Questions in Urologic Radiology For Medical Students
Questions in Urologic Radiology For Medical Students
Questions in Urologic Radiology For Medical Students
medical students
Dysuria
refers to painful urination
Difficult urination is also sometimes
described as dysuria
It is one of a constellation of irritative
bladder symptoms, which includes
urinary frequency and haematuria
Incontinence:
is any involuntary leakage of urine.
Common etiology are:
1.Polyuria
2.Prostate disorders (BPH and cancers)
3.Caffeine and Cola
4.Brain disorders (MS, spinal cord
injuries, Parkinson disease, stroke)
Abnormalities of Urine
Volume
Oliguria:
is the low output of urine, It is clinically
classified as an output below 400
ml/day
The decreased output of urine may be
a sign of dehydration, renal failure,
hypovolemic shock, multiple organ
dysfunction syndrome, or urinary
obstruction/urinary retention.
Anuria:
absence of urine, clinically classified
as below 100ml/day
Anuria can be caused by
1. total urinary tract obstruction
2. total renal artery or vein occlusion
3.Shock
4.Cortical necrosis
5. severe ATN
6.Rapidly progressive
glomerulonephritis
Polyuria:
urine>3 L/d
Polyuria results from two potential
mechanisms:
1. nonabsorbable solutes diuresis
2. water diuresis (DI)
If the urine volume is >3 L/d and
urine osmolality is >300 mosmol/L,
then a solute diuresis is clearly
present and a search for the
responsible solute(s) is mandatory
METHODS OF INVESTIGATION
ULTRASONOGRAPHY
RADIOLOGY
Simple abdominal X-ray
Intravenous urography
Retrograde/anterograde
pieloureterography
Cystography
Renal angiography
Uretrography
NUCLEAR MEDICINE
Static studies: static renal scintigraphy
Dynamic studies: renogram
CT
MRI
Urography
Involves
instillation
of
contrast
material to better visualize the
collecting or lumenal structures of the
kidneys, ureters, bladder, and urethra
This can be done after IV injection or
direct instillation into the urinary tract
1)
2)
3)
4)
Intravenous urography
Cystography
Voiding cystourethroography
Retrograde urethrography
Intravenous Urography
IVU/ intravenous pyelogram is the
classic modality of imaging the entire
urethelial tract from pyelocalyceal
system trhough the ureters and bladder
Excellent for indentifying small urethelial
lesions as well as the severity of
obstruction from calculi
Provides anatomical and qualitative
functional information about the kidneys
Ectopic kidney
Tumors
Cystography
Permits imaging of an opacified urinary
bladder after retrograde instillation of
contrast media through a urethral or
suprapubic catheter
Imaging is performed to demonstrate a
suspected urine leak, either from traumatic
bladder rupture or after bladder surgery
Can also demonstrate a presence of a
fistula between the bladder and vagina or
to characterize bladder diverticuli
Tumors
Tumor
Voiding Cystourethrography
Can be used to evaluate for abnormal
anatomy and function of the lower
urinary tract in both children and adults
Similar to the cystogram, instillation of
contrast media into the bladder through a
urethral cahteter is also employed
After full distention of the bladder, the
patient is instructed to void either after
removing the catheter or around the
catheter
Retrograde Urethrography
Complete evaluation of the urethra
includes both antegrade and
retrograde urethrography
Allows visualization of the anterior male
urethra
Used for evaluating a suspected traumatic
urethral injury or urethral stricture
Can also be useful for diagnosis of a
urethral diverticulum in females
Normal RUG
Retrograde urethrogram
Duplicated urethra
Urethrogram
confirmsduplicated
urethra.
ULTRASONOGRAPHY
ULTRASONOGRAPHY
ULTRASONOGRAPHY
ULTRASONOGRAPHY
RENAL ABSCESS
Doppler US
Doppler US
Testicular torsion
Presentation:
15 year old boy with acute left testicular pain.
Case Discussion:
US testes was performed which demonstrate the left testicle assuming an abnormal
orientation and lack normal color and power Doppler flow with maintained testicular
normal echogenicity, consistent with acutetesticular torsion. The right testicle is
within normal.
CT Scan
often
used
examine
structures in the abdomen
and pelvis (reproductive
organs, liver, pancreas,
gallbladder, spleen and
intestines). CAT Scans are a
diagnostic
tool
that
urologists use to detect and
diagnose: recurrent urinary
tract infections, sources of
blood
in
the
urine
(hematuria), kidney stones,
renal cysts and masses.
Moreover, it can help
urologists rule out prostate,
bladder and renal cancers
CT
No Contrast
CT
Contrast
Ectopic kidney
Ectopic kidney
Ectopic kidney
Ectopic kidney
Ectopic kidney
Renal hypoplasia
Cazul 2
Hipoplazia
renala
Renal
hypoplasia
Cazul 2
CT
Trauma
CT
Tumor
CT
Tumor
Hypervascular
process left
kidney
Hypervascular
process left
kidney
Hypervascular
process left
kidney
Hypervascular
process left
kidney
Parapelvical cyst
Bosniak 3
indeterminate, thick or multiple septations, mural nodule,
hyperdense on CT (see 2F)
treatment / work up : partial nephrectomy or RF ablation in
elderly / poor surgical risk
% malignant : ~ 54%6
Bosniak 4
clearly malignant, solid mass with large cystic or necrotic
component
treatment: partial / total nephrectomy
% malignant : ~100%
Extrarenal
renal cyst
expansion
Extrarenal
renal cyst
expansion
Extrarenal
renal cyst
expansion
MRI
Can be generally used in place of a CT
scan when renal insufficiency or contrast
allergy prohibits the use of CT scan
The process by which the protons realign
themselves with the magnetic field is
referred to as relaxation. The protons
undergo 2 types of relaxation: T1 (or
longitudinal) relaxation and T2 (or
transverse) relaxation
MRI
In T1-weighted images (emphasizing the difference
in T1 relaxation times between different tissues),
water-containing structures are dark. T1-weighted
images do not show good contrast between normal
and abnormal tissues. However, they do
demonstrate excellent anatomic detail.
T2-weighted images emphasize the difference in
T2 relaxation times between different tissues.
Because water is bright in these images, T2weighted images provide excellent contrast
between normal and abnormal tissues, although
with less anatomic detail than T1-weighted images
MRI
MRI
renal carcinoma
MR ANGIOGRAPHY
Table1
Comparisonofadvantagesanddisadvantagesbetween
computedtomography(CT)
andmagneticresonance(MR)imagingmodalities
CT
MRI
Usesionizingradiation,highdose
procedure
Usesmagneticresonance,noionizingradiation
Actualscanningtimemeasuredinseconds
Actualscanningtimemeasuredinminutes(typically45min)
(typically<10s)
Rarelyrequiresgeneralanestheticin
children
Frequentlyrequiresgeneralanestheticinchildren,dependingonage
Excellentatshowingedemaandpathologicalchangesinspecifictissue
types
Usuallyrequiresintravenouscontrast
Usuallyrequiresintravenousadministrationofcontrast(butcertain
(unlesslookingforcalcificationwhennot
sequencescanbetailoredifthisiscontraindicated)
required)
Noknownriskofnephrogenicsystemic
fibrosis(NSF)
RiskofNSF(rare,butrenalpatientsbelievedtobeatincreasedrisk)
Less expensive
Expensive
Usuallyavailableasanemergency
imagingtechnique
Notroutinelyavailableasanemergencytechnique
No significant contraindications
Contraindicatedinpatientswithanyinternalferrousobjects(pacemakers,
defibrillators,recentorthopedicmetalware,otherimplantedmetallic
devices,metallicforeignbodies)
Open-style scanners
Generallyquiteenclosedscannersriskofclaustrophobia
ANGIOGRAPHY
Nuclear Medicine
uses the radiation released by radionuclides
(called nuclear decay) to produce images
A radionuclide, usually technetium-99m, is
combined with different stable, metabolically
active
compounds
to
form
a
radiopharmaceutical that localizes to a
particular anatomic or diseased structure
(target tissue).
tracer goes to the target organ and can then
be imaged with a gamma camera, which takes
pictures of the radiation photons emitted by
the radioactive tracer