radiology of urinary system IVU

Contrast injection about 50-100 cc over 10min time
1-First film immediate film
? Nephrographic phase 1st flm
1-size &position of kidney
2-Congenital malposition ;displacement by retroperitoneal mass
2-AFTER 5MIN 2ND FILM
? film of pelvicalyceal system phase
normally the minor calyceal system are curved because of pressure effect of pyramid
1- straight or convex (hydronephrosis)
2-sloughed(acute tubular necrosis)
3- pelvis is funnel shape so we look for stones ; masses ;tumors
3-AFTER 15 MIN.
? full length IVU show
1- ureter
2- urinary bladder
dilatation ;stone ; prostate
4-AFTER 25 -30 MIN
5-Postmicturition film
? 6-Several films taken according to the conditions we phase
? Prone film for ureter
? Oblique stones
II-U/S:
Non invasive. cheap &easy
Indication :
1. Patient with urinary symptoms.
2. Follow-up after lithotripsy
3. Patient with renal transplant to check rejection, stone &
hydronephrosis.
4. Renal failure
5. Patient with recurrent UTI (in children) to diagnose reflux.
In U/S the right kidney appear in relation to the liver & the left in relation to spleen.
the right kidney appear darker than the (kidney cehogenicity is less ), with smooth outline, surrounded by fat renal sinus (vessels), length 9- 12 cm adult &decrease with age.

Pelvicalyceal system doesn’t appear if normal. If it appears, means there’s dilation.
*overfilled bladder may look like hydronephrosis so don’t judge, ask
patient to void first.
*stones> 5mm can be detected as sharp acoustic shadow.
*U/S can also detect renal tumor, cyst hydronephrosis, 4rasitional cell CA, hypernephrorna.
*The ureter can’t be seen in U/S except for its upper 3cm & the lower part in the bladder.
In the bladder we see if there’s congenital anomaly, stone, tumor (prostatic).
*There are no contraindications for U/S except for gassy intestine.
III-CT scan:
Used for
1. Staging of tumor.
2. Detection of radiolucent stones (xanthine & uric acid stones).
3. Retroperitoneal mass, fibrosis
4. Sagittal reformal (to see kidney in lateral viewer), coronal reformat.
5. Renal trauma (bleeding, hernatoma).
in CT scan we 1 take a plain CT without contrast to see if there’s calcification.
IV- Radioisotope:
mainly for function of the kidney or when we can t do IVU.
We inject Tc 99 DFPA intraenously & only the functioning part of the kidney will appear.
V-MRI:
Two main indications
1. Renal vasculature before transplant for both the donor & recipient.
2. Renal artery stenosis (5 mm normally) with post stenotic dilation
If we want to do operation, we do angiography also.
VI- Antegrade & retrograde pye1oam:
Direct injection of contrast medium into the collecting system from above or below.
Antegrade pyelography requires insertion of a fine needle into the pelvicalyceal system under U/S or radiographic control.
Retrograde pylography can be performed by inserting catheters into the uretric orifices at cystoscopy.
Pylography mainly used to detect level of obstruction.
In the presence of obstruction, percutaneous nephrostomy drainage can be stablished & stent can be passed through any obstruction.
VlI- micturating cyst ourethrography:
For children with — Reflux