Retrograde Pyelography Pathologies

Bladder Carcinoma

• Cancer that most commonly originates in the epithelium (Wall) of the bladder

  • Urothelial carcinoma (previously known as transitional cell carcinoma)

• Appears as: punctuate, coarse, or linear calcifications that are usually encrusted on the surface of the tumour - can be within it

  • Frequently on the trigone where they are difficult to visualize

Calculi

• most commonly form in the kidney and are asymptomatic until they cause obstruction and pain (kidney to groin, flank pain)

• Can be caused by underlying metabolic abnormality, or increase in calcium excretion in urine, urinary stasis, infection

• About 80% can be seen on radiographs due to calcium, but x-ray misses 34% due to size, location, or obstruction by bowel or bone

• Most commonly lodge in lower portion of the ureter, at ureterovesical junction and pelvic brim

• Stone formation in bladder most occurs in older men

• Can be most shapes: circular or oval, amorphous, layered, speculation; jack stone (hard burr)

Cysts

• most common univocal mass of the kidneys

• Fluid filled land usually unilocular

  • Septa sometimes divide cyst into chambers

• Vary in size; can be single or multiple; one or both kidneys

• Appears as: beak sign, slowly increasing in size and elevating the adjacent edges of the cortex

Duplication

• common anomaly that may vary from a simple bifid pelvis to a completely double pelvis ureter and ureterovesical orifice

• Ureter draining upper renal segment enters bladder below the ureter draining the lower renal segment

• Vesicoureteral reflex normally affects lower pole; obstruction affects upper pole

Ectopic Kidney

• abnormally located kidneys

• Pelvic kidney (in true pelvis) to above the diaphragm (intrathoracic kidney)

• Usually functional

• Crossed ectopia = ectopic kidney on same side as the normal kidney; frequently fused

Horseshoe Kidney

• most common type of fusion anomaly

• Both kidneys are malrotated and lower poles joined by a band of normal renal parenchyma/connective tissue

• Ureters arise anteriorly instead of medially

• Lower pole calyces point medially instead of laterally

• Large flabby pelves, may simulate obstruction

• Ureteropelvic junction may occur because of the anterior position of the ureters

Hydronephrosis

• dilation of the pelvicalyceal system caused by urinary tract obstruction

Hydroureter

• dilation of the ureter caused by urinary tract obstruction

Acute Renal Failure

• rapid deterioration in kidney function sufficient to result in the accumulation of nitrogen-containing wastes in the blood

• Caused by: low blood volume, cardiac failure, renal artery obstruction, obstruction to urine outflow, nephrotoxic agents, etc

• Ultrasound best

• IVU would show bilateral renal enlargement with delayed and prolonged nephrogram

Chronic Renal Failure

• caused by: bilateral renal artery stenosis, bilateral ureteral obstruction, intrinsic renal disorders

• Failure to clear nitrogen containing waste leads to uraemia - eventual coma

• Decreased ability of the kidney to synthesize erythropoietin which helps the red blood cells produce, leads to anemia

• Appears as: bilateral renal calcifications or obstructions, or stones

• Kidneys can be small and smooth, small and irregular (chronic pyelonephrosis), or large (poly cystic, obstructive disease)

Ureterocele

• cystic dilation of the distal ureter near its insertion into the bladder

• Frequently, stenosis of distal ureter leads to prolapse into bladder and dilation of proximal ureter

• With contrast, appears as round/oval density surrounded by radiolucent halo (cobra head sign)

• Without contrast, appears as radiolucent mass within opacified bladder