GU imaging - INTERVENTIONAL Flashcards
Cystogram
Fluoroscopic study that images the bladder
Patient indications for a cystogram
- Bladder outlet obstruction
- Haematuria
- Trauma
- Congenital anomalies of the GU tract
- Postoperative evaluation of urinary tract
Contraindications of a cystogram
- Recent bladder surgery
- Blockage of the urethra, or damage or tearing of the urethra
- Acute phase of UTI
Complications of a Cystogram
- UTI
- Trauma to tissues during catheterisation
- Bleeding
- Pain
Patient Prep for a Cystogram
- Patient wears a gown
- Privacy and Dignity of the patient are upheld
- Patient is warned about sticky contrast
AP Cystogram procedure
- patient is catheterised (if a catheter is not in situ)
- patient is given 200ml of Omnipaque contrast
- start contrast flow and take images to show the bladder filling
Cystogram - 45 degrees oblique
- the detector is angled to the right of the patient and an image is taken
- the detector is angled to the left of the patient and an image is taken
Cystogram left lateral
- the detector is by the patient’s left side
Cystogram AP single shot
AP view taken after bladder is filled
Micturating Cystourethrogram
- A fluoroscopic procedure to show filling AND emptying of the bladder
micturating cystourethrogram (MCUG) child indications
- recurrent UTI’s
- Congenital abnormalities
- post op evaluation
micturating cystourethrogram (MCUG) adult indications
- Recurrent UTI’s
- Dysfunction
- Fistula
- Post op evaluation
micturating cystourethrogram (MCUG) contraindications
- Recent bladder emergency
- Blockage of the urethra, or damage or tearing of the urethra
- Acute phase of urinary tract infection
micturating cystourethrogram (MCUG) complications
- patient can develop a Urinary tract infection
- There may be trauma to tissues during catheterisation
- bleeding
- pain
micturating cystourethrogram (MCUG) patient prep and care
- patient is given a gown
- privacy and dignity is upheld
- contrast warning is given
- consider room temperature
Female Paediatric MCUG imaging views
- AP view
- Oblique view
- Renal area
- Bladder emptying
Male Paediatric MCUG views
- Bladder filling
- Oblique view - Reflux of contrast and hydroureter demonstrated
Urethrogram
A contrast study of the urethra under fluoroscopic control
Urethrogram Indications
- Fistula
- Strictures
- Obstruction
- Trauma
Urethrogram complications
- Patient can develop a Urinary tract infection (UTI)
- Trauma to tissues during Catheterisation
- Bleeding
- Pain
- Contrast Intravasation
Contrast Intravasation
Backflow of injected contrast into the adjoining vessels (mostly veins)
Urethrogram contraindications
- Recent bladder surgery
- Acute phase of UTI
Urethrogram patient prep and care
- Patient is given a gown
- privacy and dignity are upheld
Urethrogram patient care
- communication
- consent
- modest covering
- Aseptic technique
- reassurance
- privacy dignity
- Gown
Urethrogram after care
- give warnings about sticky contrast
- patient should drink loads of fluids
- Information about where and how to get results
- How to deal with any possible issues post procedure
- paperwork
Percutaneous Nephrostomy
The insertion of a catheter through the skin and into the renal pelvis under the guidance of fluorography and/or ultrasound. to drain kidney externally
Nephrostomy indications
- Relief of urinary obstruction
- Access- therapeutic treatment
- Urinary diversion
- to drain kidney externally, if there is injury to the ureter
Nephrostomy contraindications
- coagulation INR >1.4
- Contraindications to contrast
- Contraindication to sedation
- Patient must be cooperative
Nephrostomy complications
- pain
- tube displacement
- Urine leak into abdomen
- pneumothorax
- infection/sepsis
- bleeding
- injury to other abdominal organs and structure
Nephrostomy patient presentation
- Hydronephrosis
- pain in flank
- nausea
- vomiting
- tiredness
- pain on urination
- UTI
- Sepsis/fever
Nephrostomy pre-imaging
- Ultrasound
- CT (“stone prone” - non contrast, ?leak = contrast)
Nephrostomy patient preparation
- recent blood tests including INR
- overnight monitoring
- Nil by mouth for previous 6 hrs
- Appropriate antibiotics
- gown
- patent cannula in either arm
- completed consent form
nephrostomy procedure 1
- patient is positioned prone oblique, with affected side raised
- patient is monitored
- area is cleaned and prepped
- local anaesthetic…
- needle is positioned and probe is parallel, to image needle fully
- WHO check
Nephrostomy procedure 1- ultrasound of kidney
- is the renal pelvis dilated enough?
- Assess and mark access point
- position of ribs/ major vessels
- choose an avascular plane into minor calyx
Ureteric Stenting
The placing of a catheter between the kidney and the bladder, to affect the internal drainage of the urinary system.
- can be done retrograde or antegrade
The radio-opaque marker at the proximal end of the Ureteric stent aids..?
aids with positioning
Nephrostomy- fluoroscopy
- Access needle is moved into position, with guidance from fluoroscopy/nephrostogram - contrast is used
- A guidewire is inserted and the needed is taken out
- a dilator is put on
- A catheter is inserted over the guidewire
- once access hole is dilated, the dilator is taken off
- the nephrostomy catheter is put on and manipulated into position
- nephrostogram is checked and pigtail catheter is locked in place
- the site is cleaned and dried
- drainage bag is attached
Ureteric stenting procedure
- nephrostogram is taken
- contrast is injected, to see the level of the stricture/blockage
- wire and catheter are manipulated into PUJ
- then down the ureter and into the bladder
- stent is then deployed
- image is checked
Retrograde ureteric stenting performed under….
general anaesthetic
Retrograde ureteric stenting patient is positioned
supine, with leg rests
Retrograde ureteric stenting contrast is injected
in retrograde- against the flow
Retrograde ureteric stenting urologists do
a cystoscopy
Retrograde ureteric stenting - stent deploy
urologist deploys stent under fluoro control
Retrograde ureteric stenting procedure
- nephrostogram is checked - retrograde contrast injection
- wire is manipulated into renal pelvis
- stent is positioned over the wire under fluoro control
P.C.N.L - Percutaneous nephrolithotomy
this is where the lithotripter is passed through a small incision into the kidney
lithotripter
a noninvasive device that breaks up kidney stones - by passing electromagnetic shock waves.
P.C.N.L professionals involved
Radiologist, radiographer and IR Nurses.
Urologists and their team
Anaesthetics team
P.C.N.L
- Urologists cannulate the kidney via cystoscopy and contrast is injected
- The radiologist performs the nephrostomy under U/S guidance
- Dilators are passed over the wire
- An access cannula is positioned over the wire
- The stone is then broken up using a laser fibre, a lithoclast (small pneumatic drill) or an ultrasonic suction probe
- The fragments are then removed and the nephrostomy tube is placed and left for about 3 days
