ARRS 2022 Abstracts

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E1668. Gone But Not Forgotten: Primer on Fluoroscopic Genitourinary Procedures in Modern Clinical Practice
Authors
  1. Paul Sathiadoss; The Ottawa Hospital/University of Ottawa
  2. Mohammad Haroon; The Ottawa Hospital/University of Ottawa
  3. Yashmin Nisha; The Ottawa Hospital/University of Ottawa
  4. Sabarish Narayanasamy; University of Iowa
  5. Satheesh Krishna Jeyaraj; Joint Department of Medical Imaging, University of Toronto
  6. Nicola Schieda; The Ottawa Hospital/University of Ottawa
Background
Fluoroscopic imaging studies had long been the imaging modality of choice in the evaluation of the GU tract, but have now been largely replaced by cross-sectional modalities of CT and MRI, which can depict parenchymal as well as intraluminal abnormalities. Fluoroscopic studies may still play an important role in specific clinical scenarios such as the assessment of the urothelium (ureterogram and cystogram) and in identifying fistulas and post-operative defects of the urinary tract (voiding cystourethrogram and retrograde uretherogram). Loopogram studies provide valuable information in the assessment of post-operative leaks and strictures adjacent to the ileal conduit. The declining use of fluoroscopic studies in favor of cross-sectional modalities poses a challenge to the dissemination of knowledge in terms of instruction of technique and interpretation of these procedures. The purpose of this exhibit is to review GU fluoroscopic procedural techniques and pictorially present commonly encountered abnormalities identified during these studies.

Educational Goals / Teaching Points
After viewing this presentation, a reader will understand the normal anatomy and appearance of the ureters at retrograde/antegrade ureterogram and diagnose common conditions; know how to perform and interpret Fluoroscopic cystogram and loopogram examinations recognizing normal anatomy and common pathologies; and perform and interpret fluoroscopic urethrogram in male and female patients with an understanding technical challenges, normal anatomy and common abnormalities.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The exhibit includes basics, sterile techniques, considerations for pre-procedural antibiotics, indications which studies can be performed with CT or MRI as an alternative. 5 common fluoroscopic GU procedures: retrograde/antegrade ureterogram (basics, technique, indications, pitfalls, diagnoses [post-operative anastomosis, trauma, obstruction, calculi, neoplasm], strictures); cystography (basics, technique (how much and which contrast to use), indications, pitfalls, diagnoses (post-operative anastomosis, trauma, fistula, urodynamics); loopogram (basics, technique [cannulating the stoma, which catheter, should the balloon be inflated to form a seal], indications); reservoir types (continent versus incontinent, small versus large bowel), pitfalls, diagnoses (leak, stricture, fistula, recurrent tumor); voiding cystourethrogram (basics, technique [inserting foley catheter, can the patient void over a catheter, tips to improve voiding, use of intermittent fluoroscopy], indications, anatomy of female urethra, pitfalls, diagnoses [leak, stricture, fistula, diverticulum]); retrograde urethrogram (basics, technique [is catheterization needed in all patients, which catheter to use, should the balloon be inflated, should lubrication be used, patient positioning], indications, anatomy of male urethra, pitfalls, diagnoses [trauma, leak, stricture, tumor]).

Conclusion
Knowledge of procedural techniques and common diagnoses is essential for the adequate interpretation of GU fluoroscopic studies, a broad review of which has been presented in this exhibit.