Bladder Flashcards
In a normal urachal development,
Bladder end:
Mid portion:
Umbilical end:
Incidence:
All are completely obliterated, remnant is the Median umbilical ligament
In a Patent urachus (urachal fistula),
Bladder end:
Mid portion:
Umbilical end:
Incidence:
Bladder end: Patent
Mid portion: Patent
Umbilical end: Patent
Incidence: 50% of urachal anomalies
In a Urachal diverticulum,
Bladder end:
Mid portion:
Umbilical end:
Incidence:
Bladder end: Patent
Mid portion: Obliterated
Umbilical end: Obliterated
Incidence: 5% urachal anomalies
In a Urachal Cyst,
Bladder end:
Mid portion:
Umbilical end:
Incidence:
Bladder end: Obliterated
Mid portion: Patent
Umbilical end: Obliterated
Incidence: 30% urachal anomalies
In a Urachal sinus,
Bladder end:
Mid portion:
Umbilical end:
Incidence:
Bladder end: Obliterated
Mid portion: Obliterated
Umbilical end: Patent
Incidence: 15%
If a urachal sinus is suspected, what else must be rules out?
Meckels diverticulum (persistent omphalomesenteric duct)
What are different ways to diagnose a urachal anomaly?
Fistulogram
Ultrasound
VCUG
Etiology of a patent urachus?
secondary to congenital bladder outlet obstruction (e.g. posterior urethral valves)
Causes urine to drain from umbilicus
If a urachal cyst is infected, what is the most likely pathogen?
S. aureus
- percutaneous drainage + antibiotics, then excise
Urachal anomalies should always be excised because of the risk of developing what?
Treatment of this?
Urachal adenocarcinoma, located at the bladder dome.
Treat with a partial cystectomy.
What is megacystitis?
What is the rare syndrome that it is associated with?
Non-specific distended and thin fetal bladder from anatomic or functional obstruction
MMIH, megacystitis microcolon intestinal hypoperistalsis syndrome (Berdon syndrome)
- mistaken for Prune belly syndrome
Etiology of bladder agenesis?
Is it compatible with life?
Defect of upper anterior cloaca
Not life compatible unless ectopic ureters present
What syndromes are more commonly associated with bladder diverticula?
Ehlers-Danlos, Marfan syndrome, Menkes syndrome, William Elfin-facies
What is a Hutch diverticulum?
Paraureteral orifice diverticulum; may cause VUR, ureteral obstruction, bladder outlet obstruction, frequent UTIs, bladder stones
Etiology of bladder extrophy-epispadias complex?
Premature cloacal membrane rupture, leading to infraumbilical anomalies from deficient mesenchyme caudal migration between the ectodermal and endodermal layers
What antenatal ultrasound findings are present in bladder extrophy-epispadias?
low-set umbilical cord, lower abdominal wall mass, bladder not in the abdomen, weird genitalia
What are variants of the bladder extrophy-epispadias complex?
Classic bladder extrophy (most common) Cloacal extrophy (rare) Epispadias covered extrophy (extremely rare) Duplicate extrophy Superior vesical fissure
Describe classic bladder extrophy anomalies
Distal rectus muscles are divided and widen the pelvic bones, creating a triangular fascial defect that allows eversion of bladder with visible bladder mucosa through the abdominal wall
- high incidence of indirect hernias (due to widened pelvis)
Treatment of classic extrophy?
Immediate protection of mucosa with saline wrap
1st day of life closure without osteotomies if possible
Primary vs delayed epispadias repair
What are the primary anomalies with cloacal extrophy?
Non-tubularized cecum and hemibladder are open and everted through the midline
Split penis, completely separated into corpora cavernosa and hemi-glans
Renal anomalies, short gut syndrome, etc.
Treatment of cloacal extrophy?
Immediate closure, genital repair
Etiology of epispadias?
incomplete urethral tubularization
- dorsal drainage in boys
- females drain between clitoris and labia
When do you repair isolate epispadias
6 months
