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KUB. Bone Kidney outline Psoas shadow Calcification: mesenteric calcification, phlebolith, arterial plaque, renal cyst calcification GI shadow. Excretory urography(DIP,RSP). the basic radiologic study of the UT 전처치 과거 : 수분섭취 제한 , 금식 최근 : 조영제 개선 , 대량투여

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Kub

KUB

  • Bone

  • Kidney outline

  • Psoas shadow

  • Calcification: mesenteric calcification, phlebolith, arterial plaque, renal cyst calcification

  • GI shadow


Excretory urography dip rsp

Excretory urography(DIP,RSP)

  • the basic radiologic study of the UT

  • 전처치

    과거: 수분섭취 제한, 금식

    최근: 조영제 개선, 대량투여

    소아, 노인, DM, MM, azotemia환자는 전처치 안함

  • 촬영방법

    정맥주사 후 3-5분, 10-15분, 25분에 촬영

    복부에 압박

    24시간 delay, oblique, tomography, postvoiding film


Excretory urography

Excretory urography

  • 조영제

    methylglutamine, iothalamate, sod. diatrizoate, methylglutamine cliatrizoate등을 흔히 쓰나 최근 metrizamide 등의 비이온화 조영제를 주로 쓴다.

  • 조영제의 부작용

    vasomotor collapse: nausea, febrile sensation

    anaphylactic Rx: flushing, urticaria, bronchial edema

    vagal Rx: hypotension, bradycardia

    renal failure: DM, MM


Retrograde pyelography rgp

Retrograde pyelography(RGP)

  • Cystoscope을 넣고 ureteral catheter를 통해 조영제를 주입

  • 적응증

    inappropriate IVP

    조영제에 부작용


Antegrade pyelography agp

Antegrade pyelography(AGP)

  • 적응증

    RGP failed or CIx

    Nephrostomy state

  • 요관 폐색 부위의 진단에 도움


Retrograde cystography

Retrograde cystography

  • 무균적으로 방광에 카테타를 삽입한 후 25-30%의 조영제를 200-300ml 주입

  • 잔뇨, 게실, 방광천공 등이 의심되면 postvoiding 사진

  • Ix

    bladder rupture

    bladder tumor, stone, diverticulum

  • Christmas tree app.

    Pear-shaped bladder

    Pie-in-the- sky


Voiding cystourethrogram vcu

Voiding cystourethrogram(VCU)

  • vesicoureteral reflux

  • urethra evaluation


Retrograde urethrography

Retrograde urethrography

  • urethra evaluation(anatomic)

  • Ix

    urethral injury

    urethral stricture

    urethral diverticulum

    urethral stone


Chain cystourethrography

Chain cystourethrography


Vasography

Vasography

  • investigation of male sterility

  • 무정자증의 남성불임 환자에서 고환 생검에서 정자생산이 정상인 경우


Angiography

Angiography

  • US, CT와 DSA의 사용 증가로 arteriography의 사용이 줄어들고 있다.

  • renovascular disease

    kidney donor

    renal tumor(embolization)

    renal trauma

  • Arterial phase

    Nephrogram phase

    Venous phase


Utrasonography

Utrasonography

  • 장점: non-invasive, no radiation

    excellent spatial & temporal resolution

    flexibility for imaging in many planes

  • 단점: cannot travel through air & skilled operator

  • DDx of renal mass (cystic or solid)

    Transrectal US(TRUS)

    Scrotal US

    Penile duplex US


Ct scan

CT scan

  • expensive but cost effective

  • Hounsfield unit

  • 장점 1)X선 흡수계수의 사소한 차이를 알 수 있다.

    2)단층영상을 얻을 수 있다.

  • 단점 1) 다양한 각도의 영상을 얻는데 한계

    2) 연부조직의 해상도가 낮고 동태적 검사에 부적합

    3) 병리조직학적 구분에 한계가 있다.

    4) 조영제를 사용하여야 한다.

  • 적응증: 부신, 신종물, 신외상, 신이식, 선천성기형, 방광암, 후복막강 및 전립선암의 병기 결정 등


Kub

MRI

  • 조직의 자기성을 이용하여 영상을 얻는다.

  • 장점 1)no radiation

    2)no contrast media, no bowel preparation

    3)great flexibility for imaging in many planes

    4)better information about soft tissue

  • 단점 1) expensive, longer time than CT

    2) metallic hazard(magnetic field)

  • 적응증: 부신, 신, 방광, 전립선


Kub

핵의학 검사


Kidney

Kidney

  • Function

    (1) glomerular function(GFR)

    - iothalamate, 51Cr-EDTA

    - 99mTc-DTPA

    (2) tubular function (RBF)

    - 131I-,121I-hippuran, 99mTc-MAG-3

    - 99mTc-DMSA


Renal imaging

Renal imaging

  • cortical imaging : 99mTc-DMSA

  • excretory imaging: 99mTc-DTPA,

    99mTc-MAG-3


Indications

Indications

  • upper UT obstruction

    99mTc-DTPA

    diuretic renal scan

  • chronic PN in children(renal scarring in VUR)

    99mTc-DMSA

  • renal transplantation: 131I-hippuran

  • renovascular hypertension

  • functional renal mass quantification

  • space occupying renal lesions


Kub

기타

  • Bladder: VUR

  • Testis scan

    99mTc-sodium pertechnetate

    DDx: testicular torsion & epididymitis

  • Adrenal scintigraphy

    cortex: Cushing's synd.- NP59

    medulla: pheochromocytoma- 123I-MIBG

  • Bone scan


Kub

비뇨기계 기계와 사용법

  • catheter is a foreign body

  • the leading cause of nosocomial UTI

  • the most common predisposing factor in gram-negative sepsis in hospital


Transurethral procedures

경요도적 시술(Transurethral procedures)

  • size: 3F = 1mm (external diameter)

  • Latex, silicone, polyethylene, polyvinyl chloride

  • Foley, Pezzer, Malecot, Coude, Nelaton, Robinson


Transurethral procedures1

경요도적 시술(Transurethral procedures)

  • Cxs of catheterization

    1) UTI

    2) urethritis, epididymitis

    3) urethral stricture

    4) stone formation

  • Risk patients

    1) prior to delivery or post-partum

    2) the elderly or debilitated

    3) diabetic patients


Cystoscope urethroscope

Cystoscope & urethroscope

  • Cystoscope

    urethra, prostate, bladder wall, dome & neck, ureteral orifices

  • Urethroscope

    0 degree lens

    urethral stricture, urethral diverticulum


Ureteral catheterization

Ureteral catheterization

  • RGP, cytology & culture를 위한 urine collection

  • stone basket manipulation, draining an obstructed kidney


Transurethral surgery

경요도적 수술(Transurethral surgery)

  • 방광종양의 내시경적 절제, 쌍합진

  • 전립선비대증의 내시경적 절제

    경요도적 전립선절제술

    레이저를 이용


Percutaneous procedures

경피적 시술(Percutaneous procedures)

  • 선행성 신우조영술 (AGP)

  • 선행성 방광요도조영술 (antegrade cystourethrography)

  • 신우관류검사 (Whitaker test, pr.-perfusion study)

  • 경피적 방광루 설치술 (percutaneous cystostomy)


Percutaneous endourology

Percutaneous endourology

  • Diagnostic Ix.

    AGP

    pressure/perfusion study(Whitaker test)

  • Therapeutic Ix.

    nephrostomy catheter drainage

    antegrade ureteral stenting

    dilatation of ureteral strictures

    percutaneous endopyelotomy

    perfusion chemolysis of renal stones

    percutaneous nephrolithotomy(PNL)

    percutaneous resection & coagulation of urothelial tumors


Ureterorenoscope urs

Ureterorenoscope(URS)

  • Diagnostic Ix.

    lesions of ureter or renal pelvis

    hematurias from upper tract

  • Therapeutic Ix.

    ureteral stone Tx.

    internal ureterostomy of ureteral strictures

    endoscopic resection & coagulation of ureteral tumors


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