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GU Exam 1 > Urological Diagnostics and Procedures > Flashcards

Urological Diagnostics and Procedures Flashcards

1
Q

Conventional Radiography usefulness

A

May demonstrate osseous abnormalities, abnormal calcifications, or large
soft-tissue masses, bowel gas pattern (Gas, Mass, Bones, and Stones)
○ Low sensitivity for stones and GU masses (rarely used as first line
imaging modality)

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2
Q

KUB (Kidney, Ureter, Bladder) advantages and disadvantages

A

● Advantages
○ Low cost and readily available
○ Less radiation than CT
■ Can use in pregnancy and peds
● Disadvantages
○ Limited visualization/soft tissue contrast
○ Radiation

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3
Q

IV Pyelography (IVP)

A

AKA – IV urography/excretory urography
● An IVP is performed by obtaining plain films
of the abdomen initially, then at timed
intervals after an IV injection of contrast

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4
Q

IV Pyelography (IVP) Indications

A

● Stones – medullary sponge kidney or renal
papillary necrosis
● Congenital anomalies of the urinary tract
● Surgery or scarring from surgery or frequent UTIs
● Pregnant Pts (with limited contrast)

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5
Q

IV Pyelography (IVP) advantages vs. disadvantages

A

Advantages
● Cheaper than CT
● Less radiation exposure compared to CT
Disadvantages
● Time consuming
● Utilizes contrast

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6
Q

Voiding Cystourethrography (VCUG)

A

Technique for visualizing the urethra and urinary bladder during micturition

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7
Q

Voiding Cystourethrography (VCUG) indications

A

Frequent UTIs (especially in children)
○ Ureteral reflux – most common etiology for
peds febrile UTIs
○ Suspected outflow obstruction
○ Bladder trauma or post-op evaluation
○ Urinary stress incontinence

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8
Q

Filling defects – ____

A

urethral strictures, urethral or bladder diverticulum,
false tracts

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9
Q

Vesicoureteral reflux

A

contrast moves retrograde into the ureter(s) and kidney(s)

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10
Q

Voiding Cystourethrography (VCUG) process

A

● The patient is catheterized and the bladder with radiocontrast
● The patient then voids
● Using fluoroscopy or standard X-ray, images are taken as the bladder
contracts

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11
Q

Post-Void Residual (PVR)

A

PVR measures the amount of urine left in the bladder after micturition
● The amount of residual urine can be measured by draining the bladder via catheterization or by using ultrasound

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12
Q

Post-Void Residual (PVR) Indications

A

Patients presenting with retention, incontinence, or incomplete emptying
○ Neurogenic bladder
■ Spinal cord injury, CVA, MS,
Parkinson’s disease
○ Urinary obstruction
○ Previous pelvic surgery/trauma
○ Medications
■ Sedatives, opiates, calcium channel
blockers

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13
Q

Interpretation of PVR urine volume

A

○ PVR < 50 cc is adequate bladder emptying
○ PVR < 100 cc is acceptable in patient over 65
○ PVR > 200 cc is incomplete bladder emptying

Higher risk of UTI with higher PVR

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14
Q

Renal/Bladder Ultrasound: what to assess

A

● Renal and testicular size (>2 cm difference is abnormal)
● Renal and testicular masses (solid vs cystic)
● Hydronephrosis (stones vs pregnancy)
● Doppler sonography (renal and spermatic vessels,
vascularity testicles, and renal masses)
● Bladder contour (mass, diverticulum, PVR)
○ Seen as round/oval
● Stones (brightly echogenic with shadowing)

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15
Q

Advantages vs. Disadvantages of Renal/bladder ultrasound

A

Advantages
● Ease of use
● High patient tolerance
● No need for contrast
● Lack of ionizing radiation
● Relative low cost
● Wide availability

Disadvantages
● Tissue nonspecificity
● Limited field of view
● Dependence on operator’s skill
● Dependence on patient’s body
habitus

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16
Q

Degrees of Hydronephrosis

A

● Grade 0 – no dilation (considered normal)
● Grade 4 – severe, gross dilation of
pelvis/calyces (ballooned effect)
● Grade 5 - most severe?

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17
Q

Simple or complex renal cysts on ultrasound:

A

Smooth, anechoic and with or without internal echoes; multiple in polycystic disease

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18
Q

CT Scan indications for kidneys

A

● Acute flank pain
● Hematuria
● Renal infection (abscess)
● Trauma
● Characterization and staging of renal
masses/neoplasms and polycystic kidney disease
○ Can detect small cysts down to 2-3 mm in diameter
○ Renal U/S used initially for screening

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19
Q

CT Scan other applications in the GU system

A

● Urinary bladder: Stage bladder tumors and diagnose bladder rupture following trauma
CT Scan
● Prostate: Detect lymphadenopathy, extraprostatic tumor extension
● Testes: Staging of testicular tumors
● Adrenal gland: Lesions can be characterized with delayed post-contrast images

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20
Q

CT Scan advantages vs. disadvantages

A

Advantages
● Quick
● Wide field of view
● Good spatial resolution
● Able to detect subtle differences in tissue
● Anatomical cross-sectional images

Disadvantages
● Low soft-tissue contrast resolution (but
better then U/S)
● Need for contrast media
○ Check BUN/Creatinine ratio and
eGFR with renal impairment
● Radiation exposure (10x more than plain
abdominal radiographs)

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21
Q

When to do CT with contrast

A

● All angiograms
● Any CT of the Abdomen or Pelvis looking at the organs
● Evaluation of renal and ureteral anatomy benefits greatly from administration of IV contrast

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22
Q

When to do CT without contrast

A

● Renal stones
● Patients with renal failure (and not on
dialysis)
● Post trauma with suspected bleed

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23
Q

Evaluation of stones requires a _____

A

noncontrast CT (Gold Standard)

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24
Q

CT Urogram (CTU)

A

● CT without and then with contrast, with at least one set of images from the
excretory phase
● Higher yield than IVP

25
CT Urogram (CTU) Indications
● Evaluation of hematuria ● Identification of urothelial (bladder/ureter) tumors
26
Three scanning phases of CT Urogram (CTU)
● Noncontrast – Stone detection ● Nephrographic (90 seconds) – Eval kidneys for mass/lesions ● Delayed excretory (8-10 minutes) – Assess collecting system
27
CT Urogram is the gold standard for ____
characterization of renal masses
28
Indications for Magnetic Resonance Imaging (MRI)
● Demonstration of congenital anomalies ● Diagnosis of renal vein thrombosis ● Diagnosis and staging of renal cell carcinoma ● MR/Ultrasound fusion prostate guided biopsy
29
MR/Ultrasound fusion prostate guided biopsy
○ Fewer Bx (3-4 Bx instead of 12-15) ○ Find more significant cancers (30%) ○ Find fewer insignificant cases
30
MRI advantages and disadvantages
Advantages ● Direct imaging in any desired plane ● Excellent soft-tissue contrast ● No exposure to ionizing radiation ● Does not use iodinated contrast, instead uses Gadolinium Disadvantages ● Scanning time is relatively slow ● Image clarity is often inferior to CT ● Higher cost
31
Absolute Contraindications for MRI
● Intracranial aneurysm clips ● Intra-orbital metal fragments ● Many implants
32
Nephrogenic Systemic Fibrosis (NSF)
A form of contrast induced nephropathy precipitated by use of Gadolinium ○ If occurs, mostly in ESRD patients with GFR <30 mL/min ○ Progressive multiorgan fibrosing condition ○ Resemble skin diseases, such as scleroderma
33
Renal Angiography (Arteriogram)
Percutaneous needle puncture and catheterization into common femoral artery → administration of contrast → plain film or fluoroscopy ○ Gold standard for direct visualization of renal vasculature
34
Gold standard for direct visualization of renal vasculature
Renal Angiography (Arteriogram)
35
Renal Angiography (Arteriogram) Indications
● Suspected renal artery stenosis/renal vein thrombosis ● Vascular malformations ● Pre-op mapping/tumor embolization to minimize blood loss
36
Magnetic Resonance Angiography (MRA) Indications
● Same as arteriogram with additions of evaluating renal transplant vessels, ○ Atherosclerosis within aorta and iliac arteries often visualized
37
Magnetic Resonance Angiography (MRA) advantages and disadvantages
Advantages ● Highly accurate/detailed in determining number of renal arteries, size of kidneys, and any anatomic anomalies ● No radiation ● Less invasive Disadvantages ● Time intensive ● Gadolinium exposure ● Cost
38
Indications for CT angiogram
Same as MRA ● CTA is more commonly ordered if looking primarily at renal vasculature due to faster image acquisition and technically easier to perform
39
Cystoscopy
A procedure where a thin, lighted cystoscope is inserted to visualize the lining of the urethra and bladder. Often done in office.
40
Cystoscopy indications
● Evaluation of Pts with voiding symptoms ● Gross or microscopic hematuria ○ Gold Standard for diagnosing bladder cancer ■ Biopsy obtained during the procedure ● Evaluation of urethral or bladder diverticula ● Congenital abnormalities in pediatric patients ● Bladder hydrodistention ● Intraop evaluation after incontinence/prolapse procedure
41
Gold Standard for diagnosing bladder cancer
Cystoscopy
42
Cystoscopy contraindications
● Febrile patients with UTI ● Those with severe coagulopathy
43
Cystoscopy Therapeutic Indications
● Treatment of urethral strictures ● Bladder neck procedures ● Intravesical procedures ● Reflux treatment in peds
44
Advantages of flexible endoscopes:
less painful, able to see entire bladder (incl. neck).
45
Advantages of rigid endoscopes:
more instrumentation options, better optics, and more durable (use in OR)
46
Renal Biopsy
● A procedure to extract kidney tissue for laboratory analysis ● Usually performed as an outpatient procedure ● Used to identify various renal diseases, especially glomerular or interstitial pathologies
47
Renal Biopsy indications
● Unexplained renal failure ● Acute nephritic syndrome ● Nephrotic syndrome (peds) ● Renal masses (primary or secondary) ● Renal transplant rejection ● Connective-tissue diseases
48
Percutaneous (or renal) needle biopsy
● Conscious sedation is used ● Local anesthetic is applied and small incision made ● A needle is then inserted through the incision into the kidney ● Typically U/S or CT the needle will be guided to the area of concern ● Biopsy obtained
49
Open Biopsy
Typically done if history of bleeding or blood clots, or if only one kidney ● General anesthesia is given and a small incision made ● A tissue sample is surgically removed
50
Collection of Urethral Swab specimen
Generally obtained when evaluating for an STI
51
Urinary Catheterization options
● Foley (indwelling) ● Suprapubic ● Intermittent/straight cath (in/out) ● External sheath (condom)
52
Urinary Catheterization indications
● Empty the bladder ● Measure urine production ● Obtain clean catch for urine culture
53
The single most important factor for preventing urinary catheter-related complications is _____
limiting their use to appropriate indications
54
Indications for Urinary catheterization
● Urinary retention (with or without bladder outlet obstruction) ● Hourly urine output measurement (critically ill pts) ● Daily urine output for fluid management ● Intraoperatively to assess fluid status ● Immobilized patients ● Neurogenic bladder ● Incontinence – ONLY in patients with open wounds in perineal regions
55
Inappropriate reasons to catheterize
● Management of JUST urinary incontinence ● Monitor I’s and O’s in those who can spontaneously urinate ● PVR *
56
T/F Prophylactic antibiotic use is not recommended unless a proven UTI is present
T
57
Absolute contraindication to catheterization
● Presence of urethral injury (typically seen with pelvic injury) ○ Blood at meatus or gross hematuria → consult Urology
58
Urinary Catheterization complications
● Urethral dilatation ● Urethral irritation ○ Urethral ulceration ● Trauma ● Infection ○ Increases with BPH, bladder neck contracture, or urethral strictures ● “U-Turn”
59
Urinary Catheterization complications
● Inappropriate filling of the foley balloons ● False tracts ○ Urethral tears ○ Migration into the distal ureter

GU Exam 1 (5 decks)

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