Urology

Question 1

what does IVU demonstrate on the radiograph

Answer 1

• renal calyces
• renal pelvis
• ureters
• urinary bladder

Question 2

purpose of IVU

Answer 2

• visualise the collecting portion of the urinary system
• to assess the functional ability of the kidneys
• evaluate the urinary system for pathology or anatomic anomalies

Question 3

anatomy of kidneys

Answer 3

• lie in retroperitoneal space
• surrounded by fatty tissue
• 10-12cm long, 5-7.5cm wide, 2.5cm thick
• right kidney more inferior to the left kidney

Question 4

position of kidney

Answer 4

• backward rotation - 30deg
• posterior oblique done to place kidney parallel to IR
• on expiration, kidneys lie halfway between the xiphoid process and the iliac crest

Question 5

anatomy of ureters and bladder

Answer 5

• ureter lie mostly anterior to kidney
• diameter: 1mm to almost 1cm
• 28-34cm
• bladder and urethra are infra-peritoneal structures
• bladder capacity: 350-500ml
• prostate gland surrounds proximal urethra
• 3 points of constriction of the ureter
• ureteropelvic junction
• brim of pelvis
• ureterovesical junction

Question 6

indications of IVU

Answer 6

• evaluate abdominal masses, renal cysts, renal tumours
• urolithiasis
• pyelonephritis
• hydronephrosis
• glomerulonephritis
• renal hypertension
• congenital anomalies
• cystitis
• polycystic kidney disease
• evaluate effects of trauma
• vesicorectal fistula
• preoperative evaluation

Question 7

contra-indications of CM

Answer 7

• hypersensitivity to iodinated contrast media
• anuria
• multiple myeloma
• DM
• severe hepatic or renal disease
• congestive heart failure
• pheochromocytoma
• sickle cell anemia
• acute or chronic renal failure
• elevated creatinine level

Question 8

room prep for IVU

Answer 8

• correct type and amount of CM drawn in appropriate syringe
• empty container of CM to shower doctor/nurse
• selection of sterile needles (18, 20, 22-gauge), over the needle catheter, butterfly needle and connecting tube
• clean procedure gloves
• alcohol wipes
• sharps container
• tourniquet
• support for elbow – sponge, sandbag
• emesis basin
• lead markers - anatomical, minute, numbers
• ureteric compression
• male gonadal shield
• water flask
• towel
• oxygen supply
• suction apparatus
• emergency cart
• cardiopulmonary resuscitation equipment
• BP apparatus
• emergency drugs
• saline
• heparin
• chlorpheniramine/hydrocortisone

Question 9

patient preparation for IVU

Answer 9

• pregnancy precautions
• check any premedication prescribed
• bowel preparation
• patient should void just prior to examination
• patient with urine bag - tube should be clamped

Question 10

possible contrast media reactions

Answer 10

local

• extravasation
• phlebitis

systemic

• mild
• moderate (true allergic/anaphylactic reaction)
• severe (vasovagal)

Question 11

basic IVU imaging sequencing

Answer 11

1. contrast administration
2. tomogram of kidney (1 min)
3. compression immediately
4. cone down kidney image (10 mins)
5. release compression (20 mins)
6. KUB projection (20mins)
7. pass urine
8. KUB

Question 12

purpose of nephrogram

Answer 12

AP of renal areas done immediately after injection.
renal parenchyma becomes opacified immediately after the arterial phase.
contrast agent appears in pelvicalyceal system within 2-8mins.
to capture the early stages of contrast media entering the collecting system
to assess kidney function, size, shape

Question 13

contra-indications of ureteric compression

Answer 13

• abdominal mass
• aortic abdominal aneurysm
• recent abdominal surgery
• severe abdominal pain
• acute abdominal trauma

Question 14

purpose of ureteric compression

Answer 14

applied to enhance filling of the pelvicalyceal system and proximal ureters

Question 15

purpose of 10 mins coned down kidney projection

Answer 15

• determine if excretion is symmetrical

- assess if further injection of CM is required when there has been poor opacification

Question 16

purpose of 20 mins radiograph

Answer 16

to demonstrate the filling of ureters as the CM flow from kidneys to bladder

Question 17

purpose of post-micturition radiograph

Answer 17

• presence of residual urine may demonstrate small tumour masses or enlargement of prostate gland
• to confirm the position of the stones within the renal tract
• detail secondary effects as the result of obstruction
• prone position can be used to enhance pelvicalyceal and ureteral filling
• erect position:
• better visualisation of the ureters as well as mobility of the kidneys
• evaluation of prolapsed bladder and/or enlarged prostate

Question 18

additional projections of the kidneys

Answer 18

• oblique views of kidneys
• 15- or 20- min delayed cone down kidneys images
• oblique bladder views to demonstrate UV junction
• bladder view (15deg caudad)
• prostate view (20deg cephalad)

Question 19

what can be seen in the bladder view

Answer 19

shows contrast-filled urinary bladder and distal ureters for possible reflux, prostate and proximal male urethra

Question 20

central ray of bladder view

Answer 20

• CR angulated 15-20deg caudally 5cm above superior border of SP
• bladder neck and proximal urethra: 10deg caudal angulation
• if PA: 10-15deg cephalad, 2.5cm distal to the tip of coccyx
• prostate: CR directed 20-25deg cephalad to project it above the pubic bone

Question 21

how to carry out IVU for a hypertensive patient

Answer 21

• radiographs taken at 1,3,5mins instead of 1,10,20 mins

- use of trendelenburg position to enhance filling of the renal pelvis and calyces for the first 2 exposures