CM: Cystography & Retrograde Urography

What are pertinent Hx questions for a routine cystogram?

Incontinecne, anastomoses, bladder diverticula

Cystograms are obtained in what two basic ways?

As part of an excretory IVU, or as a retrograde cystogram

When a patient having an IVU has a Foley catheter in place, drain the bladder _______ the injection, then _____ it

Before, clamp

When working with a catheterized patient, do not raise the bag _______ the level of __________

Above, the bladder

With a _________ cystogram, contrast is instilled via a urinary catheter

Retrograde

With a retrograde cystography, how is contrast administered?

Contrast is dripped under gravity

What contrast is used for retrograde cystography?

Iodine preparation of approximately 18-30%

What is the central ray for an AP bladder

CR 10-15 degrees caudal, centered 2" superior to pubic symphysis at the MSP, 40" SID

What is the obliquity of the RPO & LPO bladder positions

45-60 degrees

What is the central ray for RPO & LPO bladder positions

CR vertical perpendicular to IR, centered 2" superior to pubic symphysis and 3" medial to the upside ASIS, 40" SID

Phleboliths

Stones in veins. Common in larger division of the iliacs around the pelvic floor

Suprapubic catheter

Used when a urethral catheter cannot be inserted

What is an indication on film that suggests you're looking at an AP bladder

Obturator foramen are symmetrical, symphysis pubis is midline

What is an indication on film that suggests you're looking at RPO bladder position?

The rami on the right are superimposed, while the obturator on the left is seen in profile. Also, the left SI joint is demonstrated and left ala is foreshortened

What is the critique criteria for oblique bladder?

All of the bladder is included, free of superimposition by lower extremities, ureterocystic junction demonstrated on side up

The _____ degree oblique is designed to demonstrate the ureterovesical (UV) junction of the side up

60 degrees

What is the central ray for a lateral bladder position?

CR vertical perpendicular to IR, centered 2" superior and 2" posterior to pubic symphysis, 40" SID

What is the critique criteria for the lateral bladder?

All of bladder is included, anterior and posterior walls of bladder are well demonstrated

What are the reasons to why a lateral bladder projection is most often done on special request?

Quality is compromised because of high kVp, and the gonadal dose is higher

What is a VCUG?

Voiding cystourethrograms

The VCUG is a __________ study that examines the ________

Functional, urethra

For a VCUG, the bladder is filled __________ via a urinary catheter

Retrograde

What catheter is used to fill the bladder in a VCUG?

Foley

For a female, the VCUG is performed in an ________ position

AP

For a male, the VCUG is performed in an _______ position

RPO

What is the degree of obliquity for a male RPO VCUG?

30 degrees

What is the criteria for VCUG?

All of the bladder is included. The entire urethra is seen during micturition

When do we perform injection urethrography?

Injection urethrography is done when an obstruction hinders the insertion of a catheter, or trauma prevents urination

Injection (retrograde) urethrogram is ______ only and performed rarely

Male

Extravasate means ___________ whereas infiltrate means __________

Escape out of, passing or forced into

What are retrograde pyelograms?

Minor surgical procedures that are performed that allows visualization of the interior of the bladder

Retrograde pyelograms are performed with the patient in the ________ position

Lithotomy

A _______ is used to visualize the interior of the bladder while performing retrograde pyelograms

Cystoscope

___-___ cc of contrast is injected by the urologist during retrograde pyelography

3-5cc

Calcified prostate gland

With age, the prostate gland atrophies, and sometimes calcifies

Calcified prostate gland can lead to:

A narrowing of the prostatic urethra and the inability to completely empty the bladder

The surgical remedy for a calcified prostate gland is:

A transurethral resection of the prostate (TURP)

Bladder stones

hard masses of minerals in the bladder

Cystocele

A hernia of the bladder, into the vagina, caused by a weakening of the vesicovaginal fascia during delivery

What does a cystocele cause?

Causes a urinary frequency, urgency, and dysuria

Renal calculi

Kidney stones are formed in the parenchyma, calyces, pelvis on the kidneys

Nephrolithiasis

Kidney stones

Hematuria

Blood in urine

_______ is an alternative to surgery that pulverizes stones by using shock waves

Lithotripsy

Calculi filling large parts of the calyces are called _______ _______

Stag horn calculi

Hydronephrosis

A build up of fluid in the collecting systems

How is hydronephrosis caused?

When a ureter is obstructed from calculi or other causes, urine causes the renal pelvis and calyces to dilate as long as the kidney is functioning

A _____ is a device that holds tissue in place, or holds open a hollow organ or vessel

Stent

________ ______ are typically placed post lithotripsy to create an open channel from the renal pelvis to the bladder, to allow the passage of stone remnants

Ureteral stents

Bladder cancer tends to be fairly _______, with less than _______ cases in the US every year

Rare, 200,000

The primary symptom of bladder cancer is _____ ________

Gross hematuria

Nephrostomy

creation of an artificial opening into the kidney to allow access to the collecting system in the kidney