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Index
Multiple renal stone
Stag horn stone Index
1-Calcium stones : 75% of kidney stones contain calcium, mostly calcium oxalate and calcium phosphate
2-Infection stones : urea-splitting bacteria such as proteus, produce a more alkaline urine that favors
precipitation of magnesium ammonium phosphate and calcium phosphate These stones vary from hard to
soft and friable, they can eventually fill calyces and the renal pelvis to form stag horn calculi. Infection
stones are frequently responsible for complications such as bleeding, pain, and urinary tract infection and
sepsis
3-Uric acid stones : occur in patients with and without gout, can develop in patients with diseases where
there
4 is a high rate of cell turnover such as leukemias, pure uric acid stones are radiolucent (not ©visualized
UROLOGY on
x-rays). Calcium containing stones are radiopaque.
Investigations for urinary stones
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Index
Plain UT:
Lt. stag horn stone
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Index
Normal IVP (30 minutes)
•Normal calyces
•Renal pelvis
•Ureter
•Bladder
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Index
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Index
IVU showing:
Rt. stag horn stone
with non visulization
of the Rt. ureter
Lt. hydronephrosis
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Index
Early film: Late film:
Normal Rt. Kidney function The Rt. Kidney is not seen anymore
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Index Delayed excretion with Lt. hydronephrosis
Lt. renal stoned with no dye excretion yet
Bilateral multiple renal stones
Note delayed renal excretion
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Bilateral multiple renal stones
Note delayed renal excretion
The dye is excreted only in late films
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Index
Stag horn stone
Plain X-ray
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Lt. Renal stone
Lt.
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Ureteric Stones
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Effects of stone Lt. ureter
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Early film Index Late film
Dornier basket
Extraction of ureteric stone
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Urinary Bladder Stones
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Index
Plain U.T.
Multiple stones – urinary bladder
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Index
Plain U.T.
Stones urinary bladder
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Index
Plain UT:
UT
Stone bladder
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Index
Plain UT:
UT
Stone bladder &
Rt. lower end
ureter
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Index
Stone urethra
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Ureterocele
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IVU:Lt.
IVU ureterocele (copra head) Note: ballooning of the intramural
part of the Lt. ureter with mild back
pressure on the ureter (the whole
course of the Lt. ureter is seen)
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Index
Ureteroceles:
Ureteroceles Mild dilatation of both distal ureters
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Ureterocele
IVU showing cystic
dilatation of the
intramural part of
the ureter with cobra
head appearance.
Note the radiolucent
stone in the
ureterocele.
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Index
Hydronephrosis
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Hydronephrosis due to pelvi-ureteric junction obstruction
Normal kidney
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IVU36Lt. Hydroureter - hydronephrosis
Index
Double ‘J’ ureteric catheter
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Index
Urinary Bilharziasis
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Index
Stricture in the lower
end Lt. ureter
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Index
Bilharzial ureteral
strictures
PUT showing multiple radio- IVU showing bilateral ureteral dilatation with
opaque shadows in the pelvis bilateral multiple lower ureteral stones
secondary to bilharzial bilateral ureteral
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40
strictures.
Index
Urinary tract
Bilharziasis
Calcification of ureters,
bladder & seminal
vesicles
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Pain X-ray:
Calcified
urinary bladder
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Bladder Tumors
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IVU
Bladder carcinoma
Note the irregular outline
of the filling defect
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IVU:
CA bladder with
back pressure
on the Rt. ureter
& kidney
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IVU:
CA bladder with
Rt. hydroureter
&
hydronephrosis
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CA bladder
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Bladder Carcinoma
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IVU:
Bladder tumor (filling defect)
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Bladder Cancer
IVU:
IVU Right lateral
wall bladder mass
appearing as filling
defect in the
cystogram.
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Index
Bladder Cancer - CT
Pelvic CT with IV
contrast:
contrast Anterior
wall bladder mass
infiltrating the
anterior
abdominal wall
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Index
Bladder Cancer - CT
Pelvic CT
without
contrast:
Bladder mass
arising from
posterior and RT
lateral bladder
wall.
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Index
Benign Prostatic Hypertrophy
(BPH)
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Trans Abdominal U/S of BPH
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IVU
Benign senile
prostatic enlargement
Note the smooth outline of the
prostatic shadow
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Benign prostatic hypertrophy
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For comparison
IVU: normal
This is a female
Notice the smooth
impression of the
uterus
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IVU of BPH
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Urinary bladder stone
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Plain UT Index
Ureter Vas
Bladder
Prostate
Benign enlargement of the middle lobe of the prostate resulted in back pressure on the
ureter and renal pelvis on both sides (hydroureter & hydronephrosis)
hydronephrosis
Prostatic enlargement resulted in elevation of the bladder base as well. The ureters are hooked
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by the vas crossing their terminal ends giving this characteristic sign (fish hook sign) © UROLOGY
Index
IVU of BPH
Fish hook sign of the
lower ureters:
ureters
Elevation of bladder
base by the enlarged
prostate push the lower
end of ureter upwards
against the crossing vas
deferens.
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Index
IVU of BPH
Middle lobe
causing filling
defect in the
cystogram
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IVU of BPH
Chronic retention
of urine, bladder
with dilute
contrast reaching
above umbilicus
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IVU of BPH
Bladder diverticulum
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Bladder diverticulum
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BPH removed by open surgery
Prostate adenoma
removed by surgery
BPH complicated by
multiple bladder
stones
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Renal
Neoplasms
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Nephroblastoma (Wilm’s tumour)
Mixed tumour arising from the emberionic nephrogenic tissue. Usually discovered during the first 4 years of life. Occur in
one or other pole of the kidney. The cut surface is grayish or pinkish white. Rapidly growing tumors may be soft in
.consistency
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Microscopically, Index
it is a mixed tumour composed of epithelial & connective tissue cells. It may occasionally contain islands
of bone, cartilage or muscle fibers. Some elements may be less sensitive to radiotherapy than others
Nephroblastoma
(Wilm’s tumour)
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Index
Renal cell carcinoma
(Hypernephroma)
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Renal cell carcinoma (Hypernephroma)
Notice the
yellow (lipid/fat),
the focal
hemorrhage,
and areas of
necrosis
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Renal malignancy
PUT:
PUT
Note the soft tissue
shadow of an enlarged
left kidney
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Renal malignancy
IVU:
IVU Space occupying
lesion in the left kidney.
Note the stretching,
splaying, and amputation
of calyces.
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Lt. Renal cell carcinoma
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Renal malignancy
Abdominal CT
with IV contrast:
contrast
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Cannon ball metastasis
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Index in the lungs © UROLOGY
Congenital
anomalies
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Bilateral double ureter
If the condition is
asymptomatic and
discovered accidentally, no
treatment is required.
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Rt. Lt.
Double Double
pelvis pelvis &
double
ureter
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IVU:
Lt. pelvic kidney
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IVU
Horseshoe kidney
C.T.
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IVU
Horseshoe kidney
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IVU:
IVU
The "left" kidney is
located below the
right kidney
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Congenital pelvi-ureteric
junction obstruction
Normal right kidney
Left kidney revealed moderate
dilatation of the intra-renal
collecting system up to the
level of the UPJ
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Bladder extrophy
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Trauma
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Renal Trauma
Motor car accident. Chest X-Ray showed multiple right sided rib fractures and pneumohaemothorax.
On laparotomy
IVU showed extravasation of contrast from the Large laceration of the lower pole of the right
right kidney, and a functioning left kidney kidney
What are the types of closed renal injuries & how are they managed. What are the
92
possibleIndex
complications? © UROLOGY
Extraperitoneal bladder rupture
Cystography shows bladder rupture secondary to a pelvic fracture
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Polycystic kidney
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Autosomal dominant (adult)
polycystic kidney disease
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polycystic kidney The kidneys are
enormously
enlarged, each with
a length of 30 cm
(normal < 12.5 cm),
and appear to be
completely replaced
by cystic spaces,
some of which
contain blood.
There is no
recognisable
normal kidney
tissue
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polycystic kidney
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polycystic kidney
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TB of the
Kidney
TB of the urinary tract
occurs secondary to
haematogenous infection.
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Compare & contrast
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Testis &
Epididymis
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Normal anatomy of testis,
epididymis & spermatic cord
Testicular
artery
Cremasteric
muscle
Pampiniform
venous plexus Head
Tunica
vaginalis
Testis
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Hydrocele
Trans-illumination
Remember the
predisposing
causes for
testicular torsion
What are the clinical
features of torsion of © UROLOGY
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testis? Index
Seminoma
Closed Opened
Lymphatic
107
spread of testicular tumors will follow the spermatic cord to the
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para-aortic LNs near the Index
origin of the gonadal vessels