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Imaging in

Genitourinary
System
dr. Harry Galuh Nugraha, Sp.Rad

ANATOMY
Genitourinary System
Urinary System
Kidney
Ureter
Bladder
Urethra

ANATOMY

ANATOMY
Genitourinary System
Genital/Reproductive
Male

Testis
Epidydimis
Vas deferen
Ejaculatory duct
Prostate
Seminal vesicle
Penis

Female

Uterus
Salphynx
Ovaries
Cervix
Vagina

ANATOMY

Male Reproductive System

ANATOMY

Female Reproductive System

ANATOMY
KIDNEY
Bean shaped (convex laterally & concave
medially)
Length: 11,5cm or 31/2 vertebral body)
Width: 5-8cm
Thickness: 3cm
Retroperitoneal
Between Th12- L3
Right kidney is lower 1cm than left kidney

ANATOMY
KIDNEY

ANATOMY
KIDNEY

ANATOMY
URETER
Diameter 1mm-1cm
Length: 25-30cm
Retroperitoneal
Three normal narrowing area
Pelvoureter junction (PUJ)
Pelvic brim where the iliac vessels cross the
ureter
Vesicoureter junction (VUJ)

ANATOMY
URETER

ANATOMY
BLADDER
Urine reservoir
Posterosuperior to the pubic bone
Position:
Empty: In the pelvic cavity
Full: Extend to the abdominal cavity

Capacity
Adult: 350-500 cc
Children: (Age [in year] + 2) x 30 cc

ANATOMY
BLADDER

ANATOMY
URETHRA
Length:
Male: 17,5-20cm
Female: 4cm

Male urethra divided by inferior aspect of


urogenital diaphragm into:
Anterior part
Cavernous/Penile part
Bulbar part

Posterior part
Membranous part
Prostatic part

ANATOMY
URETHRA

ANATOMY

IMAGING MODALITIES
Plain abdominal x ray
BNO-IVP
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Voiding Cystourethrography
Ultrasonography
CT Scan
MRI
Nuclear Imaging
Hysterosalphingography

PLAIN ABDOMINAL X-RAY


Routine
Good quality films will show the kidney
outlines
Enlargement (mass/hydronephrosis) can be
recognized

Calcification
Opaque calculi in the kidney, ureter or bladder
Nephrocalcinosis : calcification in the renal
parenchym.

Air distribution in the bowel


Sentinel loop

NORMAL

KIDNEY STONE

KIDNEY STONE

URETERAL STONE

BLADDER STONE

IMAGING MODALITIES
Plain abdominal x ray
BNO-IVP
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Voiding Cystourethrography
Ultrasonography
CT Scan
MRI
Nuclear Imaging
Hysterosalphingography

BNO-IVP
Blass = Urinary bladder, Nier =
Kidney, Overzicht = Examination
Synonim:
Intravenous urography
Excretory urography
Intravenous pyelography

BNO-IVP
Use contrast media intravenously
Anatomic function:
Depict the minor calyx, major calyx,
renal pelvis, ureter, urinary bladder.

Physiologic function:
Assess the kidney function in contrast
media filtration and excretion.

BNO-IVP
Indication
Evaluate mass or cyst
Urolithiasis (calculi in the kidney or
urinary tract)
Pyelonephritis
Glomerulonephritis
Hydronephrosis
Trauma
Renal hypertension

BNO-IVP
Contraindication
Allergy
Asthma
Anuria
Renal failure
Cardiovascular disease
Severe liver function abnormality
Diabetes mellitus
Sickle cell disease
Multiple myeloma
Pheochromocytoma
Pregnancy

BNO-IVP
Contraindication
Allergy
Asthma
Anuria
Renal failure
Cardiovascular disease
Severe liver function abnormality
Diabetes mellitus
Sickle cell disease
Multiple myeloma
Pheochromocytoma
Pregnancy

BNO-IVP
Procedure
1-3minute
: Nephrogram phase
Ureteral compression
5 minute
: Excretory function
15 minute
: Pelvocalyceal system
Compression can be released if the pelvocalyceal
system has been seen adequately
30 minute
: After the compression was
released to
see the urinary tract
from the kidney
to the bladder
45-60 minute : fullbladder
Post voiding
: passage of contrast agent

BNO-IVP
Contraindication of compression :
Suspected stone
Acute abdomen
Following abdominal surgery
Large abdominal mass
Aortic aneurysm
Use trendelenburg position instead

BNO
IVP

1-3

15

30
Minute

Full Blast

Post
Voiding

HYDRONEPHROSIS
CAUSED BY
URETERIC STONE
(Black arrow

IMAGING MODALITIES
Plain abdominal x ray
BNO-IVP
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Voiding Cystourethrography
Ultrasonography
CT Scan
MRI
Hysterosalphingography

Retrograde Urethrography
To assess the urethra
The contrast media is injected from
the distal to the proximal part of the
urethra (retrograde or ascending)

Retrograde Urethrography
Indication
Urethral rupture
Urethral stricture
Congenital anomaly
Urethral fistule
Urethral diverticle
Urethral obstruction
Hematuria
Recurrent urinary tract infection
Slow urinary flow
Urinary mass

Retrograde Urethrography
Contraindication
Acute urinary tract infection

Retrograde Urethrography

Retrograde Urethrography
Urethral rupture

Retrograde Urethrography
Urethral stricture with
periurethral abscess

Retrograde Cystography
To assess the urinary bladder
The contrast media is injected
through the urinary catheter into the
urinary bladder
Retrograde to the urinary flow

Retrograde Cystography
Indication
Recurrent urinary tract infection
Suspicion of urinary bladder rupture
Stone
Mass
Inflammation
Diverticle
Fistule
Incontinentia
Hematuria
Measure the urinary volume post micturition
Assess the integrity of the anastomosis or suture post
operative

Retrograde Cystography
Contraindication
Pregnancy
Urethral rupture (contraindication to
the urinary catheter insertion)

Retrograde Cystography

Retrograde Urethrocystography
To assess the urinary bladder and the
urethra.
Combination of the retrograde
urethrography and cystography.
The contrast media is injected
through the external urethral
orificium to fill the urethra and then
the urinary bladder.

IMAGING MODALITIES
Plain abdominal x ray
BNO-IVP
Retrograde & antegrade pyelography
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Voiding Cystourethrography
Ultrasonography
CT Scan
MRI
Hysterosalphingography

Bipolar Urethrocystography
To assess the urethra from the
proximal and distal aspects.
Retrograde from the distal urethra
Antegrade from the cystostomy
catheter
Patient is asked to void so that the
contrast media will fill the proximal
part of the urethra.

Bipolar Urethrocystography
Indication
Assess the proximal and distal
margin of obstruction (stricture,
stone, mass) in the urethra
Contraindication
Allergy to contrast media

IMAGING MODALITIES
Plain abdominal x ray
BNO-IVP
Retrograde & antegrade pyelography
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Ultrasonography
CT Scan
MRI
Hysterosalphingography

Ultrasonography
The kidneys are well shown by
ultrasound
Mass
Cyst (simple or polycystic)
Hydronephrosis
Stone
Nephrostomy guiding

Ultrasonography
Renal Mass

Ultrasonography
Simple cyst

Ultrasonography
Hydronephrosis

Ultrasonography
Kidney stone

Ultrasonography
The distended urinary bladder is also
well shown by abdominal ultrasound
Mass
Stone
Inflammation
Infection
Diverticle

Ultrasonography
Urinary Bladder Mass

Ultrasonography
Urinary bladder stone

IMAGING MODALITIES
Plain abdominal x ray
BNO-IVP
Retrograde & antegrade pyelography
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Ultrasonography
CT Scan
MRI
Hysterosalphingography

CT scan
Mass, cyst and various lesion of the
kidneys are all well shown
Gold standard in urinary tract stone
Staging in tumour

CT scan
Ureteric stone
with
hydronephrosis

IMAGING MODALITIES
Plain abdominal x ray
BNO-IVP
Retrograde & antegrade pyelography
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Ultrasonography
CT Scan
MRI
Hysterosalphingography

MRI
Staging in tumour
Superior to CT in staging the bladder
and prostatic tumour
Good contrast resolution

MRI
Renal mass

IMAGING MODALITIES
Plain abdominal x ray
BNO-IVP
Retrograde & antegrade pyelography
Retrograde
uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Ultrasonography
CT Scan
MRI
Hysterosalphingography

Hysterosalpingography
Primarily demonstrate the uterus and
the salpynx (fallopian tube)

Hysterosalpingography
Indication
Infertility assessment
Obstruction (can be therapeutic)
Anatomic anomaly (e.g.uterine bicornis)

Intrauterine pathology
Endometrial polyps
Uterine fibroids
Intrauterine adhesion

Post operative assessment after tubal


ligation or reconstructive surgery

Hysterosalpingography
Contraindication
Pregnancy (performed 7-10 days
after the onset of menstruation)
Acute pelvic inflammatory disease
Active uterine bleeding

Hysterosalpingography

Left Hydrosalpynx

Uterus bicornis

Thank you for your attention

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