URINARY SYSTEM
ANATOMY &
CONTRAST STUDIES
URINARY SYSTEM
TERMINOLOGY
Ectopic - Congenital disorder in which kidneys fail to
assume their proper position in abdomen
Frequency - Having to urinate often
Hematuria - Blood in urine
Horseshoe Kidney - Congenital condition in which
the lower poles of the kidneys are fused together
Hydronephrosis - Dilation of renal pelvis & calyces
with urine due to ureteral obstruction
URINARY SYSTEM
TERMINOLOGY
Hypertension - High blood pressure, may be caused
by narrowing of the renal arteries, the large amount of
blood which is delivered to the kidneys (25% of
stroke volume) can cause increased pressure if the
flow is restricted by a narrowed renal artery
Incontinence - Inability to control micturation,
involuntary urination
Micturation - The act of urination
URINARY SYSTEM
TERMINOLOGY
Nephrolithotripsy - Procedure in which renal calculi
are broken up, or fragmented, into smaller pieces to
facilitate removal, may be done percutaneously as a
surgical-type procedure or with sound waves in a
water bath
Polycystic Kidney - Congenital condition in which
fluid-filled sacs are present in renal parenchyma,
often fatal in newborns, also seen in older adults
Ptosis - Condition in which kidney drops from its
normal position in abdomen, usually from weakness
of the abdominal muscles
URINARY SYSTEM
TERMINOLOGY
Pyelocystitis - Inflammation of bladder & renal pelvis
Pyelolithotomy - Surgical removal of kidney stones
through an incision into renal pelvis
Pyelonephritis - Inflammatory disorder of renal
parenchyma & pelvis
Reflux - Abnormal backflow of urine from bladder
into ureters
Retention - Inability to void
URINARY SYSTEM
TERMINOLOGY
Retrograde - Against flow, type of urographic exam
done in surgery where contrast is injected by catheter
placed from the urethra into renal pelvis
Suppression - When kidneys are not producing urine
Transurethral Resection of the Prostate (T.U.R.P.) Surgical procedure in which prostate is removed by
placing a cutting device into prostate via urethra
Urinary Stone (kidney stone or renal calculi) - Calculi
formed in collecting tubules & migrate to renal pelvis,
attributed to abnormal metabolism
Uremia - Excessive amounts of urea in blood
URINARY SYSTEM
Anatomy
Kidneys (2)
Ureters (2)
Bladder (1)
Urethra (1)
Adrenals (2)
Kidneys
Ureters
not strictly part of
urinary system
Bladder
URINARY SYSTEM
Kidney Anatomy
Location
Lie on either side of spine at the level of T-11 to L-3
Right kidney is lower than left
Retroperitoneal
Physical Characteristics
Bean-shaped
Size:
» 11 cm long
» 6 cm wide
» 3 cm thick
» Weighs 150 g.
URINARY SYSTEM
Kidney Anatomy
Physical Characteristics
Functional part of system
Blood supply
» Renal Artery
» Renal vein
Movement:
» Respiratory
• Normal - 3 cm
• Deep - 5 cm
» Prone to erect - 5 cm
URINARY SYSTEM
Kidney Physiology
Functions:
Remove nitrogenous wastes
Regulate fluid balance
Regulate Acid-Base balance
Removes 180 L. of filtrate/day, but 99% is
reabsorbed.
Produces 1.5 L. of urine/day - requires 2.5 L. fluid
intake/day
URINARY SYSTEM
Kidney - Macroscopic Anatomy
Adipose Capsule Perirenal fat
Fibrous Capsule
Cortex
Highly vascular
Functional area
Contains nephron
units
Medulla - Collecting area
Collecting tubules
Renal pyramids - 8-18 funnelshaped
Minor calyces - 4-13 cup-shaped
Major calyces - 2-3
Renal Pelvis
Hilum - Entry/Exit for:
Renal artery
Renal vein
Ureter
URINARY SYSTEM - Kidney Microscopic Anatomy - Nephron Units
Glomeruli (capillary tuft) - filtration area
Afferent Arteriole - provides blood supply to
glomeruli
Efferent Arteriole - returns blood from glomeruli
Bowman’s Capsule - surrounds glomeruli
Convoluted tubule - readsorption area
Proximal
Loop of Henle
Distal
Collecting Tubules
URINARY SYSTEM
Ureter Anatomy
Function - Transport urine to bladder by peristalsis
& gravity
Physical Characteristics
28-34 cm long
1 mm diameter
S-shaped, following curvature
of spine
Three points of narrowing:
» Ureteropelvic junction
» pelvic brim
» Ureterovesical junction
URINARY SYSTEM
Bladder Anatomy
Musculomembranous sac
Elastic - balloon-like as it fills, normally flat
Holds 500+ cc’s, urge to urinate at 250 cc’s
Trigone
Defined by the entry of the 2
ureters & exit of urethra
Contains “bladder flaps” to
prevent reflux
Apex is marked by the internal
urethral orifice
URINARY SYSTEM
Urethra Anatomy
Function - Transport urine to exterior of body
Physical Characteristics
Female - 4 cm long
URINARY SYSTEM
Urethra Anatomy
Physical Characteristics
Male - 20 cm long
» Proximal (prostatic portion) - 3 cm
» Middle (membranous portion) - 2 cm
» Distal (cavernous portion) - 15 cm
URINARY SYSTEM
Contrast Studies
Urography - General term denoting study of
the urinary system.
Purpose - Conventional radiography does
not adequately differentiate soft tissue. The
introduction of contrast media into the
structure facilitates differentiation.
URINARY SYSTEM
Contrast Studies
Contrast Media
Types - Water-soluble Iodine
» Injectible - Renografin, Hypaque, Isovue, etc..
» Non-injectible - Cystografin, Cysto-Conray, Retrografin, etc..
Concentration - varies with study & routing
» Drip infusion - low concentration
» IV bolus - medium concentration
» Retrograde - high concentration
Routing
» Indirect - IVP
» Direct - all others
URINARY SYSTEM
Contrast Studies
Injection Procedure
Prepare patient
psychologically &
physically
Obtain patient history
Select & prepare contrast
media
Check availability of crash
cart or emergency tray
BE PREPARED FOR A
REACTION!
URINARY SYSTEM
Intravenous Pyelogram
Most common urographic study
More correctly it is Excretory Urography
(XU), however, it is more commonly referred
to as an Intravenous Pyelogram (IVP)
This is a functional exam, assessing the
filtration system and visualizing the minor
calyces, major calyces, renal pelvis, ureters,
& bladder
URINARY SYSTEM
IVP
Indications
Renal failure
Abdominal/pelvic mass
Renal/ureteral calculi
Kidney trauma
Flank pain
Hematuria
Preop pelvic surgery
Hypertension
Urinary tract infection (UTI)
Contraindications
Anuria
Hypersensitivity to contrast
Increased risk
» Multiple myeloma
» Diabetes
» Severe hepatic or renal
disease
» Congestive anemia
» Dehydration
URINARY SYSTEM
IVP
Patient Preparation
Light dinner the night before.
Laxative &/or enema
No food for 8-12 hours, liquids permitted.
Have patient empty bladder just before exam.
Have patient remove all clothing except shoes &
socks & put on gown.
URINARY SYSTEM
IVP
Room Preparation
Draw up contrast
Gather venipuncture supplies
Check Crash cart/drug box
Cassettes & markers available
Doctor available
Scout film - KUB
Used by Radiologist to check prep & abnormalities.
Used by Tech. to check positioning & technique.
Used by both to check position of various structures.
URINARY SYSTEM
IVP
Stasis - Stagnation of normal fluid flow
Trendelenburg
Compression - do not use if:
» Stones
» Mass
» Aortic aneurysm
» Recent surgery
» Severe pain
» Acute Trauma
URINARY SYSTEM
IVP
Routine Procedure - overhead films,
conventional tomography optional
Films are taken at specific time intervals to provide
best visualization of various parts.
Timing begins with start of injection/infusion.
Routines vary, see local protocol
First film is a nephrogram because opacification of
the nephron units permit visualization of the cortex
(30 sec. to 1 min.)
URINARY SYSTEM
IVP
Routine Procedure - example
1 min. - AP supine centered at kidneys (11 x 14 cw)
5 min. - AP supine centered at kidneys (11 x 14 cw)
10 min. - AP supine, RAO, LAO centered at kidneys
(11 x 14 cw) OPTIONAL - Tomos instead of obliques
15 min. - KUB (14 x 17 lw)
Erect or prone post-void centered at bladder (10 x 12
cw)
URINARY SYSTEM
IVP
Variation - Hypertensive IVP - same are regular
IVP except filming is accelerated:
AP supine centered at kidneys
(11 x 14 cw) at 30 sec., 1, 2,
3, 4, & 5 min.
Continue as for Routine IVP
URINARY SYSTEM
IVP
AP supine centered at kidneys (11 x 14 cw)
Place bottom of cassette at level of ASIS & center to
film
URINARY SYSTEM
IVP
AP Oblique Projections - 30° Oblique
CR – Level of Crest, 2” lat.
to midline on elevated side
URINARY SYSTEM
IVP
OPTIONAL - Tomos instead of obliques
URINARY SYSTEM
IVP
KUB
CR – MSP & Iliac crest
URINARY SYSTEM
IVP
Erect or prone postvoid centered at
bladder
10 x 12 cw
CR – 10 ° -15° caudal
CR 2” above pubic
symphysis & center
cassette to CR
URINARY SYSTEM
Retrograde Pyelogram
Non-functional exam
Generally surgical w/ sedation or under general
Contrast injected directly into
collecting system through a
catheter
3-5 cc’s of iodinated contrast
Filming routine
AP scout
AP Pyelogram
AP Ureterogram
URINARY SYSTEM
Cystogram
Non-functional exam
Visualizes urinary bladder only
150-500 cc’s of contrast introduced by gravity
via a catheter
Filming routine
o
AP - 15 caudad
o
Both obliques - 60
Optional - Lateral
URINARY SYSTEM
Cystogram
o
AP - 15 caudad
URINARY SYSTEM
Cystogram
Both obliques – 40°-60°
CR – perpendicular, 2” above Pubic Symphysis &
2” medial to ASIS
URINARY SYSTEM
Voiding Cystourethrogram
Same as cystogram except that after bladder is
filled, catheter is remove & radiographs are taken
as patient voids
Filming - as previously stated plus
o
Male - 30 RPO
Female - AP
URINARY SYSTEM
Miscellaneous
Bead-Chain Cystogram
Performed only on females with stress-incontinence
Chain used to determine anatomical relationship
between bladder & urethra
Requires about 60 cc’s contrast - only voiding films are
needed
Filming - AP & Lat... relaxed & straining (4 films)
URINARY SYSTEM
Miscellaneous
Retrograde Urethrogram
Performed to visualize full length of the male
urethra
Utilizes a Brodney Clap attached to glans of
penis
50 cc’s Iodinated contrast media mixed with KY jelly
o
Filming - 30 RPO
URINARY SYSTEM
Miscellaneous
Renal Arteriogram
– demonstrating
pronounced
nephrogram
phase in upper
pole of the left
kidney.