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The Urinary System

Fatimah
2014
Urinary System

• Often called the excretory system

• Two kidneys
• Two ureters
• One urinary bladder
• One urethra
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)
• Minor calyces unite to form
major calyces

• Major calyces unite to form


renal pelvis

• Renal pelvis then drains into


ureters

• Hilum - longitudinal slit in


medial border for transmission
of blood vessels, nerves,
lymphatic vessels, and ureter
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

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

• Serves as Urine
reservoir
Urinary Bladder
• How much fluid can
bladder hold?
– up to 500 mL
• Urethral orifice
located in bladder
neck
• Area between ureteral
openings and urethral
orifices is trigone
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
controls flow
• Male urethra contains following
parts:
– Prostate
– Membranous area
– Spongy area
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)
• Effects of trauma
• Pre-op evaluation
• Renal hypertension
Contraindications

• Inability to filter contrast medium from


blood
• Allergy to contrast

• Abnormal BUN and Creatinine levels


Preparation Of Pt
• Pt should follow low residue diet for 1-2 days
prior to exam
• laxative taken day before
• 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

• Must be used to visualize


urinary tract

• Iodinated, water-soluble
contrast administered
intravenously to examine
system

• Antegrade filling
Contrast Media
• Excretory urography (IVU) generally uses a 50 to
70% iodine solution

• Lower concentrations 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
• Crucial not to 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 associated with a
sudden drop in blood pressure and difficulty breathing). Can lead to death in a
matter of minutes)
Injection Procedure
• Obtain allergy history
• Explain exam to pt
• Prepare contrast and supplies (sterile tech.)
• Assist radiologist as necessary
– or
• Perform injection if IVcertified
Injection Supplies (cont.d)
• Tourniquet
• IV arm board
• Towels
• Emergency kit
• Emesis basin
• Alcohol wipes, hibiclens, or povidone iodine wipes or swabs
• Contrast
• 19-22 G needle, butterfly or angiocath for infusion
• Extension tubing
• Tape or clear-type dressing
IVU Procedure
• Scout – KUB

• Contrast is injected

• Timed sequence of films obtained until bladder


begins to fill-
– Immediate image of kidneys
– 5 minute image of abd. or kidneys
– Compression applied
Ureteral Compression
• Applied over distal ends
of ureters

• Inhibits flow of urine into


bladder

• Distends renal pelvis and


calyces

• Compression device
should be centered at
ASIS
Ureteral Compression (cont’d)

• As much compression as
pt can tolerate!

• Should not be applied


when:
– stones, abd. mass or
aneurysm, colostomy,
suprapubic catheter, recent
abd. surgery or trauma

• (Because of improvement of contrast


agents, compression no longer
generally used)
Radiographic Positions IVU
AP Projection-IVU
• KUB
• (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

3 minute
6 minutes
Time delay- IVU

With compression
9 minutes
Retrograde Urography

What does Opposite normal flow


retrograde
mean?
Retrograde Urography
• Considered an
operative procedure
• Pt may be under
general anesthesia
• Sterile technique is
used
• Nurse responsible for
set-up of exam and
pt. care
Retrograde Urography
• Requires
catheterization of
ureters
• Contrast injected
directly into
pelvicaliceal system
via cathethers
• Provides improved
opacification of renal
collecting system
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
APG
APG
Cystography
Cystography

• Radiologic exam of
urinary bladder

• Contrast
administration usually
performed
retrograde (against
normal flow of urine)
Excretory Cystogram Retrograde Cystogram
Cystography
Indicated for:

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)
Cystography indications cont’d
– Bladder trauma

– Prostate enlargement

– Lower urinary tract fistulae

– Urethral stricture

– Posterior urethral valves (obstructive congenital defect


of the male urethra)
Cystography

• Contraindications – anything
related to catheterization of
urethra!
“Retrograde” Cystography

• Contrast will be drip-


infused via a catheter
• Bladder will be filled to
capacity
• Fluoro-spot and overhead
films will be obtained
Cystography Routine Series
Scout

filled AP

both obliques

lateral

voiding

post-void
AP Axial Bladder

• CR( similar to coccyx projection)

– Angled 10 to 15
degrees caudad to
center of IR
– Enters 2 above
upper border of
pubic symphysis
AP Axial Bladder (excretory method)
PA Axial Bladder
(prone)
CR
– Angled 10 to 15 degrees cephalad

– Enters about 1”distal to coccyx

– Exits just above superior border of pubic


symphysisPatient prone

– Arms out of anatomy of interest

– IR centered to CR
AP Oblique Bladder

• Pt position

– 40- to 60-degree
– RPO or LPO
depending on
physician
preference
AP Oblique Bladder
CR
– Perpendicular to center of
IR

– CR 2 above upper border


of pubic symphysis and 2
medial to upper ASIS

– If bladder neck and


proximal urethra is of
interest, 10-degree caudal
angle of CR will project
pubic bones below them
Lateral Bladder
• Patient position
– Lateral recumbent,
right or left side
• Part position
– Knees flexed
– MCP aligned to
midline
• CR to midcoronal
plane at 2 in. above
symphysis pubis
Lateral Bladder

– Demonstrates
anterior/posterior
bladder walls
– Base of bladder
– Any vesicovaginal
or vesicorectal
fistulae
Cystourethrography
Cystourethrography
• Retrograde study to
visualize bladder and
urethra
• Contrast does not
enter blood stream
• Sterile technique
must be used
• Nurse will generally
perform
catheterization
Male Cystourethrography
• Images are obtained as
contrast is injected

• Entire urethra must be


visualized

• Bladder can be filled to


obtain antegrade voiding
study

• Why is this antegrade if


its injected into urethra?
Female Cystourethrography
• Retrograde
• AP Projection (maybe obliques)
• Bladder can be filled and patient void for
antegrade studies
• Cassette should be centered as for
cystography
• Abduct thighs to prevent superimposition
of bone or soft tissue
Incontinence Studies

• Positioning is same as retrograde


cystography

• On lateral films, pt. asked to strain to


demonstrate any prolapse or incontinence
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

• 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
The End