GU Diagnostics and Procedures Flashcards
KUB stands for
Kidney, Ureter, Bladder (plain films)
-preliminary radiograph in extended radiologic examinations
Advantages / Disadvantages of KUB
A- Cost is low, x-ray is readily available at most facilities.
D- is the use of ionizing radiation and relatively poor soft- tissue contrast
Average size of adult kidney
12-14 cm (top to bottom)
what is Intravenous Pyelography (IVP)
plain film x-ray of abdomen initially; followed by more x-rays at timed intervals after IV injection of Iodine-containing contrast medium
What is a normal test with IVP
normal kidneys promptly excrete contrast agents
What is one thing that intravenous Pyelography (IVP) is very useful for
demonstrating small lesions in the urinary tract
Voiding Cystourethrography (VCUG) is utilized for
visualizing the urethra and urinary bladder during micturition.
How is VCUG conducted
Technique consists of catheterizing the person in order to fill the bladder with radiocontrast agent.
Under fluoroscopy or standard x rays, the radiologist watches the contrast enter the bladder and looks at the anatomy of the pt.
Name of the diagnosis for when contrast will move into the ureter and back to the kidneys during a VCUG
Vesicoureteral reflux
Indications of a VCUG
- frequent UTI’s
- suspected obstruction
- Bladder trauma or post-op evaluation (examples prostatectomy, bladder repair)
- Urinary stress incontinence
What is renal ultrasound commonly used for
the evaluation of the kidney, urinary bladder, prostate, testis, and penis.
ultrasound is useful for assessing renal size and growth and in detection and characterization of renal masses (solid vs cystic)
Advantages / Disadvantages of utilizing renal ultrasound
A- Ease of use, High pt tolerance, non invasiveness, lack of ionizing radiation, low relative cost, and wide availability
D- Tissue nonspecificity, limited field of view, and dependence on the operator’s skill and the pt’s habitus
What is the name of the test that measures the amount of urine left (residual) in the bladder after micturition
Post-Void Residual (PVR)
What are some of the disease processes that validate the need for post-void residual tests (PVR)
Neurogenic bladder
spinal cord injury, CVA, MS, Parkinson Dz
urinary outflow obstruction ie (BPH) .
previous pelvic surgery/trauma
medications - sedatives, opiates, calcium channel blockers
What is a big risk when PVR volumes are abnormal
High risks of UTI
what are the two methods to measure the amount of residual volume post micturition
which is safer
catheterization or or by using ultrasound (bladder scan)
Bladder scan is safer because it does not have risks of causing infection like the cath
however the use of Ultrasound is more expensive for the pt
what is an appropriate urine retention to be considered adequate bladder emptying
less than 50 cc
True or false - PVR of less than 100 is acceptable in pt’s that are over 65
True
what volume remaining in the bladder is likely due to incomplete bladder emptying or
grater than 200 cc
When is renal CT most commonly utilized
in the evaluation of acute flank pain, hematuria, renal infection (abscess), trauma, and in the characterization and staging of renal neoplasm/ masses
mostly iodinated contrast media is used for renal CT’s
when is Contrast not utilized
in the evaluation for renal or perirenal calcification (stones), hemorrhage, or urine extravasation is suspected
Advantages / Limitations of renal CT
A- wide field of view, ability to detect subtle differences of various tissue types, good spatial resolution, anatomical cross-sectional images, and relative operator independence
L- Include restriction to the transaxial plane when images obtained, low soft tissue contrast resolution, and the need for contrast media. Finally, radiation exposure is much higher than plain films
No Contrast (CT)
renal stone study, pts who are in renal failure!!!, pts where renal function is i question need a referral for BUN/creatinine, within last 30 days
Contrast is needed (CT) for
All abdominal work that emphasizes liver, pancreas, kidney, and or bladder
Gold standard for the characterization of renal masses
CT of abd/pelvis
Applications for use of Magnetic Resonance Angiography (MRA) in renal imaging
include demonstration of congenital anomalies, diagnosis of renal vein thrombosis, and diagnosis and staging of renal cell carcinoma.
MR angiography is useful in
evaluating renal transplant vessels, renal vein tumor or thrombosis, and renal artery stenosis
Advantages / Disadvantages of MRA in renal examination
A- direct imaging in any plane desired, choice of large or small field of view, excellent soft-tissue contrast, imaging without exposure to ionizing radiation. MRI can image blood vessels and the urinary tract without contrast material.
D- The scanning time is relatively slow and as a result image clarity is often inferior compared to CT. there are also higher costs associated
indications for Renal Angiography
Suspected renal artery stenosis, vascular malformations, Tumor embolization to minimize surgical blood loss, Trauma
Complications of renal angiography
include bleeding at puncture site, contrast allergy or nephrotoxicity, and renal emboli
What is Cystoscopy
is a procedure were a thin, lighted cystoscopy is inserted into the bladder and urethra to better visualize the internal lining that is not seen by imaging.
Indications for cystoscopy
Gold standard for diagnosing bladder cancer (can biopsy during procedure).
Evaluation of pat’s with voiding symptoms
gross or microscopic hematuria
Evaluation of urethral or bladder diverticula
congenital anomalies in pediatric pop.
intraop. evaluation after incontinence / prolapse procedures
Retrograde pyelography for upper urinary tract evaluation
bladder hydrodistention needs anesthesia in OP surgery setting
Therapeutic indications of Cystoscopy
treatment of urethral strictures
bladder neck procedures
intravesical procedures
Reflux treatment in peds pop.
Contraindications of Cystoscopy
febrile pt’s with UTI and those with severe coagulopathy
Renal Biopsy indications
unexplained renal failure, acute nephritic syndrome, nephrotic syndrome, isolated non nephrotic proteinuria, isolated glomerular hematuria, renal masses, renal transplant rejection, connective-tissue diseases.
Types of renal Biopsy
Percutaneous (needle)
Open - typically open is done if history of bleeding or blood clots in the past or if there is one kidney.
Urinary Catheterization is utilized for
urinary drainage
often as a means of collecting urine for measurement
Catheters that are left in (foley) are known as
Indwelling catheters
what percentage of catheters placed in hospitalized pt’s are unwarranted
up to 50%
often these are utilized as convenience, understaffing, incorrect orders, low compliance to general rules, etc. complications arise including infections
What are the actual indications for catheterization
- Urinary retention with or without bladder obstruction
- hourly urine output measurement
- daily urine output for fluid management
- intraoperative to assess fluid status
- Neurogenic bladder
- incontinence in pt with open wounds in sacral / perineal regions
True or false - it is actually appropriate to utilize catheters for the incontinent pt’s as they can not control the release of their urine
false- other inappropriate uses include but are not limited to: obain urin in those who can spontaneously urinate, residual urinary bladder volume
what is the timeframe that indicates greater risks of UTI with an indwelling foley
greater than 5 days with same indwelling foley there are higher risks of infection
True or false- Collection of urethral specimens indicate the use of a swab with rotations in both directions of the urethra for a minimum of 10 seconds
False- one direction for 10 seconds
tips- insert swab gently 1-2 cm for women and 2-4 cm for men
** ensure you label the vial with the appropriate pt information
