Urinary tract

Question 1

Each ureter usually measures _____ long; diameter of _____ but is narrower at three sites ____, ___, ___.

Answer 1

25-30 cm long

3mm

> The junction of the pelvis and ureter.
The pelvic brim
The intravesical ureter where it runs through the muscular bladder
wall.

Question 2

a pyramidal muscular organ when empty. It has a triangular-shaped base
posteriorly.

Answer 2

Urinary bladder

Question 3

ncomplete fusion of upper and lower pole
moieties resulting in complete or incomplete duplication of the
collecting system

Answer 3

Dulex collecting system

Question 4

duplex collecting system - a duplex kidney draining into:
 ___ ureter - i.e. duplex kidney’s duplication pelvicalcyeal systems
uniting at the pelvi-ureteric junction (PUJ)
 ___ ureter (ureter fissus) - two ureters that unite before emptying into
the bladder
 ___ ureter (complete duplication) two ureters that drain separately
into the bladder or genital tract

Answer 4

single
bifid
double

Question 5

Orthotopic ureter

ectopic urter

Answer 5

Orthotopic ureter: drains lower pole and
enters bladder near trigone
 Ectopic ureter: drains upper pole and enters
bladder inferiorly and medially (WeigertMeyer rule); the ectopic ureter may be
stenotic and obstructed

Question 6

Drooping lily sign

Answer 6

a urographic
sign of duplicated renal
collecting system. It refers to the
inferolateral displacement of
the opacified lower pole moiety
due to an obstructed (and
relatively unopacified) upper
pole moiety.

Question 7

Weigert-Meyer

law.

Answer 7

n duplicated collecting system
it is classically the upper pole
ureter that is obstructed due to
a ureterocoele and the lower
pole ureter that refluxes

Question 8

Most common congenital anomaly of th GUT in neonates.

Intrinsic, 80%: defect in circular muscle bundle
of renal pelvis
• Extrinsic, 20%: renal vessels (lower pole artery
or vein)

Answer 8

Congenital ureteropelvic junction

(UPJ) obstruction

Question 9

s an incidental finding which mimics hydronephrosis. It is a result of
underdevelopment of the renal medullary pyramids with resultant
enlargement of the calyces.

Answer 9

Congenital megacalyces

Question 10

Congenital megacalyces is more frequently seen in _____ (M/F).

Answer 10

Males

Question 11

The renal pelvis is of normal size helping to distinguish _____
from hydronephrosis.
 In addition to enlargement of the calyces there is often also polycalycosis (increased number of calyces); they are crowded and multifaceted with a mosaic-like appearance.

Answer 11

Congenital ,egacalyces

Question 12

Outpouching of calyx into corticomedullary region.

Answer 12

(PYELO)Calyceal diverticulum

Question 13

(PYELO)Calyceal diverticulum

Type I: originates from
• Type II: originates from
• Type III: originates from

Answer 13

minor calyx
infundibulum
renal pelvis

Question 14

Imahing features of (PYELO) Calyceal diverticulum

Answer 14

 Cystic lesion connects through channel with collecting
system.
• If the neck is not obstructed, diverticula opacify retrograde from the
collecting system on delayed IVP films.
• May contain calculi or milk of calcium, 50%

Question 15

This imaging feature on sonography is pathognomic of a

pyelocalyceal diverticulum.

Answer 15

presence of mobile, echogenic and
dependent layering due to milk of
calcium

Question 16

Renal papillary necrosis (RPN)

Answer 16

represents an ischemic coagulative necrosis involving variable
amounts of pyramids and medullary papillae.

Question 17

Classical imaging features of RPN includes:

Answer 17

ball on tee
 forniceal excavation
 lobster claw
 signet ring
 sloughed papilla with clubbed caly

Question 18

Pyonephrosis

Answer 18

infection of the renal pelvic system
which can then subsequently get filled with pus and is then
complicated by obstruction.

he diagnosis of pyonephrosis is suspected when the clinical
symptoms of fever and flank pain are combined with the radiologic
evidence of obstruction to the urinary tracts 1
.

Question 19

Most reliable sign in diagnosing pyonegrosis in ultrsaound

Answer 19

echogenic collecting system debris

other features:
fluid-fluid levels within the collecting system
 incomplete (dirty) echoes of collecting system gas can be
occasionally seen.

Question 20

A sensitive indicator of pyonephrosis in CT

Answer 20

infection with hydronephrosis

ther features:
thickening of the renal pelvic wall (>2 mm)
 parenchymal or perinephric inflammatory changes, dilatation and
obstruction of the collecting system, higher than usual attenuation
values of the fluid within the renal collecting system, and layering of
contrast material above and anterior to the purulent fluid on
excretory studies.

Question 21

Ectopic ureter

Answer 21

Ureter does not insert in the normal location in the trigone of the
bladder

Question 22

Can detect and grade ectopic ureter

Answer 22

VCUG

Question 23

herniation of the distal ureter into the bladder

Answer 23

ureterocele

Question 24

Enlarged ureter

Answer 24

Megaureter

Question 25

Types of megaureter

Answer 25

obstructed primary megaureter  refluxing primary megaureter (although vesico-ureteric reflux (VUR) is a cause of primary congenital megaureter it is usually considered separately)  non-refluxing unobstructed primary megaureter

Question 26

Define / describe obstructive primary megaureter

Answer 26

Obstructive primary megaureter is related to a distal adynamic segment with proximal dilatation, and is a common cause of obstructive uropathy in children It is analogous to oesophageal achalasia or colonic Hirschsprung disease although lack of ganglion cells within the wall of the ureter has not been proven to be the cause .

Question 27

Define / describe refluxing megaureter

Answer 27

Refluxing primary megaureter is a result of an abnormal vesico-ureteric junction, which impedes the normal anti-reflux mechanisms. This can be due to a short vertical intramural segment, congenital paraureteric diverticulum, ureterocoele with or without associated duplicated collecting system etc..

Question 28

Define / describe non-refluxing unobstructed primary megaureter

Answer 28

most common cause of primary megaureter in neonates, and even though the vesicoureteric junction is normal, with no evidence of reflux or obstruction the ureter is enlarged. The cause for this is unknown.

Question 29

the term for abnormal flow of urine from the bladder into the upper urinary tract and is typically a problem encountered in young children

Answer 29

VUR Vesicoureteral reflux

Question 30

Primary diagnostic procedure for evaluation of VUR. Imaging of presence and grade VUR

Answer 30

VCUG voiding cystourethrogram (

Question 31

VUR grading ``` Grade I: • Grade II: • Grade III: • Grade IV: • Grade V: ```

Answer 31

Grade I: reflux to ureter but not to kidney • Grade II: reflux into ureter, pelvis, and calyces without dilatations • Grade III: reflux to calyces with mild dilatation,blunted fornices • Grade IV: to calyces with moderate dilatation,obliteration of fornices • Grade V: gross dilatation, tortuous ureters

Question 32

Describe / define urolithiasis

Answer 32

presence of calculi anywhere along the course of the urinary tracts. most common stone is calcium oxalate