Excretory urography

1.IVU
2.MCUG

2. •Aka Excretory urography
•Use decreased significantly in recent years
CT, US, MR
•Remains primary modality for visualization of pelvi-
calyceal system

3. •Haematuria
•Renal colic
•Recurrent urinary tract infection
•Trauma
•Renal tumor
•Renal hypertension
•Calculi (kidney , ureter, bladder)
•Bladder pathology ( diverticula ,fistula )

4. Urogram
•Visualization of kidney parenchyma,
calyces and pelvis resulting from IV injection of
contrast
Pyelogram
•Describes retrograde studies visualizing only the
collecting system So, IVP is misnomer, should be
IVU

5. •Cystography
Describes visualization of the bladder
•Urethrography
Visualization of urethra
• Cystourethrography
Combined study to visualize bladder and
urethra

6. •NBM for 5 hrs
•Ambulent for 2 hrs to reduce bowel gases

7. •Inject nonionic contrast Or LOCM as bolus, 30-60 sec
•Adult 50-100 ml
•Pediatric 1ml/kg

8. •True contrast reactions are uncommon
•Most commonly seen are minor side effects
Flushing
Metallic taste in mouth
Tachycardia
Usually resolve within a few minutes

9. •Scout view
•Additional views

10. •Supine , full-length AP abdomen, full inspiration
•Lower border of cassette at the level of symphysis pubis,
beam centered in midline at the level of iliac crests
•Often difficult to fit this large area on a single radiograph,
may need….
• 14 x 17 of abdomen
• 10 x 12 of lower pelvis

11. •Look for…
• Calcifications
• Abnormal soft tissue
• Air within urinary tract
• Bony abnormalities
• Determine if a contraindication to abdominal
compression exists

13. •Oblique Views (35 degree posterior oblique)
- Good for questionable ureteral lesions
- For differentiating extrinsic and intrinsic renal and
ureteral masses
-Visualization of posterolateral aspect of bladder
•Supine AP of renal areas in expiration
•Tomography of kidneys

15. •Immediate Film
•AP of renal areas.
•10-14 sec after injection
•Shows nephrogram
•5-min Film
•AP of renal areas
•Determine if excretion symmetrical
•Assess the need to modify technique
•Application of compression band baloon at level of anterior
superior iliac spines

16. •Compression contraindicated in
•Recent abdominal surgery
•Renal trauma
•Large abdominal mass or aortic aneurysm
•Already dilated calyces on 5-min film

17. •10-min Film
•AP of renal areas
•Compression released if pelvicalyceal system adequately
visualized
•Release film
•Supine AP abdomen
•Whole urinary tract
•Empty bladder

18. •Post voiding Film
• Full length OR
• Coned view of bladder(tube 15 degree caudal, centered 5 cm
above symphysis pubis)
• Must be obtained immediately after voiding
•To determine residual urine in bladder >especially in
older male patients
•To look for bladder neoplasms
•VUJ calculi
•Urethral diverticulum in females

19. TCC

20. Delayed Views
•1 hour to 48 hours- in cases of obstruction
•Better to CT patient for immediate diagnosis

21. Prone film
•Helps fill ureteral areas not seen in supine position since
upper ureters more anterior than kidney

22. Erect film
•Promotes emptying of collecting system
•Optimal for showing bladder hernias
•Shows layering of calculi in cysts
•Demarcates areas of ureteral obstruction better than prone
views

28. Dynamic test used to define
• The anatomy
• the function of the lower urinary tract.
Performed by..
•placing a catheter through the urethra into the bladder
•filling the bladder with contrast material
•taking x-rays while the patient voids.

30. •Vesico-ureteric reflux
•Bladder abnormalities
•Stress incontinence
•Urethral trauma leading to obstruction
•Posterior urethral valves

31. •Acute UTI

32. •HOCM or LOCM
•Fluoroscopy unit with spot film device and tilting table
•Video recorder
•Jaque’s or folley’s catheter. In small infants 5-7 size
feeding tube is adequate

33. Patient preparation
•Micturate prior to examination
Preliminary Film
•Coned view of bladder , using the under-couch tube

34. To demonstrate vesico-ureteric reflux
Exclusively in children
•Supine on x-ray table
•Insert catheter aseptically
•Drain residual urine
•Contrast medium dripped into bladder and observed under
fluoroscopy
•Record reflux
•Patient asked to micturate
•Spot films taken during micturition

35. •Oblique/lateral position for males to observe entire
urethra
•Full length abdominal view to look for..
•Unnoticed contrast reflux into kidneys
•Post-micturition residue

36. To demonstrate vesico-vaginal / recto-vesical fistula
•Films taken in lateral position
To demonstrate stress incontinence
•Catheter left in situ until patient is in erect position

37. Include sacrum and symphysis pubis
•Lateral bladder
•Lateral bladder, straining - catheter removed
•Lateral bladder during micturition

38. •KUB
evaluate the bones of the spine and pelvis (injury or
congenital anomaly such as spina bifida) and the soft
tissues (calcifications, foreign bodies, etc.)

40. •posterior processes are absent
below L-4. This patient has lower
lumbar spina bifida.

41. •This child has significant
constipation, the variegated
pattern of stool and gas in the
colon.

42. •Images are obtained while the bladder is being filled with
liquid contrast.
•The bladder should appear smooth and regular and there
should be no filling defects except the balloon of the
urethral catheter.
•The edges of the bladder image should be smooth.

44. •This patient has an obstruction
in the urethra. She has spina
bifida (see that shunt tubing?).
Nerve damage from the spina
bifida results in a physiologic
obstruction to urine drainage
through the urethra. Her
bladder responded to the
obstruction by detrusor muscle
hypertrophy. This thickened
muscle caused the irregular
border of the bladder.
•‘Christmas tree’ bladder

45. •To demonstrate the urethra (strictures or obstruction) and
the bladder
•The presence or absence of vesicoureteral reflux.

46. •This film shows a
normal male urethra;
there is no obstruction.
The variation seen in
the diameter of the
urethra is normal.
Indentation at the urethral
sphincter (normal)

47. •May demonstrate
•Reflux
•Extravasation of urine from the
bladder or urethra
•Residual urine in bladder
•No reflux and no residual
bladder urine is seen in normal
post-void film.
Normal post-void film

48. •No special care needed
•Rarely dysuria leading to urinary retention - analgesic
•Antibiotics prescription to patients with reflux

49. •Due to contrast medium
1.Contrast induced cystitis
2.Contrast reaction due to absorption by bladder mucosa
•Due to technique
1.Acute UTI
2.Catheter trauma - dysuria , frequency, hematuria ,
retention
3.Perforation from over distention
4.Catheterization of vagina or an ectopic ureteral orifice
5.Retention of Foley's catheter

50. I:Ureter only
II: Into sharp,
delicate calyces
III.Blunted calyces

51. IV:severe blunting
V:Dilated, tortuous ureter