Urinary Tract Abnormalities Quiz

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