The lecture has been given on Nov. 30th & Dec. 7th, 2010 by Dr. Nasrin Alatrushi.

1. Lectures of genitourinary systems Fifth year Collage of medicine Dr . Nasrin Alatrushi

2. Urinary system Imaging Techniques

4. Urinary tract Us Us is the first line investigation in most patients , it is non invasive, easy to perform , need no preparation & not costly. The main uses of US are 1- investigation patients with symptoms thought to be arise from urinary tract . 2- demonstrate the size of the kidneys and exclude hydronephrosis in patients with renal failure . 3-diagnos hydronephrosis , renal tumours, abscesses and cysts including polycystic diseases . 4- assess and follow up renal size and scaring in children with repeated urinary tract infection 5 – assess the bladder and the prostate

5. Urinary tract Normal renal us At US the kidneys should be smooth in out line . The parenchyma surrounded a central echodense region known as echo complex ( also called the renal sinus ), the renal sinus consisting of renal pelvicaliceal system, together with surrounding fat and blood vessels .The renal cortex is homogenous low echogenic , it is less reflective than the adjacent liver or spleen and the renal pyramids seen as triangular hypoechoic areas adjacent to the renal sinus . During the first two months of life cortical echoes are relatively more prominent and the renal pyramids are disproportionately large and hypoechoic . The normal adult kidney length is about 9 – 12 cm . Renal length varies with age being maximum in young adult . There may be a difference between the two kidneys , normally less than 1,5 cm but the kidney with bifid collecting system usually one to two cm larger than the normal kidney . Normal ureter are not usually visualized due to over lying gas bowel . The bladder should be examined in the distended state and the wall should be smooth and sharply defined . The bladder should be assessed following micturation to assess post voiding volume of urine , .

9. Intravenous urography The IVU as a standard technique has now been largely replaced by ultrasound . The main current indications for IVU are . 1 – when detailed demonstration of the pelvicaliceal system and ureter is required . 2 – the assessment of suspected acute ureteric colic . 3 – the investigation of renal calculi . 4 – the investigation of haematuria .

15. CT scan Haw to perform CT scan. CT is initially performed without using intravenous contrast medium ( non contrast CT to identify calcification).then images are obtained following intravenous administration of the contrast medium usually during the early renal cortical enhancement phase, which occurs at 40 seconds after the contrast injection ( the corticomedullary phase ) . then further scan is obtained several minutes later to demonstrate the homogenous nephrogram phase and the collecting systems , with using a new multidetector CT images may be reformatted in the coronal or sagittal plane, for surgical planning .

17. CT scan The ureters are seen in cross section as a dotes laying on the psoas muscles . they will not necessarily be seen at all levels because of peristalsis The bladder has smooth out line and stands out against the pelvic fat the wall is thin and uniform diameter . The contrast medium appear more dense than urine and because the contrast medium is heavier than the urine so it collect in the depending portion so the depending portion appear more densely opacified . .