imaging pada.pptx

Imaging in Genitourinary System

Imaging in Genitourinary Systemdr. Harry Galuh Nugraha, Sp.Rad

ANATOMYGenitourinary SystemUrinary SystemKidneyUreterBladderUrethra

ANATOMY

ANATOMYGenitourinary SystemGenital/ReproductiveMaleTestisEpidydimisVas deferenEjaculatory ductProstateSeminal vesiclePenis

FemaleUterusSalphynxOvariesCervixVagina

ANATOMY

Male Reproductive SystemANATOMY

Female Reproductive SystemANATOMYKIDNEYBean shaped (convex laterally & concave medially)Length: 11,5cm or 31/2 vertebral body)Width: 5-8cmThickness: 3cmRetroperitonealBetween Th12- L3Right kidney is lower 1cm than left kidneyANATOMYKIDNEY

ANATOMYKIDNEY

ANATOMYURETERDiameter 1mm-1cmLength: 25-30cmRetroperitonealThree normal narrowing areaPelvoureter junction (PUJ)Pelvic brim where the iliac vessels cross the ureterVesicoureter junction (VUJ)ANATOMYURETER

ANATOMYBLADDERUrine reservoirPosterosuperior to the pubic bonePosition:Empty: In the pelvic cavityFull: Extend to the abdominal cavityCapacityAdult: 350-500 cc Children: (Age [in year] + 2) x 30 ccANATOMYBLADDER

ANATOMYURETHRALength: Male: 17,5-20cmFemale: 4cmMale urethra divided by inferior aspect of urogenital diaphragm into:Anterior partCavernous/Penile partBulbar partPosterior partMembranous partProstatic part

ANATOMYURETHRA

ANATOMY

IMAGING MODALITIESPlain abdominal x rayBNO-IVPRetrograde uretrography/cystography/urethrocystographyBipolar UrethrocystographyVoiding CystourethrographyUltrasonographyCT ScanMRINuclear ImagingHysterosalphingography

PLAIN ABDOMINAL X-RAYRoutineGood quality films will show the kidney outlinesEnlargement (mass/hydronephrosis) can be recognizedCalcification Opaque calculi in the kidney, ureter or bladderNephrocalcinosis : calcification in the renal parenchym.Air distribution in the bowel Sentinel loop

NORMAL

KIDNEY STONE

KIDNEY STONE

URETERAL STONE

BLADDER STONE

IMAGING MODALITIESPlain abdominal x rayBNO-IVPRetrograde uretrography/cystography/urethrocystographyBipolar UrethrocystographyVoiding CystourethrographyUltrasonographyCT ScanMRINuclear ImagingHysterosalphingography

BNO-IVPBlass = Urinary bladder, Nier = Kidney, Overzicht = ExaminationSynonim:Intravenous urographyExcretory urographyIntravenous pyelographyBNO-IVPUse contrast media intravenouslyAnatomic 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-IVPIndicationEvaluate mass or cystUrolithiasis (calculi in the kidney or urinary tract)PyelonephritisGlomerulonephritisHydronephrosisTraumaRenal hypertension

BNO-IVPContraindicationAllergyAsthmaAnuriaRenal failureCardiovascular diseaseSevere liver function abnormalityDiabetes mellitusSickle cell diseaseMultiple myelomaPheochromocytomaPregnancy

BNO-IVPContraindicationAllergyAsthmaAnuriaRenal failureCardiovascular diseaseSevere liver function abnormalityDiabetes mellitusSickle cell diseaseMultiple myelomaPheochromocytomaPregnancy

BNO-IVPProcedure1-3minute : Nephrogram phase Ureteral compression 5 minute : Excretory function 15 minute : Pelvocalyceal system Compression can be released if the pelvocalyceal system has been seen adequately30 minute: After the compression was released to see the urinary tract from the kidney to the bladder45-60 minute : fullbladder Post voiding : passage of contrast agent BNO-IVPContraindication of compression : Suspected stoneAcute abdomenFollowing abdominal surgeryLarge abdominal massAortic aneurysm

Use trendelenburg position instead

BNO IVP1-3 Minute

5 Minute

15 Minute

30 Minute

Full BlastPost Voiding

HYDRONEPHROSIS CAUSED BY URETERIC STONE (Black arrow

IMAGING MODALITIESPlain abdominal x rayBNO-IVPRetrograde uretrography/cystography/urethrocystographyBipolar UrethrocystographyVoiding CystourethrographyUltrasonographyCT ScanMRIHysterosalphingography

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

Retrograde UrethrographyIndicationUrethral ruptureUrethral strictureCongenital anomalyUrethral fistuleUrethral diverticleUrethral obstructionHematuriaRecurrent urinary tract infectionSlow urinary flowUrinary mass

Retrograde UrethrographyContraindicationAcute urinary tract infection

Retrograde Urethrography

Retrograde UrethrographyUrethral rupture

Retrograde UrethrographyUrethral stricture with periurethral abscess

Retrograde CystographyTo assess the urinary bladderThe contrast media is injected through the urinary catheter into the urinary bladderRetrograde to the urinary flow

Retrograde CystographyIndicationRecurrent urinary tract infectionSuspicion of urinary bladder ruptureStoneMassInflammationDiverticleFistuleIncontinentiaHematuriaMeasure the urinary volume post micturitionAssess the integrity of the anastomosis or suture post operative

Retrograde CystographyContraindicationPregnancyUrethral rupture (contraindication to the urinary catheter insertion)

Retrograde Cystography

Retrograde UrethrocystographyTo 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.

IMAGING MODALITIESPlain abdominal x rayBNO-IVPRetrograde & antegrade pyelographyRetrograde uretrography/cystography/urethrocystographyBipolar UrethrocystographyVoiding CystourethrographyUltrasonographyCT ScanMRIHysterosalphingography

Bipolar UrethrocystographyTo assess the urethra from the proximal and distal aspects.Retrograde from the distal urethraAntegrade from the cystostomy catheterPatient is asked to void so that the contrast media will fill the proximal part of the urethra.

Bipolar UrethrocystographyIndicationAssess the proximal and distal margin of obstruction (stricture, stone, mass) in the urethraContraindicationAllergy to contrast media

IMAGING MODALITIESPlain abdominal x rayBNO-IVPRetrograde & antegrade pyelographyRetrograde uretrography/cystography/urethrocystographyBipolar UrethrocystographyUltrasonographyCT ScanMRIHysterosalphingography

UltrasonographyThe kidneys are well shown by ultrasoundMassCyst (simple or polycystic)HydronephrosisStoneNephrostomy guiding

UltrasonographyRenal Mass

UltrasonographySimple cyst

UltrasonographyHydronephrosis

UltrasonographyKidney stone

UltrasonographyThe distended urinary bladder is also well shown by abdominal ultrasoundMassStoneInflammationInfectionDiverticle

UltrasonographyUrinary Bladder Mass

UltrasonographyUrinary bladder stone


CT scanMass, cyst and various lesion of the kidneys are all well shownGold standard in urinary tract stoneStaging in tumour

CT scanUreteric stone with hydronephrosis


MRIStaging in tumourSuperior to CT in staging the bladder and prostatic tumourGood contrast resolution

MRIRenal mass


HysterosalpingographyPrimarily demonstrate the uterus and the salpynx (fallopian tube)

HysterosalpingographyIndicationInfertility assessmentObstruction (can be therapeutic)Anatomic anomaly (e.g.uterine bicornis)Intrauterine pathologyEndometrial polypsUterine fibroidsIntrauterine adhesionPost operative assessment after tubal ligation or reconstructive surgery

HysterosalpingographyContraindicationPregnancy (performed 7-10 days after the onset of menstruation)Acute pelvic inflammatory diseaseActive uterine bleeding

Hysterosalpingography

Left Hydrosalpynx

Uterus bicornis

Thank you for your attention

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