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Kidney Ureter Bladder Diagnostic Technique

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Kidney Ureter Bladder Diagnostic Technique KUB Kidney Ureter Bladder Diagnostic Technique . Plain KUB . Intravenous urography : IVP . Voiding cystourethrography : VCUG . Hysterosalpingography . Ultrasonography Plain KUB . The projection includes the entire urinary system . From the superior aspects of the kidneys . To the pubic symphysis . Not include the diaphragm Indication Plain films are widely used in the management of stone diseases What are you looking for? . Calcifications . Abnormal soft tissue . Air within urinary tract . Bony abnormalities Transverse Process Urinary Tract Stone . Most common cause of acute ureteral obstruction . Clinical presentation : 1. Flank pain 2. Intermittent hematuria Clinical Perspective Acute flank pain, with dramatic relief upon passage of the stone 1. UPJ stone : flank pain 2. Proximal ureteric stone : flank pain radiating to the genitals 3. UVJ stone : voiding urgency and suprapubic discomfort, and they cause pain that radiates into the groin and genitals Hematuria Radiologic Evaluation of Hematuria . The AUA guidelines recommended upper tract imaging for low- and high-risk patients with microscopic hematuria . Gross hematuria -> much higher risk of malignancy than microscopic disease Hematuria : Cause . Calculi . Infection . Cancer . Obstruction . Anticoagulation . Artifactual cause: menstrual blood, food such as beets, berries, rhubarb Radiologic Work-up of Hematuria . No universal agreement about the optimal imaging work-up of hematuria . Traditionally : IVP was the standard . Recently : . Multidetector CT scans have become routine . MRI can be used to detect urinary tract abnormalities, but has limited use because of its expense and the lack of data supporting its use ACR Appropriateness Criteria Scale for Hematuria ACR Appropriateness Criteria Scale for Hematuria ACR Appropriateness Criteria Scale for Hematuria Urinary tract stone . Increasing overall prevalence in the last decade . Significant impact on the healthcare system : .Direct costs : approximately $3,500 per person in 2000 .Morbidity associated with complications such as infection and chronic renal failure Urinary tract stone . 14% of men and 6% of women . Recurrence rates : . 50% within 5–10 years . 75% within 20 years Renal stone Ureteric stone Renal stone . Renal stone Bladder stone . Ureteric stone . Bladder stone Stone : Plain KUB . Depend on stone composition . Stones : combination of crystals and proteins . Calcium-based stones : 70%–80% of upper urinary tract stones . Calcium oxalate monohydrate . Calcium oxalate dehydrate . Calcium phosphate stones Stone Classification Based on Composition Stone Classification Based on Composition Imaging of Urinary Tract Stone Renal stone : A 1 cm calcification at left kidney shadow Renal stone : A 1 cm calcification at left kidney shadow Renal stone : A 1 cm calcification at lower part of left kidney shadow Renal stone : A 1 cm calcification at lower part of left kidney shadow Staghorn stone at both kidney shadows Staghorn stone at both kidney shadows A 1 cm oval shape calcification at left lateral aspect of L4 ; representing left ureteric stone A 1 cm oval shape calcification at left lateral aspect of L4, representing left proximal ureteric stone A 5-mm oval shape calcification at right pelvic cavity ; representing right distal ureteric stone A 5 mm oval shape calcification at right pelvic cavity ; representing right distal ureteric stone A 7 cm oval shape well-defined calcification in pelvic cavity; representing bladder stone Several oval shape well-defined calcification in pelvic cavity; representing bladder stones Limitation . Bowel gas or bowel content . Phlebolith : . Calcification in pelvic veins . May be confused with ureteric calculi . Radiolucent stone Multiple calcifications with internal radiolucency in pelvic cavity, representing phlebolith IVP Intravenous Pyelogram Intravenous Pyelogram • Use decreased significantly in recent years • CT, US or MRI is replacing • Remains primary modality for visualization of pelvocalyceal system and ureter Indication : • Demonstrated the renal collecting system and ureters • Investigate the level of ureteral obstruction in renal unit displaying delayed function • Demonstrate renal and ureteral anatomy in special circumstances such as congenital abnormality(horseshoe kidney) Contraindication : • Renal insufficiency for worsening of their renal function(contrast induced nephrotoxicity) • Multiple consecutive contrast studies – < 48 Hr • Allergic reaction to contrast such as urticarial Standard Procedure What is the abnormality? Hydronephrosis A 1 cm calcification at left lateral aspect of L4, representing left mid ureteric stone, causing severe hydronephrosis and hydroureter A 1 cm calcification at left lateral aspect of L4, representing left mid ureteric stone, causing severe hydronephrosis and hydroureter Well-defined filling defect in the right renal pelvis: Right renal stone Well-defined filling defect in the right renal pelvis. Right renal stone VCUG Voiding Cystourethrography VCUG • Functional study • The bladder is filled retrograde via a urinary catheter (Foley) • After filling the bladder the retention balloon is deflated, and the catheter is removed VCUG • Strictures • Obstructions • Diverticula • Reflux into the ureters Normal VCUG : Male Bladder Urethra Vesicoureteric Reflux Vesicoureteric Reflux Hysterosalphingography Indication • The radiographic evaluation of the uterus and fallopian tubes • Predominantly in the evaluation of infertility Two contraindications for HSG: • Pregnancy • Active pelvic infection • The examination should be done during days 7–12 of the menstrual cycle – The endometrium is thin during this proliferative phase – Ensure that there is no pregnancy • Abstain from sexual intercourse from the time menstrual bleeding ends until the day of the study to avoid a potential pregnancy Complication • Two most common : bleeding and infection • The patient should be made aware that she may experience light spotting after the procedure, usually lasting less than 24 hours Normal Hysterosalphingography Hysterosalphingography Ultrasonography A 1 cm hyperechoic lesion with posterior acoustic shadow at mid portion of the kidney, likely calyceal stone A 1 cm hyperechoic lesion with posterior acoustic shadow at mid portion of the kidney, likely calyceal stone A 2 cm hyperechoic lesion with posterior acoustic shadow at renal pelvis, causing mild hydronephrosis Computer Tomography Multiple small hyperdensity lesions at right upper/mid/lower calyces and left lower calyx: calyceal stones Infection . Emphysematous Pyelonephritis . Emphysematous Cystitis • Emphysematous pyelonephritis • Pneumoretroperitoneum • Mottled gas within renal fossa and crescentic gas collection within Gerota's fascia -> Emphysematous pyelonephritis • Linear gas along paraspinal region -> Pneumoretroperitoneum curvilinear or mottled gas in the bladder wall.
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