Discuss the radiological anatomy

of the urinary bladder and male

urethra and the technique of RUG
Dr Ojo N.K

Radiology Department FMC Abk

26-10-16

OUTLINE

Radiological Anatomy of the

bladder
Radiological Anatomy of the
male urethra
Technique of RUG

Gross Anatomy of the

Bladder
The

urinary bladder is situated within

the pelvis. It is an extraperitoneal
pyramidal muscular vesicle for
storing urine temporarily. As it fills it
becomes ovoid and rises into the
abdomen, stripping the loose
peritoneum off the and displacing
bowel loops superiorly.

Contd
The

ureters enter the posterolateral

angles and the urethra leaves
inferiorly at the narrow neck which is
surrounded by the involuntary
internal urethral sphincter. The
trigone is the triangular inner wall of
the bladder between the ureteric and
the urethral orifices, this part of the
wall is smooth while the remainder of
the bladder wall is coarsely
trabeculated by crisis- cross muscle

Urinary Bladder

Blood supply of the Bladder

Superior

and inferior vesical arteries.

Veins

of vesical plexus drain to the

internal iliac veins

Lymphatics

to the external iliac

group of Lymph nodes and paraaortic
nodes

Imaging Modalities of the

Urinary Bladder
X-Ray
Ultrasound Scan
IVU (Cystogram)
CT-Scan
MRI

Imaging Modalities
On plain film especially when full, it is
seen as a round soft tissue density
surrounded by a lucent line of
perivesical fat. It should be smooth
and symmetrical

bladder

Contd
On

ultrasound: When filled with urine

the bladder content should be
anechoic. The wall is proportionately
thicker in infants than in older age
groups. Its wall is approximately
3mm thick when distended and 5mm
thick when empty. The ureteric jets
can be assesed using the doppler
ultrasound

USS

IVU

On IVU the ureters and bladder are

opacified, the full bladder outline should
be smooth and regular , where as after
micturation , small amounts of contrast
medium are seen trapped between the
mucosal folds of the empty bladder.

The prostate gland may protrude up into

the bladder base (prostatic impression).

CT

On CT Scan, bladder is best appreciated

when filled with urine or contrast medium.

Unenhanced CT , normal bladder filled with

urine has fluid density of less than or equal
to 10 H.U.

Has rectangular shape.

Wall thickness should not exceed 4 5 mm.

MRI

T1WI sequence , the bladder wall and its

contents are homogenous , showing a low
signal intensity.

T2 WI sequence , the high signal urine

within the bladder contrasts with the low
signal bladder wall.

Anatomy of the Male

Urethra

It runs from the internal urethral sphincter

at the neck of the bladder to the external
urethral orifice at the tip of the penis. In
radiological terms it may be divided into
Posterior & Anterior urethra
Posterior , about 4cm long

- Prostatic ,
3cm

- Membranous, 1.0 cm
Anterior urethra / Spongy. 16cm long

- Bulbous

- Penile parts

Contd
The Prostatic Urethra is the widest part of
the posterior urethra. It has a sinus/groove
and about 15-20 prostatic ducts that open
into the sinus
In the middle of the crest is a prominence
called verumontanum and the Prostatic
utricle opens into it
The ejaculatory ducts open on each side of
the utricle.

contd

The membranous urethra runs through the

external urethral sphincter within the
urogenital diaphragm.

Narrowest , most fixed & least dilatable

part.

Prone to injury, eg pelvic fractures.

Imaging Modalities of the

Urethra
Micturating Cystourethrogram (MCUG)

Retrograde Urethrogram (RUG)

MCUG/ voiding
Cystourethrogram

The urethra is seen as contrast filled

smooth walled tubular structure of varying
calibers.

The areas of normal narrowing are the

membranous part and the penobulbar part

Voiding Cystourethrogram
The verumontanum is seen as an oval
filling defect in the prostatic urethra(open
arrow)
A slight constriction (straight arrow) at
the lower edge of the verumontanum
marks the location of the membranous
urethra.
The bulbous urethra (bu) extends to the
penoscrotal junction (curved arrow).
The penile urethra (pu) travels in the
corpus spongiosum to the penile meatus

contd
Ultrasound

evaluation is generally
limited to the posterior urethra
above the external sphincter. The
posterior urethra is surrounded by
the prostate. .

Outline for RUG

Defintion
Indication
Contraindication
Contrast
Euipment
Patient preparation
Preliminary film
Technique

The Technique of RUG

Retrograde urethrogram is a diagnostic

procedure performed most commonly in
male patients to diagnose urethral
pathology.

INDICATION
Trauma
Strictures
Congenital abnormalities
Peri-urethral or Prostatic abscess
Fistulae
Lower urinary tract symptoms e.g poor
bladder emptying frequency
Post operative evaluation.

CONTRAINDICATION
Active UTI
Recent Instrumentation

Severe Allergy to radiopaque contrast

Contrast Medium
HOCM

or LOCM Urograffin 20ml.

Prewarming the contrast medium will
help reduce the incidence of spasmof
the external sphincter.

Equipment

Tilting radiography table with fluoroscopy

unit and spot film device.

Foleys catheter

Patient prepation

Reassurance

Preliminary Film

Coned supine P-A of Bladder base and

Urethra

Technique
The

patient lie supine on the x-ray table

Using aseptic technique the foleys
catheter is inserted through the external
urethral meatus so that the balloon lies
in the fossa navicularis and its balloon is
inflated with 2mls of water. Contrast
medium is injected under flouroscopic
control and films are taken in the
following positions

contd
30degree LAO, with right leg abducted and
knee flexed
Supine P-A
30degree RAO, with left leg abducted and
knee flexed.
In RAO position a micturating
cystourethrogram .

contd

After Care
None

Complications

Due to contrast medium

Due to technique; trauma, intravasation of

contrast medium, especially if excessive
pressure is used to overcome a stricture.

Thank you for

you time

Have a great day