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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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Presentation Transcript
  • 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

  • investigation of male sterility
  • 무정자증의 남성불임 환자에서 고환 생검에서 정자생산이 정상인 경우
  • US, CT와 DSA의 사용 증가로 arteriography의 사용이 줄어들고 있다.
  • renovascular disease

kidney donor

renal tumor(embolization)

renal trauma

  • Arterial phase

Nephrogram phase

Venous phase

  • 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
  • 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
  • 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,


  • upper UT obstruction


diuretic renal scan

  • chronic PN in children(renal scarring in VUR)


  • renal transplantation: 131I-hippuran
  • renovascular hypertension
  • functional renal mass quantification
  • space occupying renal lesions
  • Bladder: VUR
  • Testis scan

99mTc-sodium pertechnetate

DDx: testicular torsion & epididymitis

  • Adrenal scintigraphy

cortex: Cushing's synd.- NP59

medulla: pheochromocytoma- 123I-MIBG

  • Bone scan
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.


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
  • 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