AUA Summit - What is Urologic Radiology?


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What is Urologic Radiology?

Improvements in medicine have helped all doctors, especially urologists. Urologists now have many tools to help diagnose disease in our most private body parts. Urologic Radiology includes several ways to carefully look inside organs like the kidneys, ureters, bladder, and reproductive organs. Imaging tools can be basic like x-rays to more complex tools.

Generally, these imaging tests are detailed, often pain-free, and quick.

What is Angiography

Angiography, also called Arteriography, is the X-ray imaging of blood vessels using a contrast agent (dye). The dye makes the blood vessels visible with an X-ray.

Its purpose is to show the blood supply moving to and from an organ. For example, an angiogram can show how blood flows to and from the kidney through the aorta and renal arteries.

Angiography is helpful to:

  • Learn the location of a narrow or blocked blood vessel
  • Treat a diseased blood vessel
  • Find internal bleeding (to stop the bleeding)
  • Locate and remove a blood clot in a blocked blood vessel
  • Treat certain types of tumors by blocking their blood supply
  • Make a map of your blood vessels before surgery

It is most commonly used to help with treatment, rather than for diagnosis alone.

For more information please visit our article on Angiography.

What is Antegrade Pyelography

Antegrade pyelography uses a special dye to see detailed x-ray images of the upper urinary tract (kidney and ureter).

It is used to diagnose hydronephrosis, ureteropelvic junction (UPJ) obstruction, and obstruction of the ureters, for example.

For more information please visit our article on Antegrade Pyelography.

What are Bone Scans

Bone scans may be used to see if prostate, bladder, kidney , testicular or penile cancer has advanced. Although the number of bone scans has decreased over the years, these studies are helpful in assessing advanced urologic cancers.

In these studies, a radionuclide is injected into the body. Over a period of hours, images are taken of the bones in the body. Absorption of the radionuclide in a specific area may indicate trauma or cancer in the bone.

This test is generally safe. In rare cases, people have an allergic reaction to the liquid injected.

What is a CT Scan

The CT scan is used by doctors to see and evaluate cross-sectional slices of tissue and organs. It is one of the best tools for diagnosing problems in the urinary tract and renal systems. It combines X-rays and computer calculations for detailed images.

The CT scan uses special X-ray equipment to gather data from different angles. More specifically, very small, controlled x-ray beams rotate completely around the patient to collect data. Beams pass through the tissue as detectors measure thousands of X-ray images. A computer then produces detailed pictures shown on a screen.

It can show solid vs. liquid structures, so it is used to diagnose masses in the urinary tract. These scans can accurately gather real-time images of the kidney and urinary system in seconds, with no gaps.

CT scans are often combined with radiopaque dye, injected into a vein to create clearer images. Specialized CT scans can make 3-D images of the kidney and blood supply. These can show problems with blood flow and offer a "road map" for planning surgeries.

CT scans are generally safe, efficient, and effective, with minor risks. Some patients can have an allergic reaction to the radiopaque dye.

For more information please visit our article on CT scans.

What is Cystography

Cystography uses X-rays and iodine contrast dyes to look at the bladder for a blockage or birth defect. It can find a vesical fistula , a bladder rupture , or vesicoureteral reflux (VUR).

There are two versions of this test. The first type is one with X-ray. The second type of test is with nuclear medicine. Many physicians believe the radionuclide cystography is better for tracing urine flow through the urinary tract. It uses less radiation and does not rely on fluoroscopy.

To insert the dye, the doctor will first insert a catheter through the urethra to the bladder. The dye is injected into the bladder. X-ray pictures are taken as the bladder fills, from different angles. More images are taken after the dye drains. The test takes about 1.5 hours and the patient may wait while films are developed.

While voiding cystograms are still used to evaluate the male urethra for bladder trauma, most reflux studies today are done with radionuclide cystography.

While the risks are low, patients could get a urinary tract infection from the catheter. Also, the catheter could damage the urethra, bladder or nearby structures. It’s best to work with a highly experienced urologist.

For more information please visit our articles on Contrast and Radionuclide Cystography and on radionuclide cystogram.

What is Intravenous Pyelography

Intravenous pyelography (IVP) is an x-ray exam that uses contrast dye to outline the kidneys, ureters, and bladder. It provides information about renal function to see how well your system handles fluid waste. This helps your health care team find problems in the urinary system.

The exam is used to diagnose why a patient has blood in their urine or pain in their side or lower back. It can find:

It may also be used as a screening tool or to help guide surgery. It can let your urologist know if other tests are needed to learn what’s going on.

Typically, an x-ray image of the abdomen is taken first, without dye. This helps the radiologist know the best way to position and give the actual test. A full set of kidney images may be done if small kidney stones are suspected.

Then, a contrast dye is injected once through a vein. The amount of dye given is based on the patient's kidney function and body weight. Children get less, and larger people get more. After the contrast dye is in the urinary tract, a series of X-rays are taken. These are taken at specific times, from two to ten minutes apart. These X-rays can show tumors, cysts, stones, or other problems.

The main risk of IVP is a reaction to the contrast dye. A small number of people can have an allergic reaction, which can result in hot flashes, nausea and vomiting. These are treated with anti-allergy drugs. Rarely, more severe reactions (breathing trouble, low blood pressure, swelling of the mouth or throat, and even cardiac arrest) can occur.

Patients with a history of hay fever, asthma or hives are at greater risk. Same is true for people with congestive heart failure, diabetes, or past reactions. Tell your doctor if you have a history of these things, so care is taken to prevent a reaction.

For more information please visit or article on IVP.

What is MRI

Magnetic resonance imaging (MRI) uses radio waves and a strong magnetic field to create highly detailed pictures. It can show soft tissues so specifically that it can detail blood vessels and other structures. It is so accurate, that it can show a hollow cyst from a solid mass.

Since the MRI can create three-dimensional images of a tumor's shape, it is often used for diagnosis and treatment. For kidney cancer, it can show if and where cancer has spread. On the other hand, the MRI may not helpful for the urinary tract. It cannot show abnormalities in the bladder, for example.

The MRI doesn’t use radiopaque contrast dye. MRI is unique because it does not use ionizing radiation. Instead, it uses a strong magnet, radio waves and computers to create detailed images. The patient lies down within the MRI’s huge, hollow magnet. This magnet finds the nuclei of hydrogen or water atoms in a patient’s body. Radio signals created by first "exciting" and then "relaxing" protons, create digital images, showing different types of tissue.

An MRI exam can last from two to fifteen minutes. For mostly healthy people, the MRI offers no risk. People with pacemakers, aneurysm clips, ear implants, or other metallic pieces should not get an MRI.

For more information please visit our article on MRIs.

What is Radionuclide or Nuclear Imaging

Nuclear medicine imaging (NMN) or radionuclide imaging is a valuable tool for diagnosis. It is used to help find cancers, heart disease, gastrointestinal, endocrine, neurological disorders, and other problems. Because tools using nuclear medicine can pinpoint molecular activity in the body, it can find disease early, when it is most easily treated.

This tool shows both the anatomy of an organ or body part, and how it functions. Information about organ function allows this exam to find problems much sooner than other imaging exams.

For this test, urologists inject a radioisotope "tracer" into the kidney system. The tracer is a molecule that has a radioactive atom or "tag" attached. The tags most often used are iodine-123 or 131, or technetium. They can be followed through the kidney system with special nuclear detectors. A series of X-ray images of the kidneys are then collected to see blood flow and function.

Radionuclide imaging is thought of as safe since there are no allergic risks. Also, since the radioisotope tracer gives off less radiation than an X-ray, this test is seen as safer than an X-ray.

What is Retrograde Pyelography

Retrograde pyelography uses a contrast dye to get detailed X-ray pictures of the upper urinary tract. For this, dye is injected into the ureter. This helps create pictures of the ureter and the kidney collecting system. It is used when IVP does not provide a clear enough view. It also is used with cystoscopy to evaluate for hematuria (blood in urine) or cancer.

This test helps your doctor diagnose blockages in the urinary system. It is used to find stones or tumors.

A patient is first given anesthesia. Then a catheter is placed through the patient's urethra, bladder and ureter. This is how dye is injected. A fluoroscope is then used to magnify details. It takes real-time X-ray images on a special fluorescent screen.

What is a Retrograde Urethrogram

Retrograde urethrogram is a tool used to evaluate trauma to the penile urethra or urethral disease.

For this test, a catheter is inserted about two centimeters into the penis. Contrast dye is injected through a tiny balloon on the catheter. Several X-rays are taken, or a fluoroscope is used to clearly see details on a special screen. If needed, the catheter is moved to fill the bladder. The patient is instructed to urinate while several more X-rays are taken.

For more information please visit our article on retrograde urethrogram.

What is Ultrasonography

Ultrasound uses high-frequency sound waves to create real-time images. It is a simple and painless way for urologists to look at many organs. It is flexible and offers helpful information, without using dyes or radiation.

A small probe and gel are placed on the skin. The transducer can then collect the sound waves from organs to create an image. The images look like thin, flat sections of the body on a computer screen. Newer technology can create three-dimensional (3-D) ultrasound images.

These exams help your doctor diagnose many things, including organ damage. It can see the bladder, ureters and the lower part of the kidney. It is used to evaluate symptoms like:

  • Pain
  • Swelling
  • Infection

Ultrasound is painless, safe and generally risk-free.

For more information visit our article on ultrasounds and the different types.

What is Venography

Venography is an x-ray exam that uses an injection of dye to show how blood flows through your veins. Your doctor may use it to find a blood clot, or to prepare for dialysis.

For this test, a contrast dye is injected into the renal veins with a catheter. Then X-ray images are taken within seconds. Epinephrine injected first, may allow for better images. Venography is being done less often, as tools such as Doppler ultrasound have improved.

Complications are rare, but include leaks around the site of the injection. Also, some people are allergic to the solution.

What is a Voiding Cystourethrogram

Called a VCUG or cystogram, this test shows your doctor the size of your bladder and how well it can drain. The test is also used to pinpoint anything abnormal about the urethra and the bladder. For example, it can find a problem with the narrowing of the urethra (stricture ), or VUR (vesicoureteral reflux), when urine flows back up from the bladder through the urethra to the kidney.

For more information please visit our article on Voiding Cystourethrogram.

What is an X-Ray

In medicine, "imaging" is the term used for any method to take pictures of bones and organs inside the body. One of the most basic imaging methods is with x-ray radiation. X-rays can help your health care provider find the cause of a medical problem. For example, x-rays may be used to find a tumor, kidney stones , or a developmental problem.

An x-ray (or conventional radiology) is a form of radiation produced by special machines that take pictures of the inside of your body. Structures that are dense, like bones, look white on the film. Structures that contain air, like your lungs, look black. Muscle, fat and fluid will show as different shades of gray.

For more information visit our article on x-rays.

More Information

  • Why do you think this test will help me?
  • How long will I have to wait until I learn the test results?
  • How accurate are the test results?
  • What other tests will I need for diagnosis or treatment?
  • If a problem is found, what are my next-steps?

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