Urinary System

1. Adrenal gland

2. Left Kidney

3. Left ureter

4. Urinary bladder

5. Urethra

Functions of Urinary system

-Production of urine and it’s elimination from the body
-Remove nitrogenous wastes
-Maintain fluid and electrolyte levels
-Secreting substances that affect blood pressure

Retroperitoneal structures

-Kidneys

-Ureters

Infraperitoneal structures

Distal ureters

Urinary bladder

Urethra

Kidney orientation

• 30 degree angle from coronal plane

• Right kidney is lower = bc of liver

Kidney Location

• Halfway between xipoid process and iliac crest

• Between T11-T12

• Right kidney more inferior than left

Nephroptosis

a condition where the kidney descends more than 5 cm (or two vertebral bodies) when moving from a supine to an upright position

-Kidney drops down

Kidney transplant

Low in the pelvis near bladder bc you have to attach the ureter

-near the pelvis

1. Abdominal aorta

2. Left renal artery

3. Left kidney

4. Left renal vein

5. Left ureter

6. Inferior vena cava

7. Lower pole

8. Hilum - mainstream, where stuff goes in and out

9. Upper pole

Macroscopic structure

Cortex

• Fibrous capsule

• Nephrons

Medulla

• Renal pyramids - 8-18

• Renal papilla

• Mior calyces - 4-13

• Major calyces - 2-3

• Renal pelvis

• Ureter

1. Medulla

2. Fibrous capsule'

3. Cortex

4. Renal pelvis

5. Major calyx

6. Ureter

7. Minor calyx

8. Renal sinuses

9. Renal column

10. Renal papilla

1. Glomerular capsule or bowmans capsule

2. Efferent arteriole

3. Glomerulus

4. Afferent Arteriole

5. Loop of henle in medulla portion

-Structural and functional unit
-Over 1 million per kidney
-Blood filtered

URINE PRODUCTION SUMMARY

H2O intake (2.5 L/day)
Bloodstream
Filtrate 99% reabsorbed
Urine (1.5 L/day)

Ureters

• 10-12 inches long, 1mm to 1 cm in diameter

• Lie on psoas muscles

• Enter posterolateral bladder

• Peristaltic contractions move urine towards bladder

• Points of constriction

  • Ureteropelvic junction (UPJ)

  • Pelvic brim

  • Ureterovesical junction (UVJ)

1. Ureteropelvic junction (UPJ)

2. Pelvic Brim

3. Ureterovesical junction (UVJ)

4. Left kidney

5. Left psoas major muscle

6. Left ureter

7. Urinary bladder

1. Right ureter

2. Ureteral opening (UV junction)

3. Trigone

4. Prostate gland

5. Urethra

Urinary bladder

-Musculomembranous sac
-Serves as a reservoir for urine
-Located immediately posterior and superior to pubic symphysis
 Anterior to rectum in males
 Anterior to vaginal canal in females
-Apex is anterosuperior aspect
-Neck is lowest part
-Trigone = triangular area of bladder base between
three openings

Micturition

process of expelling urine from the bladder

-Urination

Incontinence

Not able to hold urine, leaking urine

Retention

Holding onto the urine, not emptying the bladder all the way

Voiding

another word for urination

Urethra

-Conveys urine out of the body
-Approximately 1½ inches (3.8 cm) long in females
-Approximately 7 to 8 inches (17.8 to 20 cm) long in males

1. Symphysis Pubis

2. Urinary Bladder

3. Peritoneal cavity

4. Ureter

5. Rectum

6. Urethra

7. Scrotum

8. Testis

9. Prostate gland

10. Ejaculatory ducts

11. Seminal vesicles

Prostate

-Small glandular body surrounding the proximal part of the male urethra
-Considered part of the male reproductive system, but because of location, is often described with the urinary system
-Measures approximately 1½ inches (3.8 cm) transversely, ¾ inch (1.9 cm) at its base, and 1 inch (2.5 cm) vertically
-Benign Prostatic hyperplasia (BPH)

• Gland gets enlarged

• Bumps and lumps on the gland

1. Ovary

2. Uterine tube

3. Uterus

4. Urinary bladder

5. Symphysis Pubis

6. Urethra

7. Vagina

8. Kidney

9. Ureter

10. Rectum

IVU

• Demonstrates kidneys, ureters and bladder

• To demonstrate the function of the urinary system contrast media is injected into a vein and then, followed by imaging by either x-ray or computed tomography (CT)

• Two filling techniques

  • Antegrade- Blous or IV drip

  • Retrograde - backward flow through the urethra, catheter

Clincal indications for IVU

• Abdominal or pelvic
  mass

• Renal or urethral calculi, kidney stones

• Kidney trauma

• Flank pain

• Hematuria- Blood in urine

• Hypertension

• Renal failure

• Urinary tract infection (UTI) (pyelonephritis)

Lithotripsy - larger stones

Cystitis - inflammation of bladder

Hydronephrosis - the swelling of one or both kidneys caused by urine buildup

Functional procedures

-IVU/EXU (Intravenous/Excretory Urography)
-Nephrogram/Nephrotomogram
-CT IVU
-Hypertensive IVU
-Voiding Cystourethrogram (VCUG)= retrograde study

*Can watch the system

Basic routine of images for IVU

-Scout radiograph (KUB)
-Injection : Note time at beginning of injection.
-1 min nephrogram or nephrotomography
- 3-20 min intervals AP supine
- 5-10 min interval 30 degree posterior obliques
-Postvoid (AP bladder shot, KUB or erect)
-* special view- ureteric compression

Intravenous Urograhy Procedure

-Before procedure, patient must empty bladder,
remove clothing, and put on a gown
-Check blood chemistry (BUN, Creatinine)
-Ask if patient followed preparation : NP after midnight
-Informed Consent signed
-Make scout radiograph

-Perform venipuncture

• Administer 50 to 100 mL of contrast for adult patient of average size (usually half of body weight)

• Dosage for infants and children is adjusted according to age and weight

-Produce radiographs at specified time intervals
-When images are completed patient voids (empties bladder)
-Post Void image taken
-Patient instructed to drink plenty of fluids
-No metformin for 48 hours if applicable

CT IVU

Benefits → Minimal bowel prep: Water only at least 1 hour prior to procedure
2. Noncontrast images to evaluate for presence and location of renal calculi
3. Option to use contrast media provides a structural and functional study
4. Fast procedure with helical CT scanner
5. 3D reconstruction

Nephrogram

Radiographs taken in the first few minutes after injection to study to demonstrate the renal parenchyma or the functional portion of the kidney
- starting at 1 min
-Kidneys only- enter between xiphoid and iliac crest– one radiograph

AP Obliques

30 degrees

CR → iliac crest

2 inches lateral towards upside from the midline

LPO→ makes right kidney parallel to IR, moves left ureter off the spine

RPO→ makes left kidney parallel to IR, moves right ureter off spine

Expiration breathing

Postvoid

Can be done erect or recumbent

CR→ iliac crest

Bladder shot

CR→ 2 inches superior to symphysis pubis

10×12 IR or collimate

Used to visualize residual urine in bladder

AP with ureteric compression

CR→ iliac crest

Compression device places medial to ASIS at pelvic brim

Retrograde studies

Functional → Voiding cystourethrogram

Non functional→ Retrograde urogram, cystogram

VOIDING CYSTOURETHROGRAPHY/URETHROGRAPHY

VCUG

Purpose: Functional study of the bladder and urethra, ask to urinated and fluoro
-Performed after routine cystogram
-Catheter removed and imaged while voiding

Female= AP

Male = 30 degree RPO

Retrograde urography

Requires catheterization of ureters

-Scout radiograph taken
-Series of radiographs taken as requested
-Ureterogram taken once catheter has been removed

AP Axial bladder - cystogram

CR→ angled 10-15 degrees caudal, 2 inches abover upper border of pubic symphysis

10×12 collimation

Voiding Cystourethrogram

A. Ureter

B. Bladder

C. Neck of bladder

D. prostate gland

E. Urethra

A. Minor caylces

B. Major Caylces

C. Renal pelvis

D. UPJ

E. Ureter