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