Transrectal ultrasound (TRUS) is a technique that is used most commonly to evaluate
the prostate gland, including ultrasound-guided prostate biopsies
depth of invasion of colon/rectal cancer (for staging purposes)
It can also be used for guidance in placing a transrectal drain, or in rare pro...
Transureteroureterostomy (TUU) is a procedure in which one ureter is divided and then connected (re-routed) into the other. It is performed when a distal ureter needs to be bypassed and can be performed instead of a psoas hitch or Boari flap. It may be preferable if the patient has had prior rad...
Transurethral resection of the prostate (TURP) is a traditional therapy for lower urinary tract symptoms (LUTS) and prostatism from benign prostatic hyperplasia. TURP results in characteristic imaging features.
acute urinary retention
True hermaphroditism is a form of disorder of gender development.
Patients with true hermaphroditism have mosaicism of 46XX and 46XY. They therefore have both ovarian and testicular tissues.
There are three forms of true hermaphroditism:
unilateral true hermaphroditism
Tuberculous adrenalitis is the result of adrenal mycobacterium tuberculosis (TB) infection. Its incidence has decreased in the western world with the declining incidence of tuberculosis.
As the tuberculous infection causes destruction of the adrenal cortex, primary adrenal insufficie...
Tuberous sclerosis, also known as tuberous sclerosis complex or Bourneville disease, is a neurocutaneous disorder (phakomatosis) characterized by the development of multiple benign tumors of the embryonic ectoderm (e.g. skin, eyes, and nervous system).
Tuberous sclerosis has an in...
The tuberous sclerosis diagnostic criteria have been developed to aid the diagnosis of tuberous sclerosis and have most recently been updated in 2012 by the International Tuberous Sclerosis Complex Consensus Group (at time of writing - 2018) 1.
The identification of...
Tubular ectasia of rete testis represents dilated testicular mediastinal tubules.
This condition is more common in men over the age of 55 years.
This is a benign condition thought to result from the partial or complete obliteration of the efferent ducts. These sperma...
Tubular ectasia of the epididymis results in enlargement of the epididymis with multiple cystic interfaces. It typically occurs in those with a prior vasectomy but can be also seen with other causes of obstruction of the ductus deferens.
This can give a charac...
Tumors of the male urethra are uncommon. They can be categorized both on the grounds of histology and location.
squamous cell carcinoma of the urethra: 80%
urothelial/transitional cell carcinoma of the urethra: 15% (predominantly posterior urethra)
adenocarcinoma of the urethra: 5%...
Tumors arising primarily from the seminal vesicles are rare. Most frequently, when a mass is seen in the seminal vesicles, it represents a contiguous spread from tumors in adjacent organs, in particular, the prostate.
adenocarcinoma of the seminal vesicle
the most common pri...
Tunica albuginea (TA) cysts are the most common extratesticular benign scrotal mass lesion. They are a type of scrotal tunica cyst.
Their mean age at presentation is 40 years (although may be seen in the 5th and 6th decades).
They are usually palpable.
The tunica albuginea (TA) forms the fibrous covering of the testis and is itself covered by the serous layer, the tunica vaginalis. The covering is total, except for at the point of attachment of the epididymis, and a small defect posteriorly where the spermatic cord vessels enter and leave the ...
Tunica is a word used in anatomy to refer to a type of covering.
tunica adventitia (also known as tunica externa)
tunica albuginea (ovary)
tunica albuginea (penis)
tunica albuginea (testis)
tunica vaginalis (ovary)
Tunica vaginalis cyst is a type of benign paratesticular cystic lesion. It is a cyst that arises from the tunica vaginalis and, in conjunction with tunica albuginea cysts, they are collectively termed scrotal tunica cysts.
Their exact cause is unknown, although history of trauma, hem...
The tunica vaginalis (TV) represents the investing serosal covering of the testis. It forms as the embryological testis descends and passes out through the superficial inguinal ring carrying its abdominal peritoneal covering with it.
The tunica vaginalis is said to consist of two layers, the pa...
Tunica vaginalis testis mesothelioma refers to mesothelioma arising from the tunica vaginalis.
Malignant mesothelioma originating from the tunica vaginalis is extremely rare.
Patients usually present with enlarging or recurrent hydrocele, or less frequen...
Twinkling artifact is the result of intrinsic machine noise seen with color Doppler ultrasound 1. It occurs as a focus of alternating colors on Doppler signal behind a reflective object (such as calculi), which gives the appearance of turbulent blood flow 2. It appears with or without an associa...
An umbilical-urachal sinus belongs to the spectrum of congenital urachal anomalies and represents a non-communicating dilatation of the urachus at the umbilical end.
Presentation is commoner in children and rare in adult.
An umbilical-urachal sinus...
Unilateral renal enlargement can arise from a number of causes which include:
duplicated pelvicalyceal system
crossed-fused renal ectopia
renal arterial infarction
renal vein thrombosis
anatomic compression of the renal vein
acute bacterial nephritis
The differential diagnosis for unilateral testicular lesions is wide-ranging.
seminoma (40-50% of testicular malignancies)
non-seminomatous germ cell tumors:
testicular epidermoid (teratoma with ectodermal elements only)
Urachal cysts are one of the manifestations of the spectrum of congenital urachal remnant abnormalities.
Urachal cysts usually remain asymptomatic until complicated by infection or bleeding.
An infected urachal cyst can occur at any age.
The urachus is the fibrous vestigial remnant of the fetal allantois.
The lumen of the urachus usually obliterates after birth and it becomes the median umbilical ligament, a midline linear fibrous fold of parietal peritoneum, extending from the apex of the bladder to the umbilicus.
If the lume...
The ureter is a paired fibromuscular tube that conveys urine from the kidneys in the abdomen to the bladder in the pelvis.
The ureter is 25-30 cm long and has three parts:
abdominal ureter: from the renal pelvis to the pelvic brim
pelvic ureter: from the pelvic brim to the bla...
Ureteral duplication is the most common congenital abnormality associated with the urinary tract, and occurs in ~1% of the population.
Duplication can occur unilaterally or bilaterally, and may be partial or complete:
partially duplicated ureters fuse into a single ureter proxim...
Ureteral pseudodiverticulosis is acquired false diverticula resulting from herniation of epithelium through the muscularis layer of the ureter and characterized by the presence of multiple outpouchings smaller than 5 mm. It is sometimes bilateral and is often located in the upper two-thirds of t...
A number of tumors may affect the ureter, by far the most common histology being transitional cell carcinoma.
transitional cell carcinoma of the ureter: 95% 1
squamous cell carcinoma of the ureter: 5%
adenocarcinoma of the ureter: <1%
The ureteric bud (also known as the metanephrogenic diverticulum) is a protrusion of the mesonephric duct that appears during the embryological development of urogenital organs. It will eventually form the urinary collecting system (i.e. collecting tubes, calyces, renal pelvis, ureter) of the ki...
Ureteric calculi or stones are those lying within the ureter, at any point from the ureteropelvic junction (UPJ) to the ureterovesical junction (UVJ). They are the classic cause of renal colic-type abdominal pain. They are a subtype of the broader pathology of urolithiasis.
Ureteric injury is a relatively uncommon, but severe event, which may result in serious complications as a diagnosis is often delayed.
Ureteric injuries unreliably demonstrate macro- or micro-scopic hematuria as it may be absent in up to 25% of patients 5, 6. Classic cli...
Ureteric jets (or ureteral jets) are the visualization of the normal physiological periodic efflux of urine from the distal end of each ureter into the bladder.
When the urine passing down the ureter reaches the vesicoureteric junction it is forced out into the bladder via a strong...
Ureteric rupture is rare but has been described. It may be spontaneous or secondary to another pathology or intervention.
The most common symptoms are sudden, severe, persistent lower abdominal pain with severe peritoneal irritation. Abdominal compartment syndrome, respir...
Ureteric stents, also known as double J stents or retrograde ureteric stents, is a urological catheter that has two "J-shaped" (curled) ends, where one is anchored in the renal pelvis and the other inside the bladder.
Stents are used for the free passage of urine from the kidney to the bladder,...
Ureteritis refers to inflammation of the ureter, it is rare and is often associated with cystitis or pyelonephritis 1.
Patients may present with symptoms of cystitis or pyelonephritis with suprapubic/flank pain, dysuria, hematuria and/or fever. White cell count may also ...
Ureteritis cystica or pyeloureteritis cystica is a benign condition of the ureters representing multiple small submucosal cysts.
Typically this condition is seen in diabetics, with recurrent urinary tract infection. As such is is most frequently seen in older patients and is more...
Ureteroceles represent congenital dilatation of the distal-most portion of the ureter. The dilated portion of the ureter may herniate into the bladder secondary to the abnormal structure of vesicoureteric junction (VUJ).
Most ureteroceles are congenital, usually associated with ec...
Ureterovaginal fistulae refer to abnormal communications between the lumina of the ureter(s) and the vagina.
Patients usually present with urinary incontinence through the vagina which may be accompanied by fever and chills 1. Symptoms usually begin within 2-4 weeks foll...
The urethra is the terminal segment of the genitourinary system. Because of vastly different anatomy between the sexes, male and female urethras are discussed separately:
Urethral agenesis (or urethral atresia) refers to a situation where there is a congenital absence of the urethra. It can be a cause of fetal obstructive uropathy.
prune belly syndrome 5
bladder agenesis 2
May show a dilate...
Urethral calculi are an uncommon type of urolithiasis, accounting for ~1% of all urinary tract stones.
They almost all occur in males 2 with two peak incidences - one in childhood and the other at 40 years 3.
Most commonly acute lower urinary tract symptoms...
Various radiological and surgical instruments, including urethral clamps, have been developed to try to improve retrograde/ascending urethrogram (RUG/ASU) and voiding cystourethrogram (VCUG) technique in males. These are very rarely (if ever) used anymore.
This device has a metall...
Urethral diverticula, or urethroceles, are focal outpouchings of the urethra. They should not be confused with a ureterocele of the distal ureter.
Urethral diverticula occur far more frequently in women than in men and are estimated to occur in 1-6% of women, especially those with...
Urethral diverticulum adenocarcinoma is a rare occurrence in a urethral diverticulum.
Urethral diverticulum seen in ~0.6-6% of women. In small series, only 3-6% of resected urethral diverticula show adenocarcinoma 3-4.
Urinary frequency, urgency, burning mictur...
Urethral duplication is a rare condition in which either a part or the entire urethra is duplicated. It usually occurs in the sagittal plane and the more dorsal copy is usually the duplication.
A urethral duplication may occur due to a variety of developmental miscues. In a woman, it...
Urethral injuries can result in long-term morbidity and most commonly result from trauma. The male urethra is much more commonly injured than the female urethra and is the focus of this article.
In the setting of trauma, the classic triad of blood of the external urethral...
Urethral strictures are relatively common and typically occur either in the setting of trauma or infection.
The demographics of the affected population is dictated by the etiology, but in general, it is safe to say that adult males make up the vast majority of cases.
Urethrography refers to the radiographic study of the urethra using iodinated contrast media and is generally carried out in males.
When the urethra is studied with instillation of contrast into the distal/anterior urethra it has been referred to as:
retrograde urethrography (RUG)...
The urinary bladder (more commonly just called the bladder) is a distal part of the urinary tract and is an extraperitoneal structure located in the true pelvis. Its primary function is as a reservoir for urine.
The bladder has a triangular shape with a posterior base, an anteri...
There are numerous causes of urinary bladder diverticula:
Primary (congenital or idiopathic)
Hutch diverticulum (in paraureteral region)
bladder outlet obstruction
bladder neck stenosis
posterior urethral valve
prostatic enlargement (hypertrophy; carcinoma)
Bladder diverticulum are outpouchings from the bladder wall, whereby mucosa herniates through the bladder wall. They may be solitary or multiple in nature and can vary considerably in size.
There are two peaks - one at 10 years and the other at 60-70 years 2.
Herniation of the urinary bladder is a relatively uncommon but not a rare condition. It occurs when the urinary bladder or ureter herniates into the inguinal canal, scrotal sac or femoral canal. Herniations through ischiorectal, obturator, or abdominal wall openings have also been described. Bla...
Urinary bladder rupture is usually seen in the context of significant trauma.
Bladder rupture can be categorized into five types depending on the location and extent of the rupture:
This is commonly seen but sometimes not classed as true rupture, since i...
Causes of urinary bladder wall or lumen calcification include:
schistosomiasis of the urinary tract
calculus in a urachal cyst or in a bladder divertic...
Urinary diversion is created after the removal of the urinary bladder (radical cystectomy or cystoprostatectomy, usually done to treat invasive bladder cancer).
There are three main varieties:
neobladder formed from a segment of ileum (i.e. ileal conduit, also known as a "Bricker conduit")
The urinary system consists of the kidneys, ureter, bladder and urethra. With the exception of the urethra, this is equitable in both males and females. It spans the abdomen and pelvis, from the upper abdomen to the extreme pelvis, being inextricably linked with the genital system.
Urinary tract infection (UTI) is a common clinical condition involving the bladder (cystitis) and kidneys (pyelonephritis). It is commonly divided into 'uncomplicated' and 'complicated' infections.
UTIs occur when there is bacterial colonization of the uroepithelium and a subsequent...
Urine represents the biofluid end-product of the renal filtration process. Normally it is a transparent, sterile, pale-yellow liquid (although clearly color varies with the person's hydration status).
Urine is one of the most easily-accessible biofluids in the human body and has been intensive...
Urinomas, or uriniferous fluid collections, are urine collections usually found in the retroperitoneum, most commonly in the perirenal space, as a consequence of renal tract leakage caused by urinary obstruction, trauma, or post-instrumentation.
As there is no definitive distincti...
Urinothorax is a rare cause of pleural effusion due to the accumulation of urine within the pleural space.
Patients present with varying degrees of respiratory distress depending on the amount of fluid that has accumulated 1,3.
The etiology of urinothorax can ...
The urogenital curriculum is one of our curriculum articles and aims to be a collection of articles that represent the core genitourinary knowledge.
Topics pertaining to the urinary tract (kidneys, ureter, bladder, urethra), adrenal glands, prostate penis, scrotal content (testes, ...
The urogenital triangle forms the anterior half of the diamond-shaped perineum. The triangle's corners are defined by the pubis symphysis anteriorly and the ischial tuberosities anterolaterally. The anterolateral borders are the ischiopubic rami and the posterior border is the transverse perinea...
Urolithiasis refers to the presence of calculi anywhere along the course of the urinary tracts. For the purpose of the article, the terms urolithiasis, nephrolithiasis and renal/kidney stones are used interchangeably, although some authors have slightly varying definitions of each.
See main ar...
Urothelial cell carcinoma of the urethra (formerly transitional cell carcinoma) is rare and is almost always limited to the proximal urethra in men (membranous and prostatic).
The vast majority of urethral malignancies are squamous cell carcinomas.
squamous cell carcinoma of the uret...
This is a basic article for medical students and other non-radiologists
Ultrasound abdomen is one of the tests that is commonly used in the assessment of patients with abdominal pain. It is particularly useful for the assessment of solid organs and fluid-filled structures.
The vaginal artery is a branch of the anterior division of the internal iliac artery, and should not to be mistaken with the vaginal branch of the uterine artery. It is often considered to be a homolog of the inferior vesical artery, which is present only in males.
origin: anterior div...
The Valsalva maneuver is the forced expiration of air against a closed airway, resulting in increased intra-abdominal, intrathoracic and pharyngeal pressure. It can be performed against a closed glottis or by one closing the mouth and pinching the nose while forcibly exhaling.
It is commonly us...
Varicocele is the dilatation of the pampiniform plexus of veins, a network of many small veins found in the male spermatic cord. It is the most frequently encountered mass of the spermatic cord.
The estimated incidence is at ~15% of the general male population and ~40% of subferti...
Varicocele embolization is a minimally invasive method of treating varicoceles by embolizing the testicular vein (internal spermatic veins).
failed surgical ligation
Relative contraindications include:
Varicocele grading on color Doppler can be done variably. The most elaborate and widely-accepted grading was given by Sarteschi, as below.
For a general discussion of this condition refer to the article: varicocele.
baseline greyscale study in supine position and measure the diame...
Vasitis is an uncommon inflammatory disorder of the vas deferens and spermatic cord. It is classified as either the generally asymptomatic vasitis nodosa (seen after vasectomy) or acutely painful infectious vasitis. This article refers to the acute infective form as imaging is usually not undert...
The verumontanum or seminal colliculus is the rounded eminence of the urethral crest within the posterior wall of the mid prostatic urethra. The prostatic utricle opens into it in the midline and the two ejaculatory ducts open just distal to the utricle. On either side of it lie the prostatic si...
Vesico-urachal diverticulum is one of the congenital urachal remnant abnormalities.
It is the proximal equivalent of a urachal umbilical sinus, representing a result of the failure of the urachus to close at the urinary bladder, forming an out-pouching of variable length from the...
The vesicoureteric junction (VUJ) is the most distal portion of a ureter, at the point where it connects to the urinary bladder.
VUJ is synonymous with "ureterovesicular junction" (UVJ). It is nearly synonymous with "ureteral orifice" (UO), although depending on the context, the V...
Vesicoureteric reflux (VUR) is the term for abnormal flow of urine from the bladder into the upper urinary tract and is typically encountered in young children.
For grading of vesicoureteric reflux, please refer to vesicoureteric reflux grading.
The incidence of urinary tract in...
Vesicoureteric reflux (VUR) grading divides vesicoureteric reflux according to the height of reflux up the ureters and degree of dilatation of the ureters:
grade 1: reflux limited to the ureter
grade 2: reflux up to the renal pelvis
grade 3: mild dilatation of ureter and pelvicalyceal system
Vesicovaginal fistulas are abnormal fistulous connections between the urinary bladder and vagina, resulting in an involuntary discharge of urine through the vagina.
The overall incidence of vesicovaginal fistula is unknown but was reported to be 2.11 per 100 births in Nigeria 1.
Vesicovaginal reflux is a well-known entity rarely encountered by radiologists. It is a behavioral disorder, a type of dysfunctional elimination syndrome commonly encountered in pre-pubertal girls. It is defined as reflux of urine into the vaginal vault either in supine or upright position durin...
The vestibule of the vulva (vestibule of the vagina in some texts 2) is the area between the labia minora, and posterior to the glans of the clitoris. It marks the boundary between the vagina and the vulva. The urethra, vagina and the greater vestibular glands open out into the vestibule.
Vicarious contrast material excretion (VCME) defines excretion of water-soluble contrast material in a way other than via normal renal secretion.
The most common vicarious excretion of water-soluble contrast material is via the liver, resulting in increased bile density seen in the gallbladder...
Voiding cystourethrography (VCUG), also known as a micturating cystourethrography (MCU), is a fluoroscopic study of the lower urinary tract in which contrast is introduced into the bladder via a catheter. The purpose of the examination is to assess the bladder, urethra, postoperative anatomy an...
Von Hippel-Lindau (vHL) disease is characterized by the development of numerous benign and malignant tumors in different organs (at least 40 types 1) due to mutations in the VHL tumor suppressor gene on chromosome 3.
The disease is rare with an estimated prevalence of 1:35,000-50,...
The vulva (or pudendum) is the collective term given to the female external genitalia.
The vulva consists of the:
vestibule of the vulva
Individual component st...
The WAGR syndrome stands for:
Wilms tumors (greatly increased risk)
Occurs from a mutation related to chromosome 11p13 3 which is in close proximity to the WT1 gene.
Waterhouse-Friderichsen syndrome (also known as purpura fulminans 9 or hemorrhagic adrenalitis 10) is characterized by adrenal insufficiency that results from atraumatic adrenal hemorrhage in consequence of septicaemia.
Waterhouse-Friderichsen syndrome is due to septicaemia and comm...
The watermelon skin sign refers to diffuse, radiating, streaky areas of low signal intensity in prostate on T2WI in patients with prostatic tuberculosis 1.
The Weigert-Meyer law describes the relationship of the upper and lower renal moieties in duplicated collecting systems to their drainage inferiorly.
With duplex kidney and complete ureteral duplication, the upper renal and lower renal moiety is drained by separate ureters, e...
The white pyramid sign refers to the CT appearance of the medullary pyramids of the kidney which can be seen normally on unenhanced CT scans as high-attenuation triangular structures.
Bilateral high-attenuation renal pyramids are an occasional incidental normal finding. Additionally, the unila...
Benign renal tumors were histologically classified according to the WHO in 2004 as follows 1:
Renal cell tumors
renal papillary adenoma - renal adenoma
metanephric adenoma of kidney
metanephric adenofibroma of kidney
metanephric stromal tumor of kidney
Wilms tumor, also known as nephroblastoma, is a malignant pediatric renal tumor.
Wilms tumors are the most common paediatic renal mass, accounting for over 85% of cases 1,8 and accounts for 6% of all childhood cancers 2. It typically occurs in early childhood (1-11 years) with pea...
Wilms' tumor staging is largely anatomical and relates to the invasion and spread of the tumor. Where there is invasion or metastasises, prognosis is poorer. Wilms tumor, is one of the more common childhood malignancies.
confined to kidney
complete resection possible
The Wolffian duct (also known as the mesonephric duct) is one of the paired embryogenic tubules that drain the primitive kidney (mesonephros) to the cloaca. In both the male and the female the Wolffian duct develops into the trigone of the urinary bladder.
In the female, in...
Wunderlich syndrome is a rare condition, in which spontaneous nontraumatic renal hemorrhage occurs into the subcapsular and perirenal spaces 2.
Wunderlich syndrome is clinically characterized by Lenk's triad:
acute flank pain
Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis and represents a chronic granulomatous disease resulting in a non-functioning kidney. Radiographic features are usually specific.
Xanthogranulomatous pyelonephritis is seen essentially in all age gro...