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Kuliah Sistem Urogenital

This document provides an overview of urinary tract anatomy and the intravenous urography (IVU) procedure. It describes the normal anatomy of the kidneys, ureters, urinary bladder, and urethra. It then outlines the IVU procedure, including indications, preparation, imaging sequence, and expected phases of contrast agent appearance in the kidneys, ureters, and bladder on x-rays. The summary highlights the IVU as a procedure used to diagnose issues like tumors, obstructions, infections, and stones by imaging the urinary tract with injected contrast medium over time.

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Tiradewi Bustami
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88 views25 pages

Kuliah Sistem Urogenital

This document provides an overview of urinary tract anatomy and the intravenous urography (IVU) procedure. It describes the normal anatomy of the kidneys, ureters, urinary bladder, and urethra. It then outlines the IVU procedure, including indications, preparation, imaging sequence, and expected phases of contrast agent appearance in the kidneys, ureters, and bladder on x-rays. The summary highlights the IVU as a procedure used to diagnose issues like tumors, obstructions, infections, and stones by imaging the urinary tract with injected contrast medium over time.

Uploaded by

Tiradewi Bustami
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Dr. Achmad Bunyamin Sp.

Rad (K)

Department of Radiology, Faculty of Medicine


Padjadjaran University-Hasan Sadikin Hospital
Bandung

URINARY TRACT
ANATOMY
KIDNEY :
I. Normal Size :
Right kidney smaller than left
3 3,5 lumbar vertebral body
Discrepancies of 1,5 cm or greater :
Positive factor in hypertension

II. Normal Position


Retroperitoneal
Upper poles 1 cm closer to midline
Recumbent : Th 12 L3
Max. excursion 5 cm or 1,5 vertebral
body on erect position

III. Internal Architecture


- External cortex : 12 mm thickness
* Renal corpuscle
* Convoluted tubules
* Blood vessels
- Internal Medulla :
* 8 renal pyramids
* Separated by columns of Bertini
* Interlobar, arcuate, and interlobular artery
- Renal Pelvis :

ULTRASOUND OF THE KIDNEY

RLL
SP
RK

Right Kidney

LK

Left Kidney

LK

Left Kidney

URETER
About

25 cm long
Retroperitoneal
In pelvic : Convex posteriorly and laterally
At ischial spine bend forward and medially
> lower portion of bladder
Diameter variable : more or less 6 mm
Three normal constriction :
- Ureteropelvic junction
- Cross external iliac artery
- Uretero vesical junction

URINARY BLADDER
* Lies in pelvic space
* Anterior : Pubic symphysis
* Posterior between bladder and rectum :
- Male : ductus deferens and seminal vesicles
- Female : Uterus and vagina

URETHRA
- Female

- Male

: Short, 4 cm, diameter 6 mm


: Prostatic portion : elongated, 3 cm
Membranous portion
Bulbous portion
Cavernous portion : diameter 6 mm

BLOOD SUPPLY
Renal artery : 1

st

lumbal vertebrae > Dorsal


Ventral
Renal veins : Parallel renal artery

RENAL FUNCTIONS :
Blood

plasma filtration
Selective tubular reabsorption
Tubular synthesis and excretion
Acid base regulation
Fluid volume regulation
Maintenance normal blood regulation
Erythropoiesis

INTRAVENOUS UROGRAPHY
Indications :
1. Elevated creatinin or BUN
2. Flank Pain
3. Pyuria
4. Microscopic / gross hematuria
5. Hypertension
6. Proteinuria
7. Dribbling
8. Frequency
9. Dysuria

DIAGNOSIS
1. Neoplasia
2. Urinary tract obstruction
3. Inflammation
4. Lithiasis
5. Cystic disease
6. Hypertension
PREPARATION
- Clear liquid diet
- Fasting after midnight
- Bowel cleansing
SKIN TEST OF CONTRAST MEDIUM
PLAIN FILM ABDOMEN
COMPRESSED OF ABDOMEN
(by rubber bag / tennis ball)

NORMAL UROGRAM :

Dosage : - 1 cc / pound of 50 % diatrizoate


for patient less than 100 pound BW
- 100 200 pound BW : 100 cc
- More than 200 pound : 150 cc
Nephrographic phase : 1 minute
- Contrast in vascular and renal tubules
- Hypervascular mass : isodens
- Hypovascular, abcess and cyst : luscent

Pelvocalyceal opacification : 2,5 - 3 minute


Delayed opacification :
- overhydration
- decreased renal function
- hypotension
- small contrast volume

FILMING SEQUENCE
1 minute : Nephrogram phase
Ureteral compression
5 minute : collecting system
15 30 minute : ureter
60 minute : bladder
Post voiding > - Passage of contrast agent
- Simptom of lower urinary tract
- Suspected stone
No ureteral compression :
- Suspected stone
- Acute abdomen
- Following abdominal surgery
- Large abdominal mass
- Aortic aneurysm

BNO IVP

5 MENIT

15 MENIT

30 MENIT

FULL BLAST

POST
VOIDING

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