GENITOURINARY

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GENITO-URINARY
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Anatomy and Function (Urinary)

• Which structures are retroperitoneal?
• Which are infraperitoneal?
• What gland is located on the upper pole of the
  kidneys?
• What system do these glands belong to?
• The kidney form what angle with the midsagittal
  plane?

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• At what level is the top of the left kidney?
• The bottom of the right kidney is at what level?
• What is the function of the urinary system?
• What is the functional unit of the kidney called?
  See pg. 547

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The Ureters and the Bladder

• Name the three points where the ureter have a
  constriction?
• What is the trigone?

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BUN and Creatinine Levels

• Normal creatinine levels?
• Normal BUN level?
• How is contrasted excreted?
• If kidneys are not functioning properly, what can
  happen?

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Retrograde Pyelogram

• Is it functional or nonfunctional?
• Alternative to IVP
• ID calculi
• Pt sedated
• Sterile procedure
• Cystoscope inserted
• Catheter inserted/ contrast injected

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CYSTOGRAM pg 568

• Functional or Nonfunctional?
• Urinary Bladder
• Contrast via catheter
• Contrast flows by gravity only
• Trauma, stones, tumor, inflammation
• Aseptic technique, fluoro, images
• AP, AP w/ 15 caudal angle, obliques

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EXAMINATION OF URETHRA

• VCUG
• Urethragraphy
• Stricture
• Disease
• Trauma
• Patient catherized

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VCUG pg 569

• Studies urethra and bladder
• Studies pt ability to urinate
• Trauma and incontinence
• Patient voids after catheter removed
• Male in 30 degree RPO
• Female in AP or slight oblique

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UROGRAPHY( IVP or Excretory Urogram)

• Contrast injected intravenously
• Scout films taken
• Nephrotome-
• Timed films
• Delayed films
• Indications for study
• Stones, masses, cysts, trauma, enlarged prostate

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Anatomy of Kidney
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• Internal structure divided into 2 areas
• Cortex
• Outer area
• Contains glomeruli- functional units
• Medulla
• Inner portion
• Appearance many pyramids
• Apex terminates in minor calyx

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Renal Angiography p. 242

• Adjunct to surgery or interventional therapy
• Indications
• Lesions
• Artherosclerosis
• Stenosis
• Transplants- ( the donor)

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ULTRASOUND FACTS

• Ultrasound/ Sonography
• High frequency sound waves produce images
• Transducer- transmitter and receiver of waves and
  echoes images
• Painless and considered biologically safe
• Preferred method for imaging a fetus

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BONTRAGER PP 794-795
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US and pregnancy

• 1ST TRIMESTER
• Location- gestation sac
• Presence / absence of fetus
• Fetal
• Examination of Uterus

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2ND- 3RD TRIMESTER

• Fetal life, age .
• Amniotic fluid
• Placenta location
• Fetal anatomy

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US and Female reproductive organs

• PID
• Ectopic pregnancy
• Endometriosis
• Pelvic abscess
• Neoplasms
• Ovarian masses
• Follicle size
• Endometrial Ca (MRI or CT better)

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HYSTEROSALPINGOGRAM Snopek, Ch 20

• Indications (box, p. 384)
• Infertility assessment
• Therapeutic for blockages
• Endometriosis, fibroids, adhesions
• What time of the womans cycle should it be done?
• Equipment?

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• Oily or water contrast
• Fluoro
• Vaginal speculum
• Uterine cannula
• Syringes
• tubing

• Antiseptic
• One way stop cock
• Floor lamp
• Stool
• Stirrups
• K-y jelly

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PROCEDURE

• Speculum
• Cannula inserted
• Contrast injected
• Images taken
• Normal if contrast spills into peritoneal
  cavity

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Also on p. 390
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Uterine Fibroids

• Benign tumors
• Angiography procedure
• Femoral artery catheterized to uterine artery
• Embolic agents injected to block blood supply
• Fibroid shrinks/ dies

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THE PROSTATE

• Gland that surrounds proximal urethra
• Enlargement is detected by
• US- transrectally or through bladder
• IVPs
• Palpatation
• Symptomatically

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Elevated and impressed floor
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PROSTATE CANCER pg 417 comprehensive pathology

• 2ND MOST COMMON MALIGNANCY IN MEN
• Rarely occurs before age 50
• Increases 40 w/ advancing age
• US , CT, IVP or Cystogram
• PSA (Prostate Specific Antigen)
• Indicates abnormality
• MRI- can delineate prostate better

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Brachytherapy

• Radioactive seeds implanted
• Inserted through needle w/ US guidance
• Theoretical advantage
• Direct radiation into prostate tissue
• Minimizes damage to surrounding tissue, organs

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TESTICULAR TUMORS

• Age 20-35
• Almost always malignant
• Metastasize to lymphatic system
• Visualized best in US
• Treatment-