Bladder and Urethra
- Bladder diverticuli
These are focal herniations of the urothelium and submucosa through weak sites in the bladder wall.
- Primary/congenital/idiopathic: e.g. Hutch diverticulum which is located at paraureteral location and has board neck. Q
- Secondary diverticuli: e.g. pseudodiverticuli due to bladder outlet obstruction having constricted neck and are usually multiple. They result mostly due to chronic elevation in intravesical pressure and are frequently encountered in male patients above 60 years age. In early stages, multiple small protrusions of the bladder lumen appear between the trabeculae, called sacculations. As they enlarge above 2 cm they become defined as diverticuli. When large, they may produce classical symptom of double micturition. Q
- Ureterocele is cystic ectasia of subepithelial segment of intravesical part of ureter.
- MCU in children with Ureterocele shows a rounded or oval lucent defect near trigone which may however be effaced with increased bladder distension and eversion may be seen during micturition.
- IVU shows early filling of bulbous terminal ureter ("cobra head" appearance) and a radiolucent halo (ureteral wall + adjacent bladder urothelium) giving "spring onion" appearance.Q
- Thus, Ureterocele leads to repeated infection of renal system and has above explained radiological features.
- Urethral strictures
- Most urethral strictures are caused by trauma or inflammation.
- QInflammatory strictures most commonly occur at the bulbar urethra, the sites of
- Periurethral glands while traumatic strictures are most commonly seen at bulbomembranous area.
- Iatrogenic occur at fixed and narrow sites of urethra like membranous and penoscrotal junction.
- QVoiding cystourethrogram or micturating cystourethrogram demonstrates the prostatic urethra to best advantage, as it is better distended than the membranous and anterior urethra.
- Retrograde urethrography depicts the membranous and anterior urethra better and is preferred approach for assessing inflammatory lesions and diverticuli.
- US is able to assess both urethral and periurethral tissues and has shown to be more accurate than conventional urethrography for assessing urethral structures.
- MRI provides excellent soft tissue contrast and depicts urethra and the periurethral tissues to best advantage.
- Posterior Urethral Valves
- Varying degree of chronic urethral obstruction due to fusion and prominence of plicae colliculi, normal concentric folds of urethra.
- QUsually located in posterior urethra just distal to the level verumontanum
- QIt is the most common cause of severe obstructive uropathy in infants and children.
- MCU is gold standard in diagnosis of PUV.
- After birth, an MCU is diagnostic for PUV.
Posterior urethral valve is the commonest obstructive uropathy seen in male child and can be diagnosed by ANC ultrasound . Q
- Bladder rupture.
- Extraperitoneal Bladder Rupture
- It is commonest type of bladder rupture (80%) after blunt trauma abdomen and is associated usually with fracture bony pelvis and posterior urethral injuries. The urine extravasates in perivesical region, first in cave of Ritzius, i.e., retropubic space. Q
- Radiograph may show fracture pelvic bones, pear shaped bladder density, loss of obturation fat planes, upwards displacement of coils and paralytic ileus.
- Cystography (gold standard, definitive) reveals distorted bladder with extravasation of contrast in perivesical space and steaks of contrast into fascial planes giving typical "sun burst" appearance. Q
- US shows "bladder in bladder" appearance due to perivesical collection and rent may be detected. Q
- CT Cystography is best investigative technique as the exact site and extent of rent, bladder wall contusions, blood clots and surrounding organ injuries can be detected.