URORADIOLOGI

( RADIOLOGI SALURAN KEMIH)

Bagaswoto Poedjomartono
Bagian Radiologi FK-UGM / RS Dr.
Sardjito Jogjakarta
TUJUAN UMUM

Setelah mahasiswa mengikuti kuliah ini,

diharapkan dapat:

1. Mengerti dan memahami sistem saluran kemih

2. Mendiskripsikan sistem saluran kemih
3. Mendiskripsikan alat dan pemeriksaan
radiologi saluran kemih
4. Mendiskripsikan gambaran normal dan
kelainan radiologi saluran kemih
MODALITAS PEMERIKSAAN
GINJAL

1. USG
2. DOPPLER GINJAL
3. SKINTIGRAFI GINJAL
4. RENOGRAM
5. EFFECTIVE RENAL PLASMA FLOW (ERPF)
6. CT SCAN GINJAL
7. MRI GINJAL
8. ARTERIOGRAFI GINJAL
 URORADIOLOGI

ORGAN
Ginjal
Ureter
Vesika Urinaria

PEMERIKSAAN
IVP
Antergrad / retrograd pyelografi
Cystografi
Ultrasonografi, angiografi,
renoscan/renogram
KELAINAN-KELAINAN PADA IVP

1. Kelainan kongenital
2. Kelainan radang
3. Tumor
4. Kelainan lainnya
KELAINAN KONGENITAL

1. Kelainan letak ginjal

a. Unilateral pelvic kidney
b. Horse Shoe Kidney
c. Dystopic left kidney fused right kidney
d. Nearly complete agenesis to left kidney
2. Kelainan kista ginjal
a. Single cysta
b. Multiple cysta
 KELAINAN RADANG

1. Pyelonephritis chronica
a. Kalises menggelembung
b. Kortek menipis
c. Terdapat fibrosis
2. Renal abses
a. Ada lesi massa pada IVP
b. Terdapat internal ekho kompleks yang terdesak ke
belakang pada USG
c. Ekho kpmleks yang tidak begitu homogen pada USG
3. Contracted kidney
4. Atrophy kidney
KELAINAN LAINNYA

1. Tumor
a. Neuroblastoma supra renal
Ada desakan sistem kalises ke arah
bawah sehingga
seperti bunga lily layu (dropping lyli
sign)
b. Wilms tumor
Sering pada anak-anak, kalises
renalis menjadi tidak keruan, ada defect
pada sistem kalises
2. Nephrolitiasis
Staaghorn, urat, kalsium phosphat.
KELAINAN PADA URETER

1. Ureteritis
2. Hidroureter / ureterektasis
3. Duplikasi ureter dupleks
4. Duplikasi ureter komplit maupun non-
komplit
5. Mega ureter
6. Vesikoureteral refluks
7. Fistula
8. Hipoplasi / agenesis ureter
9. Kinking ureter
KELAINAN PADA VESIKA
URINARIA

1. Divertikulum
2. Polip vesika urinaria
3. Malignansi vesika urinaria
4. Radang atau cystitis
5. Neurogenic bladder
6. Vesikolitiasis
7. Vesikoureteral refluks
8. Fistula
URETHROCYSTOGRAPHY

Multiple diverticulum
URETHROCYSTOGRAPHY

Urethrolitiasis
URETHROCYSTOGRAPHY

BLADDER DIVERTICULUM
RIGHT OBLIQUE LEFT OBLIQUE
 Figure 3. Pattern of renographic curves.
F0 = Normal response ; F1 = Mild pelvic retention;; F2 = Moderate pelvic retention which shwn a
sharp fall after furosemide; F3 = Severe pelvic retention with normal or impaired second phase and
an impaired response to furosemide which has to be judge as appropriate indicating probable no
obstructing uropathy, or inapropriate probable obstructing uropathy; F4 = Obstructing uropathy,
usually impaired second phase which continues to rise, no peak, and no response to furosemide; F5 =
Nephropathic kidney, very impaired second phase followed by a plateau and no response to
furosemide; F6 = Atrophic non-functioning kidney, activity time curve is similar to the blood
clearance curve ( Britton and Whitfield, 1991 ).
Figure 2. Pattern of normal both right and left renogram curve, normal bladder
filling curve
Figure 4. Pattern of renogram curve for non-functioning kidney, no bladder
filling curve
SKENING GINJAL
LAINNYA

1.Effective renal plasma flow

2.Skening ginjal ( medulla )
dengan DTPA
3.Skening ginjal ( cortical )
dengan DMSA
4.Skening ginjal dinamik
SISTEM PERKEMIHAN LAKI-LAKI
SISTEM PERKEMIHAN WANITA
Radiologi Saluran Kemih
Pencitraan saluran kemih Penggolongan terhadap ren
Anatomi Pre renal Vasculair
IVP
Fungsi disease

Padat Renal
USG Infeksi
Kistik Trauma
Nefrosis
Anatomi topografi Batu
CT Padat Kel. Kongenital
Cairan Ganas
Tumor
Anatomi Jinak
MRI Padat Padat
Cairan Kistik
Fungsi Campuran
Ked. Nuklir
Post renal
Anatomi Kortikal
Medulla Obstruksi
Kongenital
Fungsi Normal Tumor
Obstruksi Ganas
Non fungsi Jinak
TOPOGRAFI GINJAL & PEMBULUH DARAH
(AP)
TOPOGRAFI GINJAL & PEMBULUH DARAH
(PA)
STRUKTUR GINJAL UTUH
STRUKTUR GINJAL DIBELAH
URINARY TRACT
INFECTION - SITES
MEDICAL
SURGICAL
Focal abscess Kidney Tuberculous cavity
Pyelitis Stone
Glomerulonephritis Perinephric abscess
Tuberculosis Ureter Obstructive uropathy
External pressure Bladder Tumor
Ascending infection Foreign body
Reflux Prostatic obstruction
Urethral stricture
RETROGRAD
PYELOGRAPHY IS
REQUIRED WHEN:
There is inadequate definition of upper
urinary tract on an IVP
Where there is an obstructive element in
the upper tract when the obstructing
cause is not clearly defined
To define the relationship of doubtful or
non-radio opaque calculi to the ureter. An
oblique film taken as part of this
examination is often mandatory
RADIOLOGY URINARY
TRACT INFECTION
Concerned with:
Evidence of function
Focus of infection
Evidence of destructive uropathy
Specific causes such as stone or tumor
Method:
Plain film
IVP
Retrograd
Cystogram
ABNORMALITY OF KIDNEY
ABNORMALITY OF
KIDNEY
ABNORMALITY OF
KIDNEY
ABNORMALITY OF
KIDNEY
ABNORMALITY OF
KIDNEY
ABNORMALITY OF
KIDNEY
ABNORMALITY OF
KIDNEY
ABNORMALITY OF URETHRA
ABNORMALITY OF BLADDER
ABNORMALITY OF
BLADDER