1. Urinary System
• Often called the excretory system
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Two kidneys
Two ureters
One urinary bladder
One urethra

2. 2 bean shaped bodies situated
behind peritoneum
Asymmetrical - left is slightly
longer and narrower than right
Why Rt kidney slightly lower
than Lt kidney?
Liver Lie in an oblique plane
Normally extend from T-12 to L3
Kidneys

3. Kidney Function
• Remove waste
products from blood
• Maintain fluid and
electrolyte balance
• Secrete substances
that affect blood
pressure
• How much urine
excreted per day?
1 - 2 liters

4. Kidneys (cont’d)
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Minor calyces unite to form
major calyces
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Major calyces unite to form
renal pelvis
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Renal pelvis then drains into
ureters
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Hilum - longitudinal slit in
medial border for transmission
of blood vessels, nerves,
lymphatic vessels, and ureter

5. Kidneys (cont’d)
• Essential microscopic
components of kidney
called nephrons
• How many nephrons
per kidney? about 1
million

6. Nephrons
Collecting ducts
drain into minor
calyx

7. Adrenal Glands
Cannot be seen on plain
radiographs
Not part of urinary system
Chiefly responsible for
regulating stress
response through
adrenaline etc

8. Ureters
• Two tubes 10 - 12 “
long
• Retroperitoneal
• Extend from renal
pelvis
• Enter bladder at ureteral
orifice
• How is urine moved
through ureters?
– peristalsis

9. Urinary Bladder
• Musculomembranous
sac situated
immediately posterior
and superior to
symphysis pubis of
pelvis
• Serves as Urine
reservoir

10. Urinary Bladder
• How much fluid can
bladder hold?
– up to 500 mL
• Urethral orifice
located in bladder
neck
• Area between ureteral
openings and urethral
orifices is trigone

11. Urethra
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Carries urine from bladder to?
exterior of body
How long is it in females?
About 1.5′′
In males?
About 7′′ to 8′′
Sphincter at neck of bladder
controls flow
Male urethra contains following
parts:
– Prostate
– Membranous area
– Spongy area

12. Prostate
• Gland surrounding
proximal part of male
urethra
• Considered part of male
reproductive system, but
due to location, often
described with urinary
system
• Prostate secretes fluid
that mixes with seminal
fluid to create ejaculate

13. Radiography of Urinary System
aka
Urography
Radiographic investigation of renal drainage or
collecting system

14. IVU- Intravenous Urogram !
Formerly known as IVP-Intravenous
pyelogram!
– pyelo refers to renal pelvis and calyces only
– study also shows ureters, bladder, and
sometimes urethra

15. Indications For Urography
• Demonstrate physiologic function and structure
of urinary system
• Evaluate abd. Masses, renal cysts and tumors
• Stones
• Pyelonephritis (Inflammation of kidney)
• Hydronephrosis (distension of renal pelvis and calyces with urine)
• Effects of trauma
• Pre-op evaluation
• Renal hypertension

16. Contraindications
• Inability to filter contrast medium from
blood
• Allergy to contrast
• Abnormal BUN and Creatinine levels

17. Preparation Of Pt
• Pt should follow low residue diet for 1-2 days
prior to exam
• laxative taken day before
• NPO after midnight
• Pts with multiple myeloma, high uric acid levels,
or diabetes should be well hydrated before IVP
exam
– Dehydration leads to increased risk of renal
failure

18. Patient preparation:
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Bowel is purged with strong laxative
and gas-absorbent tabs.
• Patient should take nothing by mouth
after midnight on the day of
examination.

19. Contrast Media
• Must be used to visualize
urinary tract
• Iodinated, water-soluble
contrast administered
intravenously to examine
system
• Antegrade filling

20. Contrast Media
• Excretory urography (IVU) generally uses a 50 to
70% iodine solution
• Lower concentrations for bladder studies due to
large amount required to fill bladder (30%)
• Non-ionic contrast is generally used
– More expensive, but– Patients less likely to have reactions with nonionic

21. Contrast Media and Adverse Reactions
• Crucial not to leave pt alone for first 5 minutes after
injection!
• Mild reactions
– warmth
– flushing
– hives, Nausea/Vomiting, respiratory edema
(accumulation of fluid in lungs)
• Severe reactions
– Anaphylactic shock
(sudden allergic response associated with a
sudden drop in blood pressure and difficulty breathing). Can lead to death in a
matter of minutes)

22. Injection Procedure
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Obtain allergy history
Explain exam to pt
Prepare contrast and supplies (sterile tech.)
Assist radiologist as necessary
– or
• Perform injection if IVcertified

23. Injection Supplies (cont.d)
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Tourniquet
IV arm board
Towels
Emergency kit
Alcohol wipes, swabs
Contrast
19-22 G needle, butterfly or angiocath for
infusion
• Extension tubing
• Tape or clear-type dressing

24. IVU Procedure
• Scout – KUB
• Contrast is injected
• Timed sequence of films obtained until bladder
begins to fill– Immediate image of kidneys
– 5 minute image of abd. or kidneys
– Compression applied

25. Ureteral Compression
• Applied over distal ends
of ureters
• Inhibits flow of urine into
bladder
• Distends renal pelvis and
calyces
• Compression device
should be centered at
ASIS

26. Ureteral Compression
• As much compression as
pt can tolerate!
• Should not be applied
when:
– stones, abd. mass or
aneurysm, colostomy,
suprapubic catheter, recent
abd. surgery or trauma
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(Because of improvement of contrast
agents, compression no longer
generally used)
(cont’d)

27. IVU Procedure cont’d
• Tomograms are obtained
once bladder is filled
– Pt is measured, divide number
by 3, cuts begin there
• Pt. measures 30cm,
beginning cuts at 10cm
• Release compression slowly
• Have pt void, and obtain
post-void film

28. Radiation Protection
• Radiographer is responsible!
• Gonadal shield - if it does not interfere
with examination objective
• Close collimation
• Avoid repeat exposures
• Shield males for all urinary studies, except
when urethra is of primary interest

29. Radiation Protection
• Shield females when IR centered over
kidneys
• Rule out chance of pregnancy before
examination
(Emergency cases may not allow time)

30. Radiographic Positions IVU

31. AP Projection-IVU
• KUB
• (All exposures at end
of expiration for any
urinary system study)

32. AP Projection- IVU (cont’d)
Must include entire
KUB region
Should include
prostatic region on
older males

33. AP Projection Variations
• Trendelenberg
– Lower head 15 - 20 degrees
– Helps demonstrate lower ureters
• Upright
– Center lower - organs change position
• Prone
– Demonstrates ureteropelvic region
– Fills obstructed ureter in cases of hydronephrosis
(distension of renal pelvis and calyces with urine)

34. AP Oblique Projections - RPO/LPO
• Patient is supine
• Patient rotated to
30 degrees
• CR to iliac crest, 2
in. lateral to
midline
– Center to side up

35. AP Oblique Projections - RPO/LPO
• Elevated
kidney will be
parallel to
cassette
• Kidney
closest to
cassette will
be
perpendicular
• Entire KUB
region must
be included

36. AP Axial Bladder
• CR( similar to coccyx projection)
– Angled 10 to 15
degrees caudad to
center of IR
– Enters 2′′ above
upper border of
pubic symphysis

37. AP Axial Bladder (excretory method)

38. AP Oblique Bladder
• Pt position
– 40- to 60-degree
– RPO or LPO
depending on
physician
preference

39. AP Oblique Bladder
CR
– Perpendicular to center of
IR
– CR 2′′ above upper border
of pubic symphysis and 2′′
medial to upper ASIS
– If bladder neck and
proximal urethra is of
interest, 10-degree caudal
angle of CR will project
pubic bones below them

40. Lateral Bladder
• Patient position
– Lateral recumbent,
right or left side
• Part position
– Knees flexed
– MCP aligned to
midline
• CR to midcoronal
plane at 2 in. above
symphysis pubis

41. Lateral Bladder
– Demonstrates
anterior/posterior
bladder walls
– Base of bladder
– Any vesicovaginal
or vesicorectal
fistulae