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Endoscopy and Radiology for Lower Urinary Tract Dysfunction

Endoscopy and Radiology for Lower Urinary Tract Dysfunction. Hann-Chorng Kuo Department of Urology Buddhist Tzu Chi General Hospital. Lower Urinary Tract . Urinary bladder Ureteral orifices Trigone Bladder neck Prostate and prostatic urethra Urethral sphincter

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Endoscopy and Radiology for Lower Urinary Tract Dysfunction

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  1. Endoscopy and Radiology for Lower Urinary Tract Dysfunction Hann-Chorng Kuo Department of Urology Buddhist Tzu Chi General Hospital

  2. Lower Urinary Tract • Urinary bladder • Ureteral orifices • Trigone • Bladder neck • Prostate and prostatic urethra • Urethral sphincter • Urethra (posterior, bulbous, anterior)

  3. Bladder wall in Cystoscopy • Smooth bladder wall • Trabeculated bladder wall • Diverticulum • Pseudodiverticulum • Bladder tumor • External compression

  4. Smooth Bladder Wall

  5. Trabeculation of Bladder Wall

  6. Bladder Tumor

  7. Bladder mucosa • Normal mucosa and vasculature • Hyperemia • Ischemia • Hemorrhagic cystitis • Cystitis cystica • Pseudomembranous trigonitis • Granulomatous cystitis

  8. Normal Mucosal Vasculature

  9. Hyperemia and Inflammation

  10. Hemorrhagic cystitis

  11. Cystitis Cystica

  12. Pseudomembranous Trigonitis

  13. Granulomatous Cystitis

  14. Tuberculosis Cystitis

  15. Prostatic enlargement • Benign prostatic enlargement • Prostatic cancer

  16. Bladder Neck Obstruction

  17. Urethral Stricture • Bladder neck contracture • Membranous urethral stricture • Anterior urethral stricture • Anterior urethral valve • Meatal stenosis

  18. Urethral Stricture

  19. Ureteral Orifice • Normal cone shape • Horseshoe shape • Stadium shape • Golf hole shape • Short submucosal ureteral tunnel

  20. Ureteral Orifice

  21. Chronic Inflammation of Female Bladder Neck

  22. Female Urethral Incompetence • Bladder neck incompetence • Urethral incompetence

  23. Interstitial Cystitis

  24. Painful Bladder Syndrome

  25. Bladder Stone

  26. Bladder musculature

  27. Uroradiology in Lower Urinary Tract Dysfunction • Intravenous pyelography (IVP) • Retrograde pyelography • Cystography • Voiding cystourethrography • Retrograde urethrography • Beaded chain cystourethrograph • Magnetic resonance image (MRI)

  28. Intravenous pyelography inBenign Prostatic Hyperplasia

  29. Inravenous Pyelography in High Grade Cystocele

  30. Retrograde Pyelography inUreteral stricture

  31. Voiding Cystourethrography • Bladder neck dysfunction • Prostatic obstruction • Urethral stricture • Anterior urethral valve • Vesicoureteral reflux • Bladder diverticulum

  32. Cystography on Straining

  33. Urethral Incompetence

  34. Bladder Base IndentationProstate Enlargement

  35. Voiding CystourethrographyProstatic Obstruction

  36. Voiding Cystourethrography inDESD and after Sphincterotomy

  37. Voiding CystourethrographyAnterior urethral valve

  38. Voiding CystourethrographyDysfunctional voiding

  39. Voiding CystourethrographyUrethral meatal stricture

  40. Transrectal sonography • Prostatic configuration • Urethral stricture • Bladder neck incompetence • Bladder base hypermobility • Intravesical pathology

  41. Prostate Configuration • Prostatic urethra • Transition zone of prostate • Seminal vesicle • Ejaculatory duct • Peripheral zone of prostate • Bladder neck

  42. Transrectal sonography of the Prostate, Seminal vesicle, Urethra

  43. Prostatic Enlargement

  44. Transition Zone Index (TZI) • Transition zone vol/ total prostate vol • A TZI of <0.3 indicates low possibility of prostatic obstruction, a TZI of >0.5 indicates highly suspicious prostatic obstruction • TZI correlates poorly with total prostatic volume

  45. Measurement of TZI

  46. Female Urethral Structure

  47. Female Urethra in SUI

  48. Hypermobility of Bladder Base

  49. Beaded-Chain Cystourethrography

  50. MRI of Cystocele

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