
vii. Presence of any masses or cysts.

Ureters : They can be traced by ultrasound, if they are dilated.

Bladder : It should be full during the ultrasonographic examination.
Other abdominal organs : As the liver , gall bladder, spleen, intra-peritoneal collections and ascites
Trus

 The following organs can be evaluated :

1. Prostate : volume – presence of stones –
abscess
2. Seminal vesicles and ejaculatory ducts
 It can be followed by trus guided prostatic
biopsy
Duplex us

1- renal Doppler :
It is used for examination of the renal blood supply and possibility of vascular
thrombosis.
2- penile Doppler :
in case of erectile dysfunction
3- scrotal Doppler : used for
Varicocele
Testicular torsion
Testicular trauma
D- CT scan with or without contrast

 It shows the urinary tract and assesses other abdominal organs

 Tumors : In diagnosis and post-operative follow up of renal , bladder,
testicular tumours, and other genito-urinary tumours.
 Trauma : Mainly in the renal trauma.
 Suppurations : Mainly in the renal and perinephric abscesses.
 Stones : Rarely, it can be done for detection of a radio-luscent ureteral
stone.
E- MRI

 Indications :
1. Replaces ivu & ct scan in case with raised renal function
, pregnancy , hyper sensitivity to contrast
2. Vascular assessment
3. Urethral strictures