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The Urinary System. Chapter 18. 8 31 2012 online ed. Urinary System. Also called “excretory system” Consists of: Two kidneys Two ureters One urinary bladder One urethra. Kidneys. 2 bean shaped bodies situated behind peritoneum

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The urinary system

The Urinary System

Chapter 18

8 31 2012 online ed.


Urinary system
Urinary System

Also called “excretory system”

Consists of:

  • Two kidneys

  • Two ureters

  • One urinary bladder

  • One urethra


Kidneys
Kidneys

2 bean shaped bodies situated behind peritoneum

Asymmetrical - left is slightly longer and narrower than right

Why is Rt kidney slightly lower than Lt kidney?

Liver

Both lie in an oblique plane (opposite sijt direction)

Normally extend from T-12 to L3


Kidney function
Kidney Function

  • Remove waste products from blood

  • Maintain fluid and electrolyte balance

  • Secrete substances that affect blood pressure

  • How much urine excreted per day?

    1 - 2 liters


Kidneys cont d
Kidneys (cont’d)

  • Minor calyces unite to form major calyces

  • Major calyces unite to form renal pelvis

  • Renal pelvis drains into ureters

  • Hilum - longitudinal slit in medial border for transmission of blood vessels, nerves, lymphatic vessels, and ureter


Kidneys cont d1
Kidneys (cont’d)

Each kidney has:

cortex

medulla

Medulla contains collecting system

Essential microscopic components of kidney called nephrons

Each kidney-contains how many nephrons?

about 1 million


Anatomy nephron
Anatomy: Nephron

  • Glomerulus - filter for blood, allows fine particles and water to pass into capsule

  • Renal tubule is continuous with capsule

    • Proximal convoluted tubule

    • Nephron loop (loop of Henle)

    • Distal convoluted tubule

  • Distal convoluted tubule opens into collecting ducts

  • Collecting ducts drain into minor calyx


Adrenal glands suprarenal
Adrenal Glands(Suprarenal)

Not part of urinary system

Cannot be seen on plainradiographs (need CT)

Regulate stress response through release of various hormones such as adrenaline


Ureters
Ureters

  • Two tubes 10 - 12 “ long

  • Retroperitoneal

  • Extend from renal pelvis

  • Enter bladder at ureteral orifice

  • How is urine moved through ureters?

    • peristalsis


Urinary bladder
Urinary Bladder

  • Musculomembranous sac situated immediately posterior and superior to symphysis pubis of pelvis

  • Serves as Urine reservoir



Urethra
Urethra

  • Carries urine from bladder to?

    • exterior of body

  • How long is it in females?

    • About 1.5

  • In males?

    • About 7 to 8

  • Sphincter at neck of bladder

  • Male urethra contains following parts:

    • Prostate

    • Membranous area

    • Spongy area


Ivu intravenous uro gram
IVU- Intravenous Urogram !

Formerly erroneously known as IVP-Intravenous pyelogram!

pyelo refers to renal pelvis and calyces only

But study also shows ureters, bladder, and sometimes urethra


Indications for urography
Indications For Urography

  • Demonstrate physiologic function and structure of urinary system

  • Evaluate abd. Masses, renal cysts and tumors

  • Urolithiasis (stones)

  • Pyelonephritis (Inflammation of kidney)

  • Hydronephrosis (distension of renal pelvis and calyces with urine)

  • Trauma

  • Renal hypertension

  • Pre-op evaluation


Contraindications
Contraindications

  • Inability to filter contrast medium from blood

  • Allergy to contrast

  • Abnormal BUN and Creatinine levels


Preparation of pt
Preparation Of Pt

  • Pt on low residue diet for 1-2 days prior to exam

  • Laxative taken day prior to clean out bowel

  • NPO after midnight

  • Pts with multiple myeloma, high uric acid levels, or diabetes should be well hydrated before IVP exam

    (Dehydration leads to increased risk of renal failure)


Contrast media
Contrast Media

  • Used to visualize urinary tract adequately

  • Iodinated, water-soluble contrast administered intravenously

  • Antegrade filling


Contrast media1
Contrast Media

Excretory urography (IVU) generally uses a 50 to 70% iodine solution

Lower concentrations required for bladder studies due to large amount required to fill bladder (30%)

Non-ionic contrast is generally used

More expensive, but-

Patients less likely to have reactions with nonionic


Contrast media and adverse reactions
Contrast Media and Adverse Reactions

Do not leave pt. alone for first 5 minutes after injection!

Mild reactions:

warmth

flushing

hives, Nausea/Vomiting, respiratory edema (accumulation of fluid in lungs)

Severe reactions:

Anaphylactic shock: sudden allergic response: sudden drop in blood pressure and difficulty breathing

Death in a matter of minutes


Ivu procedure
IVU Procedure

Scout – KUB

Contrast injected

Timed sequence of films obtained until bladder begins to fill

Take Immediate image of kidneys

5 minute image of abd. or kidneys

Then apply Compression

(Take tomograms)


Ureteral compression
Ureteral Compression

  • (Because of improvement of contrast agents, compression no longer generally used)

  • Compression device centered at ASIS over distal ends of ureters

    With as much compression as pt can tolerate!

  • Inhibits flow of urine into bladder

  • Distends renal pelvis and calyces


Contraindications for compression
Contraindications for Compression

Should not be applied when pt has:

Kidney stones

abdominal mass or aneurysm

colostomy

suprapubic catheter

recent abd. surgery or trauma


Radiation protection
Radiation Protection

Gonadal shield - if it does not interfere with exam

Shield males for all urinary studies, except when urethra is of primary interest

Shield females when IR centered over kidneys

Close collimation

Avoid repeat exposures

Rule out chance of pregnancy before examination

(Emergency cases may not allow time)



Ap projection ivu
AP Projection-IVU

  • Patient supine

  • Typical Abdomen positioning

  • Use shielding

  • (All exposures at end of expiration for any urinary system study)


AP Projection- IVU (cont’d)

Must include entire KUB region

Should include prostatic region on older males


Time delay ivu
Time Delay - IVU

3 minute

6 minutes


Time delay ivu1
Time delay- IVU

With compression

9 minutes


Ap projection variations
AP Projection Variations

Trendelenberg:

Lower head 15 - 20 degrees

Helps demonstrate lower ureters

Upright:

Must lower CR - organs change position

Prone

Demonstrates ureteropelvic region

Fills obstructed ureter in cases of hydronephrosis(distension of renal pelvis and calyces with urine)


Ap oblique projections rpo lpo
AP Oblique Projections - RPO/LPO

  • Pt. supine

    Rotated 30 degrees

  • Typical Abdomen oblique position


Ap oblique projections cont d
AP Oblique Projections (cont’d)

  • Elevated kidney will be parallel to cassette

  • Kidney closest to cassette will be perpendicular

  • Entire KUB region must be included


Nephrotomography
Nephrotomography

  • Best method for visualizing renal parenchyma (neprons and collecting tubules)

  • To visualize kidneys free of intestinal content superimposition


Tomogram procedure cont d
Tomogram Procedure cont’d

  • Tomograms are obtained once bladder is filled

    • Pt is measured, divide number by 3, cuts begin there

      • Pt. measures 30cm, beginning cuts at 10cm

  • Release compression slowly

  • Have pt void, and obtain post-void film


Retrograde urography
Retrograde Urography

What does retrograde mean?

Requires catheterization of ureters

Contrast injected directly through cathethers

Provides improved opacification of renal collecting system

Opposite normalflow


Retrograde urography cont d
Retrograde Urography (cont’d)

  • Contrast does not enter blood stream

  • Used for patients with renal insufficiency or contrast sensitivity

  • Ureters, and collecting systems can be selectively imaged and sampled

  • Little physiologic information provided


Retrograde urography cont d1
Retrograde Urography cont’d

  • Considered an operative procedure

  • Pt may be under general anesthesia

  • Sterile technique

  • Nurse responsible for set-up of exam and pt. care


Cystography
Cystography

  • Radiologic exam of urinary bladder

  • Contrast administration usually performed retrograde(against normal flow of urine)


Indications for cystography
Indications for Cystography

Vesicoureteral reflux (backward flow of urine into ureters)

Recurrent lower urinary tract infection

Neurogenic bladder: (dysfunction due to disease of central nervous system or peripheral nerves)

Bladder trauma

Prostate enlargement

Lower urinary tract fistulae

Urethral stricture

Posterior urethral valves (obstructive congenital defect of the male urethra)


Contraindications for cystography
Contraindications for Cystography

Anything related to catheterization of urethra!


Cystography procedure
Cystography Procedure

  • Contrast drip-infused via a catheter

  • Bladder filled to capacity

  • Fluoro-spot and overhead images obtained


Routine Cystography Series

Scout

Filled AP or PA (axial)

Both obliques

Lateral

Post-void


Ap axial bladder similar to coccyx projection
AP Axial Bladder(similar to coccyx projection)

CR:

Angle 10 to 15 degrees caudad

Enters 2 above upper border of pubic symphysis

Can be done PA


Ap oblique bladder
AP Oblique Bladder

Pt position:

40- to 60-deg. rotation

RPO or LPO depending on physician preference


Lateral bladder
Lateral Bladder

Demonstrates:

anterior/posterior bladder walls

  • Base of bladder

  • Any vesicovaginal or vesicorectal fistulae


Male cystourethrography
Male Cystourethrography

  • Images obtained as contrast injected by urethral syringe

  • Entire urethra must be visualized

  • Bladder can be filled to obtain antegrade voiding study

  • Why is this antegrade if its injected into urethra?

AP Oblique Projection - RPO/LPO


Female cystourethrography
Female Cystourethrography

  • Retrograde

  • AP Projection (maybe obliques)

  • Bladder can be filled and pt. voids for antegrade studies


Voiding cystourethrogram
Voiding Cystourethrogram

X-ray images of bladder and urethra during urination

Follows cystogram - urinary catheter removed

Pt. urinates into special radiolucent urinal as images taken

.


Voiding cystourethrogram cont d
Voiding Cystourethrogram cont’d

  • Shows size and shape of bladder under stress caused by urination

  • Demonstrates urethra functioning

  • Most commonly used for young girls with history of recurrent bladder infections


Metallic bead chain cystourethrography
Metallic Bead Chain Cystourethrography

  • To evaluate stress incontinence in females only

  • Beaded chain inserted in Urethra

  • Shows anatomic changes in shape and position of anatomic floor

  • Valsalva tech. applied for comparison


Summation of exams of urinary system
Summation of exams of Urinary System

IVU- entire urinary system

Retrograde Urogram- same as IVU but performed through catheter starting at urethra

Nephrotomography- slices of kidneys

Cystogram- for bladder

Voiding Cytogram

Cystourethrogram- for urethra

Voiding Cystourethrogram


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