Urinary System
Lecture 1
by
dr. shaimaa A. alzubaidy
OBJECTIVES
1. Review of anatomy of the renal system and
taking idea regarding the radiological anatomy of
the system
2. To learn about the most common radiological
modalities used to evaluate renal system
3. To learn about uses of these modalities
Introduction
The kidneys lie in retroperitoneal space ,opposite to the
upper three lumber vertebrae , surrounded by
perinephric fat.
Bean-shaped with their concave aspect pointed medially
The PCS consist of minor calyces which drain into major
calyces via a neck (infundibulum).
Introduction
The ureter run retroperitonealy anterior to the tip of
transverse process of lumbar vertebra separated from them
by psoas muscle , it descend along the lateral pelvic wall to
the level of ischial spine ,from where it run anteromedialy
until it enter the superolateral angle of the UB base ,the
ureter run obliquely through the bladder wall for 2cm .
UB lie immediately posterior to the pubic bones. located in
the center of the pelvis ,it surround by perivesical fat ,the
base of the UB give rise to the urethra .
UB may have smooth upper indentation in female by uterus
,while in male there is smooth lower indentation by
prostate .
Radiological investigation of
urinary system .
The basic examinations for urinary system:
1. US
2. KUB and contrast studies e.g IVU(intravenous urography)
, cystography ,urethrography .
3. CT
4.MRI ( selected cases )
5.Radionuclide examination .
Arteriography &other invasive investigations are limited to
highly selected patients .
Ultrasound:
It’s important investigation in renal system as its available , harmless
, repeatable & non invasive and without ionizing radiation .
USES OF US
1-to evaluate symptoms related to the urinary system
2-Evaluation of presence of obstruction
3 -Evalusation of renal size and specially in pateints with renal
failure
4- to diagnose renal masses , abscesses and cysts include polycystic
kidney disease .
5-to assess and follow up the renal size and presence of scarring in
children with UTI .
6-to assess bladder and prostate
In normal US
The kidney is smooth in outline , hypoechoic parenchyma
surrounding a central hyperechoic region (renal sinus)
which consist of PC system with surrounding fat &blood
vessels .
Normally ureters are not usually visible by US .
UB should be examined in distended state ( full bladder )
Plain film ( KUB ) : for
Assess patient preparation .
Detect bones and soft tissue abnormality.
To identify urinary tract calcification and radiopaque
stones .
Determine exposure factors/ technical adequacy .
EU ( excretory Urography )
IVU ( Intravenous Urography)
It provides both functional & anatomical
information .
It has advantage ,that whole urinary tract can be
seen on a few films .
Films following the injection of water soluble iodinated
contrast media , dose = 300mg/kg body weight .
1. KUB
2. Immediate film (nephrogram )for renal parenchyma,
particularly renal outline , size & position .
3. 2min film (pyelogram) :excretion of contrast to PCS.
4. 5 min film : ( late / filling peylogram ) contrast media
filling in the PCS
5. 15-20min ( cystogram ) film to show the bladder full
with opacified urine
6.post voiding film. to asses the residual volume
Interpretation of films taken after injection of contrast
media:
1.Renal size
2. Renal position
3.Renal outline
It provide both functional &anatomical information .
Adult renal size is 10-16cm,a difference of 1.5cm is
acceptable between 2 side.
Small kidney could be unilateral or bilateral.
1.Renal size.
Causes of unilateral small kidney :
Chronic pylonephrites , TB , Obstructive uropathy (late
stage) , renal artery stenosis , renal hypoplasia and
radiation nephritis.
Causes of bilateral small kidneys :
Chronic GN , DM , analgesic nephropathy, hypertensive
nephropathy, collagen vascular disease .
Causes of unilateral large kidney :
Compensatory hypertrophy Bifid collecting system
Renal vein thrombosis Hydronephrosis
Causes of bilateral large kidneys :
Acute GN polycystic kid. Amyloidosis
2. Renal position :
Rt kid. is lower than Lt. kid. , renal axis parallel to the
psoas muscle and extend from lower border of D12 to
lower border of L3.
Abnormal axis occur in :
Malrotated kidney
Ectopic kidney
Displacement by mass
Nephroptosis
3.Renal outline:
renal parenchyma should be smooth, symmetrical and uniform ,
measurement 2-2.5cm with no indentation
4.Renal calices :
Normal calicies have well define cup shape ,in dilated
PCS shape of calices change from cupping to flat or to clubbing .
5.renal pelvis :
varies in position ,size and shape. normally its homogenous , any
filling defect within renal pelvis may caused mainly by one of 3
most common causes
A.radiolucent stone .
B.urothelial tumor.
C.blood clot.
6. Only part of ureter is seen due to peristalsis, , 7mm is
maximum accepted diameter .
Its normal course along the transverse processes of
lumber vertebra
7.UB
In full bladder view , the UB have smooth outline
¢rally located
Urethrography :
Either ascending or descending approach.
Ascending urethrography used for anterior urethra up to
distal sphincter , it done by special catheter.
Descending exam. shows the detail of post. urethra by
filling the U.B with contrast by catheter &films taken
during voiding( to the urethra and bladder base. ) .
Ascending urethrography
Cystography :
in micturating cystogram the entire process should be
observed flourpscopically.
The major indication for maturating cystogram:
1.identify and quantify vesico-ureteric reflex.
2. helpful in patients with neurogenic bladder to
distinguish obstruction from bladder instability .
3. investigate the anatomy of the bladder neck & urethra
4. to demonstrate incontinence and detruser instability
COMPUTED TOMOGRAPHY :
CT has a wide variety of indication including:
1. Investigation of renal calculi and hematuria
2.characterization of renal masses .
3.staging and follow up of urinary tract tumors.
4.Studying vascular anatomy (e.g. previous to
donation)
5.To exclude renal injury
.
MRI :
MRI in urinary system disorders used in
selected conditions like
Renal a. stenosis
Involvement of IVC by renal tumour
Clarify problems not solved by ultrasound .
RADIONUCLIDE EXAMINATION:
There are two main radionuclide technique for studying
the kidneys :(Tc DTPA) and (Tc MAG3 )
the main indication for their use is
1- evluation of renal function ( excretion ).
2- Evaluation of obstruction specially PUJ obstruction
3- Investigate renal transplant
THANK YOU
