4. Genitourinary (Bladder) Flashcards
Normal anatomy (3)
Extraperitoneal structure with 4 layers.
Dome of bladder has peritoneal cover.
Lined with transitional urothelium
Prune belly (Eagle Barrett) (5)
Malformation triad occuring in babies.
Classically shown with baby shaped like a pear (big wide belly)
Triad:
- Deficiency of abdmonal musculature
- Hydroureteronephrosis
- Cryptorchidism (bladder distention interfered with descend of testes)
Bladder diverticula (5)
More common in males.
Most are due to chronic outlet obstruction (big prostate).
Associated with some syndromes, like Ehlers Danlos.
Bladder diverticula usually arise from lateral walls or near ureteral orifices.
Diverticula at anterior/superior bladder more likely to be urachal diverticula.
Ureters more commonly deviate medially adjacent to diverticula.
Hutch diverticulum (2)
Occurs at UVJ and NOT associated with posterior urethral valves.
Associated with ipsilateral reflux (normal slanted insertion of ureter is altered.
Bladder ears (4)
Transitory extraperitoneal herniation of the bladder.
Not a diverticulum, but lateral protrusion of bladder into inguinal canal.
Common, associated with inguinal hernia.
Smooth wall and wide neck differentiates it from diverticulum.
Cloacal malformation (2)
GU and GI both drain into common opening (like a bird).
Only happens in females.
Urachus (4)
Umbilical attachment of the bladder usually atrophies and becomes the umbilical ligament, as bladder descends into the pelvis.
Persistent patent urachus can result in urine flow from bladder to umbilicus.
Spectrum from patent > sinus > diverticulum > cyst.
Can get infected. Seen in midline. Associated with adenocarcinoma.
Rhabdomyosarcoma (4)
Most common bladder cancer under 10 years old.
Often infiltrative, hard to tell where they originate.
“paratesticular mass” is often a buzzword.
Can met to lungs, bones, nodes.
Botryoid variant produces a polypoid mass, looks like bunch of grapes.
Squamous cell carcinoma (2)
Associated with schistosomiasis.
Heavily calcified bladder and distal ureters.
TCC (2)
Most common site of TCC.
Most common subtype is Superficial Papillary.
Adenocarcinoma of bladder (2)
Associated with urachus.
90% of urachal cancers are midline at bladder dome.
Leiomyoma (3)
Benign tumour, often incidentally discovered.
Most common at trigone.
Most common mesenchymal bladder tumour.
Diversion surgery (2)
After cystectomy for bladder cancer, several urinary diversion procedures can be done. Usually split into incontinent and continent.
General idea is a piece of bowel is made into either a conduit or reservoir, then ureters are attached to it.
Diversion surgery - early complications (3)
Alteration in bowel function
- Adynamic ileus is commonest early complication, in almost 25%. 3% get SBO, usually from adhesions near enteroenteric anastamosis.
Urinary leakage
- 5% of cases, usually at ureteral-reservoir anastamosis. Urinoma can develop when leaked urine isn’t collected by urinary drains.
Fistula
- Uncommon, seen more after pelvic radiation
Diversion surgery - late complications (6)
Urinary infection (can be early or late)
Stones (look at non contrast study)
Parastomal herniation
- 15% with ileal conduits, obesity is a contributing factor. 10% need surgical Rx.
Urinary stricture
- Left side is higher risk than right, due to angulation (brought through or under mesentery)
Tumour recurrence
- more advanced original disease = higher risk of recurrence.
- Incidence between 3-15%, can present as soft tissue mass at ureter, bladder or pelvis lymph node.
