1Special Procedures in Veterinary Radiology--UrogenitalTravis C. Saveraid, DVM, DACVRAssistant Clinical ProfessorCollege of Veterinary Medicine –University of MinnesotaUrogenital Imaging -Special Procedures IIUrethrography and VaginographyUrethrography-indications• To evaluate the following for the urethra–Size– Location– Contents– Integrity• To indirectly assess the prostate2Urethrography-indications• Most indications for cystography• Difference between voided and cystocentesis urine samples• Pelvic traumaUrethrography-contraindications• None, really, other than allergy to contrast agent• May be difficult in some patients (e.g. female cats)3Urethrography-complications• Same as for cystography (biggest are bladder/ urethra rupture or infection)• Also have risk of pressure necrosis of urethra associated with balloonUrethrography-materials• Urinary catheter supplies• Contrast agent (full strength ionic iodine)Urethrography-procedure• Prepare as for cystogram• Place urinary catheter– If to follow cystography, remove gas and distend bladder with dilute contrast (better backpressure)– Can perform with just urine in the bladder, but should be fairly distended• If fluoroscopy available, withdraw catheter while injecting and imaging4Urethrography-procedure• If fluoro. not available, can make multiple exposures while withdrawing catheter (retrograde urethrogram)• Can also place catheter in distal urethra, inflate balloon, inject contrast until backpressure achieved, make exposure (sl. risky)• Can also start with contrast-distended bladder, apply pressure with paddle, make exposure during urination (voiding urethrogram)Urethrography-normal findings• Margins of urethra should be smooth• No filling defects (air bubble common artifact)• Some extravasation into prostate • Some variation in urethral diameter Urethrography-normal5Urethrography-normalUrethrography-abnormal findings• Filling defects– Intraluminal• Stones, blood clots, foreign bodies (bubbles!)– Intramural• Inifiltrative disease (neoplasia, inflammation), hematoma– Extramural• Neoplasia, prostatic cysts/abscess, hematomaUrethrography-filling defects6Urethral Stones?Urethral StonesUrethrography-filling defects7Urethrography-abnormal findings• Strictures• Dilations• Leakage of contrast–Cysts– Surrounding connective tissue– Ureter(s)– ColonUrethrography-strictureUrethrography-narrowing8Urethrography-leakageUrethrography-leakageUrethrography-leakage9Urethrography Alternatives• Similar to other procedures but disadvantages generally far outweigh advantages (except perhaps sampling with urethroscopy)Vaginography(retrograde vaginourethrographyVaginography-indications• To evaluate vagina and vaginal vestibule– Abnormal digital exam (strictures, masses, atypical anatomy)– Inability to form tie with male– Unexplained discharge– Recurrent urinary tract infections• To obtain retrograde urethrogram when catheterization not possible (hopefully)10Vaginography-materials• Foley catheter• “Atraumatic” clamp• “Half” strength ionic iodine contrast, q.s. to get slight back pressure• Sedation / general anesthesiaEquipmentVaginography-procedure• Prepare as for other studies – gentle, sterile prep• Survey lateral and VD radiographs• Insert catheter into vestibule, inflate balloon, clamp off labia• Inject contrast, make exposure while injecting• Post contrast lateral and VD (obliques when needed)11Vaginography-normal findings• Vestibule walls fairly straight-sided• Normally SOME narrowing at vaginovestibular junction (typically about 75% of lumen)• Urethral opening just caudal to VV junction• Vagina quite distensible• Cervix approximately parallel to dorsal wall• May or may not see contrast in cervical canal, uterine hornsNormal VaginogramVaginography12VaginogramVaginography-abnormal findings• Filling defects– Masses– Septations• Extravasation of contrast– Connective tissue– Ureter(s)– Rectum– Bladder– DiverticuliVaginography-abnormal findings• Strictures (lumen 50% smaller or wrong location)– Depending on location can predispose to “urine pooling” and chronic urinary tract infections• Segmental aplasia13VaginographyVaginographyVaginography14Vaginography Alternatives• Not really alternatives, should be considered complementary• Digital exam – physical exam always important!!! •