Radiology of Urinary Tract

Question 1

How do we make a urological diagnosis as a clinician?

Answer 1

• H&P
• urinalysis
• laboratory studies
• mirco studies
• radiologic studies

Question 2

What is one of the most common tests used in urology and why?

Answer 2

• ultrasound because it is easy to perform in the office.

Question 3

What is the study of choice for all intrascrotal pathology?

Answer 3

• scrotal ultrasound

Question 4

What is testicular torsion?

Answer 4

• urological emergency when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum.

Question 5

What is Bell Clapper deformity?

Answer 5

• predisposing factor for testicular torsion in which the tunica vaginalis joins high on the spermatic cord, leaving the testis free to rotate (aka the attachments of the testicle to the scrotal wall and to the septum in the middle of the scrotum are deficient).

Question 6

How do we use US to determine testicular torsion?

Answer 6

• use doppler to look at blood flow

Question 7

What would you see on US in epididymitis?

Answer 7

• hypervascularity

Question 8

What is intravenous pyelogram (IVP)?

Answer 8

• study that uses repetitive flat x-rays after injecting contrast into a vein and observing it as it is filtered in the kidneys and goes into the bladder.

Question 9

What are some problems with IVP?

Answer 9

• requires bowel prep (must be empty so you can see)

- requires a lot of contrast

Question 10

Why is CT scan used over IVP now?

Answer 10

• spiral CT stone search
• get axial, sagital, coronal or any angled image.
• is limited however to patients with normal renal function bc you can’t give them contrast if they have abnormal renal function.

Question 11

What things can you see on CT?

Answer 11

• hydronephrosis
• stones
• masses
• stranding (secondary signs of stone)

Question 12

Is a CT urogram very detailed?

Answer 12

YES and much better than old school IVP

Question 13

What can we do if a patient has a contrast allergy or has impaired renal function?

Answer 13

• MRI bc no contrast is needed and you get multiplanar imaging.
• problem is length (45 mins) and claustrophobia.

Question 14

Can you give gadolinium as contrast to a patient getting an MRI who has renal impairment?

Answer 14

• YES bc it is not renal toxic. Must still be careful with this however.

Question 15

*** What are the simple rules of MRI?

Answer 15

• FATTY 1= in T1 images, fat is bright.

- FLUIDY 2= in T2 images, fluid is bright.

Question 16

What is MRA?

Answer 16

• magnetic resonance angiography= used to look at vasculature more closely.

Question 17

When would we use a nuclear medicine study?

Answer 17

• to assess FUNCTION and OBSTRUCTION of kidneys.
• also to assess for bone metastasis in prostate cancer.
• not good for looking at anatomy.

Question 18

Do you need contrast with a nuclear medicine test?

Answer 18

NO :)

Question 19

What are the 4 types of fluoroscopic studies?

Answer 19

1. retrograde pyelogram
2. retrograde urethrogram
3. antegrade nephrostogram
4. cystogram

Question 20

What is a retrograde pyelogram?

Answer 20

• physician injects contrast into the ureter in order to visualize the ureter and kidney. The flow of contrast (up from the bladder to the kidney) is opposite the usual flow of urine, hence the retrograde name.

Question 21

What is a retrograde urethrogram (RUG)?

Answer 21

• injecting dye in through the penile urethra to observe the integrity of the urethra.
• have patient void afterward to observe flow.

Question 22

What is an antegrade nephrostogram?

Answer 22

• contrast injected to determine if the kidneys drain sufficiently into the ureters and bladder.

Question 23

What is a cystogram?

Answer 23

• x-ray of the bladder that uses dye.

- used for trauma mostly.

Question 24

Does the bladder have a portion that sits outside of the peritoneal cavity and a portion that sits inside the peritoneal cavity?

Answer 24

YES the dome sits inside the peritoneal cavity

Question 25

If the bladder ruptures when full, what is it more likely to do?

Answer 25

• rupture inside the peritoneal cavity, which is harder to treat.
• so pee before you leave the bar always!

Question 26

What tools are available to inject dyes or look at the urethra, bladder or kidneys?

Answer 26

• cystoscopes= to image and look.
• ureteroscopes= used to look at the upper ureters or kidney.
• resectoscopes= used to resect or pull out a tumor (uses an electrical wire). Used for TURP= Transurethral resection of the prostate in BPH often.