The kidney extends from the level of the upper border of 12 T to the level of the transverse process of L3. the LT.KD is lower to the RT.KD.

       Ureter is 10-12 inch (25-30 mm). It enters the bladder at the level of ischial spine.

       Urethra is a musculomembranous type (male= 7-8 cm female = 3-4 cm).

       The male is divided into three portions: Prostatic-Membranous- Spongy

   prostate measures 3.8 cm transversly,1.9 cm anteroposteriorly and 2.5 longitudinally.

     

Urinary tract

Methods of imaging of the urinary tract:

       K.U.B.

       Excretion urography (I.V.U.).

       Micturating cystourethrogaphy.

       Ascending urethrography.

       Retrograde pyelography.

       Micturating cystourethrogaphy.

       Percutaneous renal puncture.

       Angiography.

       US.

       CT.

       MRI.

        Radionuclide imaging.

   K.U.B. :

   KUB (kidney, ureter and bladder) is the standard plain radiography of the urinary tract, which consists of a full-length abdominal film.

K.U.B:

     The KUB is most usefully employed part of an intravenous urography or to follow up a previously proven calculus.

K.U.B

    The anatomical structures which can be seen on the KUB:

Kidneys- psoas- axial skeleton- bowel gas- base of the lung.

Excretion urography (I.V.U.).

The IVU consists of a series of films taken after the administration of intravenous injection of CM. The choice of whether to use an ionic or nonionic contrast medium depends on patient risk and economics.

It demonstrate both the function and structure of the urinary system.

The main indications for the IVU are:

       Haematuria.

       Ureteric calculi.

       Ureteric fistula and stricture.

       Urinary tract infection (UTI).

• Before the examination is started, the procedure is explained to the pt to be more cooperated and the patient history and blood chemistry level should be checked. (BUN= 8-25 mg/100 ml – creatinine = 0.6-1.5 mg/100ml).

Patient preparation:

   Bowel is purged with strong laxative and gas-absorbent tabs.

   Patient should take nothing by mouth after midnight before the day of examination.

Contraindication of dehydration:

•   Renal failure.

       Myeloma.

       Diabetes.

       Infancy.

        Sickle-cell disease.

• They should be well hydrated (they are at increased risk for CM induced renal failure if they are Dehydrated).

Technique:

       KUB film is done to check:

-         Exposure factors.

-         Patient preparation.

-         Site of kidneys.

-         Centering.

obvious pathology (UT calcification).

       The CM is injected through vein.

       Adult dose = 50 mm and pediatric dose = 1 mm per kg

       Most reaction to contrast media within the first 5 minutes after administration. (Should not be left alone).

Films:

1.    Immediate film (nephrogram). AP of the renal areas (14-15 S = arm-to-kidney time). It aims to show the renal parenchyma opicified by C.M. in the renal tubules.

2.    5 minutes film. AP of the renal areas. This film is taken to determine if excretion is symmetrical.

1.    A compression band is now applied around the patient’s abdomen at the level of ASIS. Its aim is to inhibit ureteric drainage and promote distension of the pelvicalyceal systems (optimizing their visualization).

1.  Compression is contraindicated:

       After recent abdominal surgery.

       After renal trauma.

       Large abdominal mass.

       When the 5-min film showed distended calyces.

1.    15-minutes film. AP of the renal areas. (Adequate distension of the PCS). *Compression is released.

2.    25-minutes film (release film). Supine AP abdomen. Its aim to show the whole urinary tract.

1.    After micturition film. Based on the clinical finding and radiological finding (full-length abdominal film or coned of view of the U.B.). This film is aimed to:

       Assess bladder emptying.       Demonstrate a return to normal of dilated

upper tract with relief of the bladder pressure.       Aid the diagnosis of the bladder tumours.       Confirm uretrovesical junction calculi.      

RADIATION PROTECTION: (IVU)

• Apply a gonadal shield (if it does not overlap the area under examination.

• Use collimation.

• Work carefully to avoid repetition of exposures.