Prefinals
Urinary System
 Is the production of urine and its
elimination from the body.
 Functions:
 Remove nitrogenous wastes
 Regulate water levels in the body.
 Regulate acid-base balance and
electrolyte levels of the blood.
Procedures:
 Urography
 Ivu or excretory urography
 Hypertensive IVU
 Percutaneous renal puncture
 Retrograde urography
 Retrograde cystography
 Voiding cystourethrography
 Retrograde urethrography
Urography
 General term for radiologic
investigations of the renal drainage. Or
collecting system are performed by
various procedures.
2 – methods routinely employed of filling
the urinary canals with contrast medium
1. Excretory, or
Intravenous Urography
2.Retrograde
Pyelography
Excretory, or Intravenous Urography
most frequently employed
method, in which the
contrast agent is routinely
administered
intravenously.
Retrograde Pyelography
contrast medium is introduced
directly into the canals by
means of catheterization –
ureteral catherterization for
contrast filling of the upper
urinary tracts.
Percutaneous Antegrade Urography
Contrast solution is introduced
directly into pelvicalyceal
system by means of puncture of
the renal pelvis.
It is seldom used method of
introducing contrast media to
the kidney
Preparation of Patient
 General Use:
1.
2.
3.
4.
5.
Low-residue diet for 1 – 2 days to prevent
gas formation caused by excessive
fermentation of the intestinal contents.
A light evening meal
Costive bowel action, a non-gas forming
laxative the evening before the
examination.
NPO after midnight on the day of
examination.
For retrograge urography, patient is often
requested to force water(4-5 glassfuls) for
severe hours before examination.
IVU or Excretory Urography
(commonly known as IVP)
 most common radiographic
examination of urinary system.
 Visualizes the minor and major
calyces, renal pelves, ureters and
urinary bladder – following an
intravenous injection of contrast
medium.
Purpose:
Visualize the collecting
portion of the U.S.
Assess the functional
ability of the kidneys.
Clinical Indications
 Abdominal or pelvic mass
 Renal or ureteral calculi
 Kidney trauma
 Flank pain
 Hematuria or blood in the urine
 Hypertension
 Renal failure
 Urinary tract infections
Contraindications
 Hypersensitivity to contrast media
 Anuria (non passage of urine)
 multiple myeloma
 diabetes
 severe hepatic or renal disease
 congestive heart failure
 Pheochromocytoma (rare tumor that arise
outside the adrenal gland)
 sickle cell anemia (another type of anemia)
IVU – basic routine
 scout radiograph & 15mins test dose before
injection
 injection of contrast media
 basic filming routine
 1 – min.(nephrogram or nephrotomogram)
 5 – min. AP supine (10x12”Film @ L2)

10mins RPO & LPO positions
 15 – min. AP supine or PA prone (to provide
compression in the abdomen
 20 – min posterior obliques (alternatives)
 Full bladder (10x12” pelvis 1” below ASIS)
 post-void ( prone or erect)
1-5mins
5-10 mins
10 mins
Prone 15 mins
Full Bladder
Post Void
Ureteric Compression
Method utilized to enhance
filling of the pelvicalyceal
system and proximal ureters.
It allows the renal collecting
system to retain the contrast
medium longer for more
complete study.
Ureteral Compression
The Ureteral Compression
Device is used in excretory
urography.
The belt fits around the waist of
the patient so that he may be
repositioned quickly for studies
at any angle
Contraindications:
Possible ureteric stones
Abdominal mass
Aortic abdominal aneurysm
Recent abdominal surgery
Severe abdominal pain
Acute abdominal trauma
Hypertensive IVU
 one special type of IVU.
 This is done on patients with high blood
pressure to determine if the kidneys are
the caused of the hypertension.
 Procedure: (sequence)
 1 min
 2 min
 3 min
 30 seconds additional radiographs
 A hypertensive IVU was commonly
requested to screen for Renovascular
Hypertension.
 This consisted of 30-second and 1-, 2-, 3-,
and 5-minute radiographs at the
beginning of IVU, which were frequently
referred to as “minute-sequence films.”
 The rationale for this study was that
physiologic changes caused by the renal
arterial stenosis would be demonstrated
on early-phase excretion radiographs.
Percutaneous Renal
Puncture
 Radiologic procedure for the
investigation of renal masses.
 It is used to differentiate cysts and
tumors of the renal parenchyma.
 Introduced by Lindblom
 It is replaced by the advent of
ultrasounography.
Retrograde Urography
Is a nonfunctional radiographic
examination of the urinary
system which contrast medium
is introduced directly into
pelvicalyceal system via
catheterization.
Procedure:
Modified Lithotomy
Position
knees are flexed over
stirrups of the adjustable
leg supports.
* 3 – routine radiographs*
Preliminary radiographs (
showing the ureteral
catheters in position)
The pyelogram
The ureterogram
Positioning
 Routine
 AP for Ureteral Catheters 14x17 film
 AP for pyelogram 14x17 film
 AP for Urography film
 Additional
 RPO
 LPO
 Lateral – for demonstration of anterior
displacement of kidneys or ureters
 Cross table – for demonstrating of ureteropelvic
region with hydronephrosis patients.
Retrograde Cystography
Another nonfunctional urinary
system examination.
Radiographic examination of
the urinary bladder following
installation of an iodinated
contrast medium via a urethral
catheter.
Procedure:
contrast material is allowed to
flow in by “gravity only” – using
an asepto syringe or drip
infusion.
150 – 500 cc’s of contrast media
to be instilled into the bladder.
Routine positions:
AP with 15 degrees
caudal angulation
Both posterior
obliques
Positioning
 AP projections of the bladder and proximal part of the
urethra with 15 degrees caudal angle.
 Oblique projections of 40-60 degrees, with
perpendicular CR, or a 10 degrees angulations if
needed.
 AP projections with 20-25 degree cephalic angulation
to demonstrate, the shadow of the prostate above that
of the pubic bones.
 Lateral positions, to demonstrate the anterior and
posterior bladder walls and base of the bladder.
 Chassard-Lapine method or “Squat
shot”, is used to obtain an axial image
of the posterior surface of the bladder
and the lower end of the ureters.
 AP projections, with a 15-20 degrees tilt
of the table to allow the filled bladders
to stretch superiorly, where it will not
superimpose the ureters.
Voiding Cystourethrography
Study of the urethra and
evaluate the patients ability
to urinate.
Trauma or involuntary loss of
urine are common clinical
indiactions.
Retrograde Urethrography
Perform on the male patient to
demonstrate the full length of
the urethra.
Contrast medium is injected
into distal urethra until the
entire urethra is filled in
retrograde fashion.
Procedure:
Brodney clamp – special
device for injection of the c+
medium w/c is attached to
distal penis.
30 degs RPO – is the position
of choice.
Summary
 Urography
 Ivu or excretory urography
 Hypertensive IVU
 Percutaneous renal puncture
 Retrograde urography
 Retrograde cystography
 Voiding cystourethrography
 Retrograde urethrography