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Imaging of the Urinary Tract

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Imaging of the Urinary Tract Imaging of the Urinary Tract National Kidney and Urologic Diseases Information Clearinghouse What is the urinary tract? tubes called the ureters. The urine is then stored in a balloonlike organ called the blad- The urinary tract is the body’s drainage der. When the bladder empties, urine flows system for removing wastes and extra water. out of the body through a tube called the The urinary tract includes two kidneys, two U.S. Department urethra at the bottom of the bladder. of Health and ureters, a bladder, and a urethra. The kid- Human Services neys are a pair of bean-shaped organs, each about the size of a fist and located below the What does “imaging” mean? NATIONAL ribs, one on each side of the spine, toward INSTITUTES In medicine, “imaging” is the general term OF HEALTH the middle of the back. Every minute, a per- for any technique used to provide pictures of son’s kidneys filter about 3 ounces of blood, bones and organs inside the body. Imaging removing wastes and extra water. The wastes techniques include conventional radiology, and extra water make up the 1 to 2 quarts of or x rays; ultrasound; magnetic resonance urine an adult produces each day. Children imaging (MRI); computerized tomography produce less urine each day; the amount (CT) scans; and radionuclide scans. Imaging produced depends on their age. The urine helps the health care provider see the causes travels from the kidneys down two narrow of medical problems. Kidney Ureter Bladder Prostate Urethra Male and female urinary tracts What problems could What steps does the health require imaging of the care provider take before urinary tract? ordering imaging tests? Imaging can help the health care provider Before ordering imaging tests, the health find the cause of care provider • urinary retention—the inability to • asks about specific urinary tract symp- empty the bladder completely toms, when they began, and their frequency • urinary frequency—urination eight or more times a day • considers general medical history, including any major illnesses or • urinary urgency—the inability to delay surgeries urination • may ask female patients whether preg- • urinary incontinence—the accidental nancy is suspected loss of urine • asks about medication use—both • blockage of urine prescription and over the counter—the • abdominal mass—swelling in a specific amount of fluid consumed each day, and part of the abdomen the use of alcohol and caffeine • pain in the groin or lower back • performs a physical exam • blood in the urine These steps help the health care provider • high blood pressure determine the possible causes of the urinary tract problems and what to look for in an • kidney failure imaging test. One symptom can have several possible causes. The health care provider can use imaging techniques to determine, for example, whether a urinary tract stone or an enlarged prostate is blocking urine flow. Imaging can help clarify kidney diseases, tumors, urinary tract infections (UTIs), urinary retention, small bladder capacity, and urinary reflux—the backward flow of urine. 2 Imaging of the Urinary Tract What are the imaging Intravenous pyelogram (IVP). An IVP is an x ray of the urinary tract. Contrast medium techniques? is injected into a vein in the person’s arm, The health care provider can use several travels through the body to the kidneys, and different imaging techniques depending on makes urine visible on the x ray. The con- factors such as the person’s general medical trast medium also shows any blockage in the history and urinary tract symptoms. urinary tract. The procedure is performed in a health care provider’s office, outpatient Conventional Radiology center, or hospital by an x-ray technician, and X-ray machines have been used to diagnose the images are interpreted by a radiologist— diseases for about 100 years. X rays of the a doctor who specializes in medical imaging; urinary tract can help highlight a kidney anesthesia is not needed. An IVP can help stone or tumor that could be blocking the locate problems in the kidneys, ureters, or flow of urine and causing pain. For men, an bladder that may be caused by urinary reten- x ray also shows the size and shape of the tion or reflux. prostate—a walnut-shaped gland that sur- rounds the urethra at the neck of the blad- der and supplies fluid that goes into semen. Conventional x rays do involve some expo- sure to ionizing radiation—radiation that is strong enough to damage some cells. Two common x-ray procedures include the injec- tion of a special dye, called contrast medium, which shows the shape of the urinary tract. IVP image 3 Imaging of the Urinary Tract Voiding cystourethrogram (VCUG). A Ultrasound VCUG is an x-ray image of the bladder and Ultrasound uses a device, called a trans- urethra taken while the bladder is full and ducer, that bounces safe, painless sound during urination, also called voiding. As the waves off organs to create an image of their person lies on the x-ray table, a health care structure. The transducer can be moved provider inserts the tip of a thin, flexible tube to different angles to make it possible to called a catheter through the urethra into the examine different organs. The procedure bladder. The bladder is filled with contrast is performed in a health care provider’s medium to make it clearly visible on the x-ray office, outpatient center, or hospital by a images. The x-rays are taken from various specially trained technician, and the images angles while the bladder is full of contrast are interpreted by a radiologist; anesthesia medium. The catheter is then removed and is not needed. The images can be used to x-ray images are taken during urination. The provide information that is valuable in diag- procedure is performed in a health care pro- nosing and treating a variety of diseases and vider’s office, outpatient center, or hospital conditions. by an x-ray technician. The technician is supervised by a radiologist while the images Abdominal ultrasound. In abdominal are taken. The radiologist then interprets ultrasound, the health care provider applies the images. Anesthesia is not needed, but a gel to the person’s abdomen and moves sedation may be used for some people. A a hand-held transducer over the skin. The VCUG can reveal abnormalities of the inside gel allows the transducer to glide easily, and of the urethra and bladder and is usually it improves the transmission of the signals. used for children to detect vesicoureteral reflux—the abnormal flow of urine from the bladder back into the upper urinary tract. A VCUG can also show whether the flow of urine is normal when the bladder empties, blockages from an enlarged prostate in men, and an abnormal bladder position in women. 4 Imaging of the Urinary Tract The procedure is performed in a health To determine whether a tumor is cancerous, care provider’s office, outpatient center, or the health care provider performs a biopsy. hospital by a specially trained technician, For the biopsy, the health care provider uses and the images are interpreted by a radiolo- the transducer and ultrasound images to gist; anesthesia is not needed. An abdominal guide a needle to the prostate. The needle is ultrasound can create images of the entire then used to remove a few pieces of prostate urinary tract. The images can show dam- tissue for examination with a microscope. A age or abnormalities in the urinary tract. transrectal ultrasound with prostate biopsy is Abdominal ultrasounds are also commonly usually performed in a health care provider’s used to take pictures of fetuses in the womb office, outpatient facility, or hospital by a and of a woman’s ovaries and uterus. doctor; light sedation and local anesthesia are used. The biopsied prostate tissue is Transrectal ultrasound with prostate biopsy. examined in a laboratory by a pathologist—a Transrectal ultrasound is most often used doctor who specializes in diagnosing dis- to examine the prostate. In a transrectal eases. The biopsy can reveal whether pros- ultrasound, the health care provider inserts tate cancer is present. a transducer slightly larger than a pen into the man’s rectum next to the prostate. The ultrasound image shows the size of the pros- tate and any abnormal-looking areas, such Prostate as tumors. Transrectal ultrasound cannot be used to definitively diagnose prostate cancer. Bladder Needle Transducer Needle guide Transrectal ultrasound with prostate biopsy 5 Imaging of the Urinary Tract MRI tract. During the sequencing, the person will Magnetic resonance imaging is a test that hear loud, mechanical knocking and hum- takes pictures of the body’s internal organs ming noises. The procedure is performed in and soft tissues without using x rays. MRI an outpatient center or hospital by a spe- machines use radio waves and magnets to cially trained technician, and the images are produce detailed pictures of the body’s inter- interpreted by a radiologist; anesthesia is not nal organs and soft tissues. An MRI may needed, though light sedation may be used include the injection of contrast medium. for people with a fear of confined spaces. With most MRI machines, the person lies on Magnetic resonance angiogram (MRA). An a table that slides into a tunnel-shaped device MRA is a type of MRI that provides the where the images are taken. The device may most detailed view of kidney arteries—the be open ended or closed at one end; some blood vessels that supply blood to the kid- newer machines are designed to allow the neys. An MRA can show kidney artery person to lie in a more open space.
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