Diagnostic Imaging of the Urinary Tract
PU/PD, stranguria, hematuria, pollakiuria, and inappropriate urination-diseases of the urinary tract present in various ways. And there are many diagnostic imaging options for the urinary tract as well.
Survey radiographs are a good place to start, especially for diseases such as urinary stones, renal asymmetry, or prostatomegaly.
Ultrasound is also often used for the urinary system. Ultrasound is noninvasive and usually well tolerated. It cannot, however, evaluate structures within or caudal to the pelvic canal. Ultrasound evaluates the size and architecture of the kidneys, the wall and contents of the urinary bladder, the prostate, and usually the proximal urethra. Unless they are dilated, the ureters are not readily visible. If they are visible (Image 1), ultrasound is usually extremely helpful in determining the cause of ureteral dilation, although intestinal gas can inhibit visualization.
CT eliminates the frustration of structures being obscured by GI gas or pelvic canal bones during an ultrasound (Image 2). Intravenous pyelogram (IVP) or cystourethrography can be performed, in which contrast is given and serial CT images are obtained to evaluate the progress of contrast through the urinary system. Renal and urinary bladder masses, ureteral dilation, and urethral, prostatic, and vaginal disease can be evaluated with CT, and is often utilized for presurgical (i.e., for nephrectomy) or radiation therapy planning.
Fluoroscopy is used most often to perform cystourethrograpy or IVPs. It allows real-time evaluation of the progress of contrast through the urinary system, either antegrade through the kidneys and ureters (i.e., for ectopic ureters) or retrograde through the urethra and urinary bladder (and vagina in females) to evaluate for lower urinary disease.
Nuclear scintigraphy is most often used for GFR studies prior to nephrectomy. It provides global and individual functional information about the kidneys to determine whether nephrectomy is possible.
Takeaway: Because the urinary tract is amenable to multiple diagnostic imaging modalities, it can be difficult to determine the best option. Please feel free to contact DVMS with any imaging questions you might have. We would be more than happy to help you determine the best choice for your patient.
We welcome your call at 480.635.1110 EXT.7 to learn more, make a referral,
or discuss a case for referral consideration.
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