Dr. Achmad Bunyamin Sp.Rad (K)

Department of Radiology, Faculty of MedicinePadjadjaran University-Hasan Sadikin Hospital

Bandung

URINARY TRACT

ANATOMY

KIDNEY : I. Normal Size : • Right kidney smaller than left • 3 – 3,5 lumbar vertebral body • Discrepancies of 1,5 cm or greater : Positive factor in hypertension

II. Normal Position • Retroperitoneal • Upper poles 1 cm closer to midline • Recumbent : Th 12 – L3 • Max. excursion 5 cm or 1,5 vertebral body on erect position

III. Internal Architecture - External cortex : 12 mm thickness

* Renal corpuscle * Convoluted tubules * Blood vessels

- Internal Medulla : * 8 renal pyramids

* Separated by columns of Bertini * Interlobar, arcuate, and interlobular artery

- Renal Pelvis :

Right Kidney Left Kidney

ULTRASOUND OF THE KIDNEY

RLL

RK

SP

LK

Left Kidney

LK

URETER• About 25 cm long• Retroperitoneal • In pelvic : Convex posteriorly and laterally• At ischial spine bend forward and medially ––> lower portion of bladder• Diameter variable : more or less 6 mm • Three normal constriction :

- Ureteropelvic junction- Cross external iliac artery- Uretero vesical junction

URINARY BLADDER* Lies in pelvic space* Anterior : Pubic symphysis* Posterior between bladder and rectum : - Male : ductus deferens and seminal vesicles - Female : Uterus and vagina

URETHRA- Female : Short, 4 cm, diameter 6 mm- Male : Prostatic portion : elongated, 3 cm Membranous portion Bulbous portion

Cavernous portion : diameter 6 mm

BLOOD SUPPLY

Renal artery : 1st lumbal vertebrae —> Dorsal Ventral

Renal veins : Parallel renal artery

RENAL FUNCTIONS :• Blood plasma filtration• Selective tubular reabsorption• Tubular synthesis and excretion • Acid base regulation• Fluid volume regulation• Maintenance normal blood regulation• Erythropoiesis

INTRAVENOUS UROGRAPHY

Indications : 1. Elevated creatinin or BUN2. Flank Pain3. Pyuria4. Microscopic / gross hematuria5. Hypertension6. Proteinuria7. Dribbling8. Frequency9. Dysuria

DIAGNOSIS1. Neoplasia2. Urinary tract obstruction3. Inflammation 4. Lithiasis 5. Cystic disease6. HypertensionPREPARATION- Clear liquid diet- Fasting after midnight- Bowel cleansingSKIN TEST OF CONTRAST MEDIUMPLAIN FILM ABDOMENCOMPRESSED OF ABDOMEN (by rubber bag / tennis ball)

NORMAL UROGRAM :Dosage : - 1 cc / pound of 50 % diatrizoate for patient less than 100 pound BW - 100 – 200 pound BW : 100 cc

- More than 200 pound : 150 cc

Nephrographic phase : 1 minute - Contrast in vascular and renal tubules - Hypervascular mass : isodens - Hypovascular, abcess and cyst : luscent

Pelvocalyceal opacification : 2,5 - 3 minute

Delayed opacification :

- overhydration

- decreased renal function

- hypotension

- small contrast volume

FILMING SEQUENCE

• 1 minute : Nephrogram phase• Ureteral compression• 5 minute : collecting system• 15 – 30 minute : ureter• 60 minute : bladder• Post voiding ––> - Passage of contrast agent - Simptom of lower urinary tract - Suspected stone• No ureteral compression : - Suspected stone

- Acute abdomen - Following abdominal surgery - Large abdominal mass - Aortic aneurysm

BNO IVP

5 MENIT

15 MENIT

30 MENIT

FULL BLAST

POST VOIDING