Urinary Bladder

• what radionuclide method is used to examine the bladder?

  Cystography
• what are the main methods used for diagnosis of vesicoureteral reflux?

  • x-ray cystography
  • direct cystography
  • indirect cystography
• who is x-ray cystography limited to?

  patients with recurrent urinary tract infection
• what the grades of vesicoureteral reflux?

  Grade I: reflux into the distal ureters

  Grade II: reflux into the renal collecting system without calyceal dilatation or blunting

  Grade III: Grade 2 but with pelvic dilatation

  Grade IV: Grade 3 but with greater dilatation of pelvis and calyces with some clubbing

  Grade V: Grade 4 associated with severe tortuosity of the ureter
• what is Direct cystography used to examine?

  the bladder of a child
• what is the procedure for direct cystography?

  1. catheter to empty the bladder of urine
  2. By the infusion bladder is filled with RF (99mTc DTPA) - which is not absorbed,
  3. after the bladder is filled up, the child will have the stimulus to urinate.
  4. Child sits on the potty and makes the recording by gamma camera in the posterior projection, as well as by indirect RN cystography.
• advantages of direct cystography

  • very low radiation exposure of the patient,
  • The higher sensitivity than the indirect cystography
  • There is a need for such collaboration patients than indirect RNCG
• disadvantages of direct cystography

  • Invasiveness (catheterization of the bladder)
  • Difficult to carry out investigations
• when is indirect cystography performed?

  after conventional renography with 99mTc MAG3 (mertiatide) or 123I OIH (orthoiodohippurate)
• advantages of indirect cystography

  • High excretion rate
  • No need catheterization
  • Less sensitive and specific than VCUG/direct cystography
• What is hydronephrosis?

  the swelling of a kidney due to a build-up of urine and occurs when urine cannot drain out from the kidney to the bladder from a blockage or obstruction.
• What is glomerular filtration rate examination (GFR)?

  measure of the function of your kidneys and the rate refers to the amount of blood that is filtered per minute.
• how is the patient prepped for glomerular filtration rate examination?

  patient has to be hydrated 30min before the examination (0.5L)
• what Rf is used in glomerular filtration rate examination?

  • 99mTc DTPA,
  • 51Cr-EDTA
• What is glomerular filtration rate examination procedure?

  RF is injected and after the initial injection, three blood samples will be taken over a 4h period – at 2, 3 and 4h
• Advantages of glomerular filtration rate examination

  • high accuracy especially when multisampling method is used.
  • Ease of use (screening), which radioactivity is measured in blood samples.
  • Low radiation exposure.
• Disadvantages of glomerular filtration rate examination

  • the time and complexity of the test,
  • the need for more blood donations,
  • the low activity of the RF not be displayed in kidney
• what are the clearance measurement methods of the urinary bladder?

  • glomerular filtration rate examination
  • tubular extraction rate
• what Rf is used in tubular extraction rate?

  99mTc MAG3