Imaging the Urological System

Question 1

Define cytoscopy

Answer 1

putting a very small, rigid camera up through the urethra to visualise the LUT.
done in small female dogs

Question 2

Limitations of radiography when viewing the urological system

Answer 2

cannot see the urethra or ureters
cannot see internal architecture
cannot visualise bladder wall
bladder similar radiopacity to other soft tissue and so difficult to visualise

Question 3

What are the things we look for in radiography

Answer 3

Size
Shape
Number
Position
Opacity
Margination

Question 4

Kidney radiographic abnormalities : size

Answer 4

small = congenital hypoplasia, end stage disease
large = inflammation, pyelonephritis, hydronephritis, neoplasia, abscesses, polycystic disease

Question 5

Kidney radiographic abnormalities : shape

Answer 5

should be bean or elliptical
irregular = end stage disease, neoplasia, polycystic kidney disease, abscesses/granulomas

Question 6

Kidney radiographic abnormalities : number

Answer 6

should be 2
decreased = congenital aplasia

Question 7

Kidney radiographic abnormalities : positioning

Answer 7

positioning can change with shape or be displaced by growths, asses or other problems in the abdomen

Question 8

Kidney radiographic abnormalities : radiopacity

Answer 8

should be uniform soft tissue

increased = uroliths most common, may also be metabolic disease
decreased = IVU and hydronephrosis

Question 9

Kidney radiographic abnormalities : margination

Answer 9

within retroperitoneum, so the fat outline should provide a contrast outline

reduced = retroperitoneal haemorrhage (trauma)

Question 10

What is a contrast radiograph used for ?

Answer 10

identify renal architecture and used to test for renal function (GFR)

Question 11

Bladder radiographic abnormalities : size

Answer 11

depends on filling

Question 12

Bladder radiographic abnormalities : shape

Answer 12

pear-shaped and uniform in size

Question 13

Bladder radiographic abnormalities : number

Answer 13

should be one. if you see two, find a way of differentiating the bladder from another structure

Question 14

Bladder radiographic abnormalities : positioning

Answer 14

caudoventral abdomen

Question 15

Bladder radiographic abnormalities : opacity

Answer 15

soft tissue, can identify mineralisation

Question 16

Define negative contrast

Answer 16

air or CO2 injected into the bladder to visualise the bladder wall. must drain first using a catheter, can be used to see neoplasia

Question 17

Define positive contrast

Answer 17

iodine based contrast medium injected directly into the bladder
highlights loss of normal architecture, provides mucosal detail, can obscure calculi

Question 18

Define double contrast

Answer 18

air first, then a small amount of the positive contrast
optimum mucosal detail
identifies intra-luminal lesions, wall thickness and radiolucent calculi and other masses

Question 19

Benefits of using ultrasound

Answer 19

can see internal architecture of kidney and bladder
can identify causes on enlargement
real time sampling
evaluation of blood flow
superior detection of small calculi

Question 20

Limitations to using ultrasound

Answer 20

distal ureter hard to visualise unless severe dilation
difficult to confirm bladder rupture / ureteral laceration
not a global picture of the abdomen

Question 21

Ultrasonographic abnormalities of the kidney

Answer 21

inflammatory (acute or chronic nephritis)
urolithiasis
trauma
neoplasia
cysts
hydronephrosis

Question 22

Ultrasonographic abnormalities bladder

Answer 22

transitional cell carcinoma
uroliths
chronic cystitis
polypoid cystitis