w






w 

m it incorporates entire urinary tract-

kidney,ureter,bladder
m Upper limit lies above adrenal gland while inferior
limit lies just below symphysis pubis
indications
m Diagnosis of calcium contianing renal tract calculi
m Control film prior to contrast admnistration
m Asses efficacy of stone Rx[eswl]
m Check status and position of ureteric stents and
foreign bodies/devices in urinary tract
m It also demonstrate intestinal gas patterns and certain
soft tissue abnormalities
 "
 "
m AP full length view in full expiration
m Bowel preparation improve image quality and yield but
is not mandatory
m Effective radiation dose is 1.5msv[equiv.to 9 month of
background radiation or 3500 miles traveled by car ]
"  ""
appropriate interpretation requires a systemic
approach.
m irstly, renal tract and its anatomical markings are
scrutinized
m ‘ther intraabdominal and pelvic organs identified
m Abnormal intestinal gas pattern is usually obviously
apparent
m Look for bony abnormality in the spine and bony
pelvis
"
"
m pidneys-renal hilum moves with respiration but tend
to lie at L2 lumbar vertebrae .size[11-13cm in adult]
shape, and position of both kidney should be observed
m Ureter-ureteric line is traced inferiorly along tip of
transverse process of lumbar vertebrae, over the
sacroiliac joint, then lateral within bony pelvis towards
ischial spine before turning medially to enter the
bladder Note any calcification
 3 




"
m Renal tract calculi
m Calcified lymph node
m Phleboliths
m Calcified costal cartilages
m Renal nephrocalsinosis
m Aortic calcification
m Prostatic calcification
m Adrenal calcification
m Parenchymal calcification
m Calcified uterine fibroids
m TB of kidney
 ô
""  " asses outline and shape, size,
displacement of kidney, liver, spleen, bladder. Absence psoas
shadow suggest retroperitoneal mass or fluid collection

 "" 
"

 "
m cheap
m Non invasive
m Small radiation dose
m Information about abdominal organs and intestinal
obstruction

 
m isses up to 30% of stone.
m Difficult to diagnose b/w calcification within and outside
renal tract
m Bowel gas and fecal loading can obscure small calcification
 
ô 

w
m Provides anatomical as well as functional information
m Iodine- containing iv contrast medium is filtered and
excreted by kidneys. Providing opacification of entire
renal tract.
m CT scan is replacing ivu in many urological condition

"
m Investigation and surveillance of urinary stone disease
m Investigation of hematuria[upper tract
tumor],obstruction [usg,radionucleotide scan]
m Assessment of anatomical abnormalities and renal
tract disease
m anagement of renal tract trauma [on table ivp]
 
 "

m Contraindicated in pregnant and pt with h/o of

contrast allergy
m luid restriction is not required with modern low
osmotic media
m Bowel preparation desirable not mandatory
m Control pUB film is taken to know any area of
calcification which may obscured later by contrast
m 50ml to 100ml of contrast [1ml/kg body weight of
300mg of iodine/ml of solution]
Ú
  
ÚÚ Ú 
 
m 

 
 ×it i 1 i e r ra [c trast i
re al t les] e se i str cti 2t 3 i
yel ra [c llecti ct]
m ½

6e strate f ll yel ra ic ase ×it
vis alizati f c llecti syste a 6 r xi al reter.
m ^ e se e ce f f rt er fil s is 6eter i e6 y t is fil s.
te a y 6ilati [s estive f str cti /stasis] a 6 a y
filli 6efect [ eristalsis ,t r ,st e ]. c ressi
a lie6 at level I t r 6
ce elvicalyceal filli
m 15- min film : may be performed to show lower ureter
m Release film :may be performed after release of
compression to visualize whole urinary tract
m Post micturition film : allows assessment of bladder
emptying but also useful in diagnosing bladder tumors
,juxtavesical stones , and urethral diverticulum
m Delayed film : may be useful at interval of 1 ,4 ,12 ,and 24 hr
following contrast injection if obstructed
m ‘ther film : oblique views may help clarify location of
calcification . Prone film provide better ureteric filling .
Erect films are best for showing renal ptosis and cystoceles
Effective radiation is 4.6 mSv [ =2.5 yr of background
radiation or 11500 miles traveled by car]
 "  ""
m Check for functioning kidneys,size shape[horse-
shoe],contour[renal masses]and cortical thickness[ renal
function].
m Renal pelvis and calyces must be examined for adequate
filling[filling
defect],distortion[sol],dupliction,distention[obstruction].
m eatures of obstructed urinary tract include.
1. Dense nephrogram
2. Delayed pyelogram
3. Distention of collecting system of ureter above level of
obstruction
4. Contrast extravasation.
m Dense neprogram may be seen in renal vein thrombosis and
renal artery stenosis but subsequent pelvicalyceal distension
seen in obstruction absent.
 
 
m Largely replaced by uss, ct scan and nuclear scan.
m Still used in children with complicated stone disease
,abnormal /variant upper tract anatomy ,and hematuria
m Certain modification are required :
D Limit amount of contrast [1ml/kg body wight]
D Limit no. of film to three
D Avoid dehydration
D Avoid bowel preparation
D Avoid compression

 "
m Prompt visualization of entire urinary tract with good
demonstration of "
m Excellent demonstration of renal tract calculi[>90%]
m unctional assessment of obstruction[high or low grade]
m Qualitative assessment of overall kidney function [degree of
opacification ,cortical thickness]
m Can be performed /interpreted by non radiologist
m Cheap

 
m Require iv assess and contrast
m Use of radiation
m Dependent on renal function
m ay miss renal masses if not in line of renal contour
m Unable to distinguish b/w cystic and solid masses
m Cannot provide accurate estimation of renal function
   

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m ost common investigation for the evaluation of male and
female urethra
m Provides superior anatomical information
m Performed via antegrade [mcug] or retrograde [ascending]
aproach
m Antegrade approach is better for visualization of posterior
urethra where as retrograde is for anterior urethra
m Some pt. can be imagined using both techniques
m Dynamics technique provides most clinically pertinent
data
 
"
m Strictures
m Urethral trauma
m Urethral diverticulum
m istulae
m Periurethral or prostatic abscess
m Congenital abnormalities
m Urethral tumors [to assess luminal patency]
‰ ’       Ú Ú      
‰   ÚÚ  Ú     Ú Ú ÚÚ  
 "  ""
m 3

     Ú best demonstrated on CUG as a
linear filling defects obstructing contrast flow with proximal
dilation of prostatic urethrae
m ?     ’ seen as contrast filled smooth , rounded
sac attached to urethra by short neck
m ô  Ú :
1. Inflammatory stricture usually occurs at proximal bulbar
urethra, may be multiple with varying length
2. Truamatic stricture bulbomembranaouÚ
Ú  
 ’
3. Complete demonstration of tight stricture may require both
approach
m ?   ’ : mainly restricted to males delayed technique
[3-6 month ] is advised
1. Trauma to anterior urethra usually secondary to
instrumentation or blunt perineal trauma and seen as
extravasation of contrast in corposa spongiosum
 2.Posterior urethral injuries classified according to their
urethrographic appearances
Type Description Contrast pattern

1[mild] Contusion or partial tear of urethra No extravasation

2 mc rupture just above urogenital diapragm[prostatic contrast extravasation in retropubic sp

apex] bulbar urethra intact 2/3rd complete no contrast in bladd

3 Rupture of membranaous urethra below Contrast in perineum usually complete

severe Urogenital diaphragm at No contrast in bladder
bulbomembranaous
Junction

 " 
m Accurate visualization of urethral anatomy


m Introduction of infection
m Catheter related injury
m Contrast allergic reaction [but rare]
  
ôô3


m USS is cheap ,easily available ,painless and safe .

m Provide real time anatomical as well functional
information
m It relies on a dual mode transducer and displays two
dimensional gray scale image or as color doppler
m requencies used in medical sonography range from 2
to 10 mhz
 
"
 !



 
m Possible upper tract obstruction
m Suspected renal /adrenal mass
m Investigation of hematuria
m Investigation of renal failure
m onitor renal cystic disease
m Diagnosis of urinary stone disease
m Aids access to kidneys for interventional procedure
m Colour doppler to demonstrate vascular lesions
m Visualize peri renal area and retroperitoneum
  "  
m Bladder outflow obstruction Ȃmeasurement of residual
urine
m Investigate intra vesical mass [clot ,stone ,tumor]
m Aid suprapubic aspiration
ë Ú  
Ú ’
 Ú
m Suspected prostate cancer [+biopsy]
m Investigation for chronic pelvic pain
Ñ ô ’
m Lump ,pain ,trauma
½ 
Ú
m investigation of erectile dysfunction
m Peyronies disease
m Diagnose high flow priapism
m Can aid visualization of urethral stricture
 "  ""
1.!
Ú
 

kidneys must be viewed in both sagittal and transverse planes
Size /contour
m 9-13 cm in length
m Difference of >1.5cm b/w two kidneys is suggestive of unilateral
pathological process
Echogenicity
m Cortex is homogenous [=or< to liver or spleen]
m Thickness of preserved renal cortex correlates renal function
m Central echogenic complex contains hilar vessels and intrarenal
collecting system
m Splaying of central echogenic complex is seen in hydronephrosis
asses
m US is excellent at distinguishing b/w solid and cystic masses over 2cm
 |ydronephrosis
å Diagnostic accuracy of uss for hydronephrosis is 90-100%
Vasculature
å Renal artery stenosis ,renal vein thrombosis ,and AV fistula
can easily be demonstrated using color doppler
Perirenal
å Urinoma, ,hematoma ,perinephric abscess can be diagnosed
and in many instances treated using usg guided drainage
techniques
Retroperitoneum
å LN enlargement ,retroperitoneal tumor ,and aorta can be
seen using uss
Adrenal
å Uss visualization is very useful , especially in children
Small lesion may be missed and a CT scan needed when
doubt
2. 
m Bladder can be scanned by transabdominal ,
transrectal , transurethral approaches.
m Transurethral approach provide excellent definition
and can be useful in the evaluation of muscle invasion
by tumors.
m ull bladder is anechoic. Stone ,tumors ,debris ,clots
,and infection causes abnormal echoes
m Bladder urine volume can measured although
inaccurately [vol. = height x width x depth/2].
m Absence of ureteric jets [color doppler] for >15 min is
suggestive of ureteric obstruction.
 ë 
"
Scrotum is scanned for abnormal masses, inflammatory
condition ,and blood flow .
Doppler flow measurement have 98% accuracy in diagnosis of
acute testicular torsion . But in most cases immediate
surgical exploration is recommended.
 w  
USG of penis used in following condition.
1. Impotence : doppler can demonstrate cavernosal and
internal pudendal blood flow
2. Peyronie s ds: area of fibroses or plaque formation is seen
on uss
3. Priapism : uss help in differentiating b/w high flow [AV
fistula] and low flow priapism
4. Urethral stricture : distal urethra stricture and periurethral
structures easily seen by uss

 " 
m Safe Ȃ no radiation involved
m Non invasive
m Cheap Ȃreadily available
m No requirement of contrast
m Not dependent on function
m Excellent anatomical detail
m ‘ccasional functional / physiological information
m Doppler studies excellent vascular / flow studies
m Useful adjunct for interventional procedures
[nephrostomy ,abscess drainage]
 

m ‘perator dependent
m Eqiupment dependent
m Limited by patient body habitus Ȃ presence of
intervening bowel gas ,bony structure ,surgical wound
,and dressings can compromise image quality
m Image quality is inferior to ivu and ct scan
m ‘ffer little functional information
m Difficulty in visualize retroperitoneal structure and
ureter
3
3

m CT scan revolutionized uroradiological imaging such that in many practices it
is first and only investigation performed for a variety of urological complaints

" 

Ú
1. Detection ,definition ,and staging renal masses
2. Delineation complex renal stone
3. Evaluation of renal vasculature
4. Characterization of perirenal and bladder inflammatory masses
5. Investigation of level and causes of hydronephrosis
6. Investigation of filling defect in the collecting system
7. Extent and staging of renal tract trauma
8. Evaluation of renal transplants
9. Investigation of congenital renal malformations
10. Adjunct to interventional procedure [renal biopsy ,puncture]
 Ê   
’
m Investigation of choice for retroperitoneum LN , masses , abscess or
fibrosis
 
m Suspected ureteric stones [>97% NCCT]
Õ

m Investigation of suspected mass
"  
m Staging of invasive bladder tumors
 Ú  
Ú ’
 Ú Ú
m Staging of prostate tumors
m Investigation of abscess ,congenital deformities ,and cyst
^ ÚÚ
m Detection of metastasis from testis cancer

 " 
m Single technique for visualization of entire renal tract with
excellent anatomical detail
m Simultaneously detect non renal pathology [liver]
m Identifies virtually all renal and ureteric calculi
m Increased sensitivity in detection of renal masses
m Allow accurate staging detected malignancies
m 3D reconstruction enable delineation of anatomy and aids
surgical planning
m CT angiography [non invasive] as accurate as conventional
[invasive]
 
 
m Radiation risk
m Requires contrast with associated risks
m Expensive
m Interpretation requires time expertise
m Poor accuracy luminal pathology



"
1. pidneys
m Assessment of indeterminate renal masses[it readily distinguish b/w
cysts and other benign or malignant neoplasm ]
m Staging renal cell carcinoma
m Renal lymphoma [ct insufficient detection of renal involvement]
m RA allow excellent demonstration of renal vasculature
m Retroperitoneal fibrosis [ may help distinguish b/w benign or
malignant etiology]
m Assessment transplanted kidney
m R urography performed to asses calculi or obstruction if
conventional iodinated contrast tech. contraindicated[ pregnancy
,renal failure ]
2.Adrenals
m Pheochromocytoma
m Distinguish b/w adrenal adenoma ,ca ,and mets
3. Bladder
m Staging bladder tumor
4. Prostate
m Staging Prostate cancer

 " 
m Can image any plane
m No radiation
m Excellent anatomical detail [soft tissue]
m Non invasive angiography [RA]
m No bony artifact due to lack of signal from bone
m Contrast use is infrequent and safe
 

m |igh operating cost
m Limited availability for emergencies
m Interpretation requires expertise
m Artifact produced pt movement ,scarring and
inflammation
m Inability to show renal tract calcification
m Tendency to over stage prostate and bladder cancers
m resh hemorrhage not as well visualized as by ct
m Can be noisy and claustrophobic