Podcast
Questions and Answers
What is the primary cause of urinary obstruction in infants with Posterior Urethral Valves syndrome?
What is the primary cause of urinary obstruction in infants with Posterior Urethral Valves syndrome?
Which of the following conditions is NOT typically associated with an enlarged prostatic urethra during sonography?
Which of the following conditions is NOT typically associated with an enlarged prostatic urethra during sonography?
What is the most likely reason for a diverticulum to increase in size after voiding?
What is the most likely reason for a diverticulum to increase in size after voiding?
What diagnostic feature distinguishes a ureterocele from a cystic abdominal mass?
What diagnostic feature distinguishes a ureterocele from a cystic abdominal mass?
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What is the most common complication associated with Posterior Urethral Valves syndrome?
What is the most common complication associated with Posterior Urethral Valves syndrome?
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What condition is characterized by a cyst-like enlargement of the lower end of the ureter?
What condition is characterized by a cyst-like enlargement of the lower end of the ureter?
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What is the most common cause of hydroureter and hydronephrosis proximal to a ureterocele?
What is the most common cause of hydroureter and hydronephrosis proximal to a ureterocele?
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Which of these conditions is NOT a possible complication of a ureterocele?
Which of these conditions is NOT a possible complication of a ureterocele?
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What is the most common type of urachal anomaly?
What is the most common type of urachal anomaly?
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Which of the following is NOT a common cause of bladder wall thickening?
Which of the following is NOT a common cause of bladder wall thickening?
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What is the most common type of bladder rupture?
What is the most common type of bladder rupture?
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What is the characteristic sonographic appearance of an urinoma?
What is the characteristic sonographic appearance of an urinoma?
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Which of the following is a common symptom of bladder neoplasms?
Which of the following is a common symptom of bladder neoplasms?
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What is the typical thickness of a normal bladder wall?
What is the typical thickness of a normal bladder wall?
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What is the most likely cause of bladder rupture?
What is the most likely cause of bladder rupture?
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What is the sonographic appearance of blood clots in the bladder?
What is the sonographic appearance of blood clots in the bladder?
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What condition is characterized by urine draining constantly from the umbilicus?
What condition is characterized by urine draining constantly from the umbilicus?
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What is the most common cause of stress incontinence?
What is the most common cause of stress incontinence?
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Study Notes
Diverticulum
- Pouch-like outward bulging of the bladder wall
- Caused by mucosal herniation through muscle wall defects (congenital or acquired)
- May have a narrow connection to the bladder, diagnosed via scanning
- Can contain tumors or stones
- May not completely empty after voiding, potentially enlarging
- Possible incomplete emptying and growth after urination
Posterior Urethral Valves
- Mucosal flap originating from the verumontanum
- Common cause of urinary blockage in infants
- Typically diagnosed in the first year of life, rarely later
- Often associated with vesicoureteral reflux (often due to periureteral diverticulum)
- 40% of affected patients have reflux;
- Dilated and elongated prostatic urethra suggests diagnosis (rather than neurogenic bladder dysfunction)
- Thickened bladder wall, hydrouretors, and dilated upper urinary tract are often present
Ureterocele
- Cyst-like swelling at the lower ureter end
- Narrowing of the ureteral opening in the sac wall can cause hydroureter, hydronephrosis, and infection
- Ureterocele sac can obstruct bladder outlet, sometimes prolapsing through urethra.
- Ectopic ureterocele: Obstructed ectopic ureter causes anterior bladder wall bulging
- Comprehensive kidney scanning is crucial for ectopic ureter and ureterocele detection
- Duplex kidneys and massively dilated, tortuous distal ectopic ureters with mildly dilated proximal ureters are possible
- Large ureteroceles can mimic multiseptate, cystic abdominal masses due to shape changes with intravesical pressure
- Oval or round, thin-walled cystic structure on distended posterior bladder wall
- Often an incidental finding during sonography
Urachal Variants
- Embryonic tract connecting bladder to umbilicus
- Normally obliterates at birth; failure results in open channel
- Four types of anomalies:
- Patent urachus/fistula (50%): Constant urine drainage from umbilicus
- Urachal sinus (15%): Urachus closes at bladder, opens at umbilicus
- Urachal cyst (30%): Both ends of urachus close, trapping urine
- Urachal diverticulum (5%): Urachus closed at umbilicus, open at bladder
Bladder Wall Abnormalities
- Thickened bladder wall is a common sonographic finding
- Often due to outlet obstruction, neurogenic bladder, cystitis, edema from surrounding inflammation, or tumors
- Thickening can also be from primary or secondary neoplasms
Trauma/Rupture
- Common with severe blunt lower abdominal or pelvic trauma, or penetrating injuries
- Usually extraperitoneal (80% of cases)
- Bladder rupture can lead to urinoma (accumulation of urine in tissues; anechoic mass with enhanced through-transmission).
- Urinoma often has irregular borders and internal septations/debris
- Leukocytosis and dropping hematocrit suggest infected hematoma; dropping hematocrit alone indicates a hematoma
Trauma/Blood Clots
- Clots can adhere to bladder wall, appearing as irregular patterns on bladder mucosal surface
- Position-dependent movement of the clots is possible
Bladder Neoplasms
- Mostly epithelial/uroepithelial in origin
- Often seen in urogenital and renal sonography
- Common symptom is painless hematuria (along with dysuria, urinary frequency, urgency)
- Tumors create irregularity in the 3-5mm thickness of bladder wall
- Often detected by cystoscopy
Stress Incontinence
- Due to poorly supported bladder neck/bladder-urethra junction
- Coughing, straining, bearing down forces bladder neck inferiorly, opening urethra, and expelling urine
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Description
Test your knowledge on various urinary tract abnormalities including diverticulum, posterior urethral valves, and ureterocele. This quiz covers important characteristics, causes, and diagnosis related to these conditions, making it an essential review for medical students and professionals.
