Bladder

Question 1

In a normal urachal development,

Bladder end:

Mid portion:

Umbilical end:

Incidence:

Answer 1

All are completely obliterated, remnant is the Median umbilical ligament

Question 2

In a Patent urachus (urachal fistula),

Bladder end:

Mid portion:

Umbilical end:

Incidence:

Answer 2

Bladder end: Patent

Mid portion: Patent

Umbilical end: Patent

Incidence: 50% of urachal anomalies

Question 3

In a Urachal diverticulum,

Bladder end:

Mid portion:

Umbilical end:

Incidence:

Answer 3

Bladder end: Patent

Mid portion: Obliterated

Umbilical end: Obliterated

Incidence: 5% urachal anomalies

Question 4

In a Urachal Cyst,

Bladder end:

Mid portion:

Umbilical end:

Incidence:

Answer 4

Bladder end: Obliterated

Mid portion: Patent

Umbilical end: Obliterated

Incidence: 30% urachal anomalies

Question 5

In a Urachal sinus,

Bladder end:

Mid portion:

Umbilical end:

Incidence:

Answer 5

Bladder end: Obliterated

Mid portion: Obliterated

Umbilical end: Patent

Incidence: 15%

Question 6

If a urachal sinus is suspected, what else must be rules out?

Answer 6

Meckels diverticulum (persistent omphalomesenteric duct)

Question 7

What are different ways to diagnose a urachal anomaly?

Answer 7

Fistulogram
Ultrasound
VCUG

Question 8

Etiology of a patent urachus?

Answer 8

secondary to congenital bladder outlet obstruction (e.g. posterior urethral valves)

Causes urine to drain from umbilicus

Question 9

If a urachal cyst is infected, what is the most likely pathogen?

Answer 9

S. aureus

• percutaneous drainage + antibiotics, then excise

Question 10

Urachal anomalies should always be excised because of the risk of developing what?

Treatment of this?

Answer 10

Urachal adenocarcinoma, located at the bladder dome.

Treat with a partial cystectomy.

Question 11

What is megacystitis?

What is the rare syndrome that it is associated with?

Answer 11

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

Question 12

Etiology of bladder agenesis?

Is it compatible with life?

Answer 12

Defect of upper anterior cloaca

Not life compatible unless ectopic ureters present

Question 13

What syndromes are more commonly associated with bladder diverticula?

Answer 13

Ehlers-Danlos, Marfan syndrome, Menkes syndrome, William Elfin-facies

Question 14

What is a Hutch diverticulum?

Answer 14

Paraureteral orifice diverticulum; may cause VUR, ureteral obstruction, bladder outlet obstruction, frequent UTIs, bladder stones

Question 15

Etiology of bladder extrophy-epispadias complex?

Answer 15

Premature cloacal membrane rupture, leading to infraumbilical anomalies from deficient mesenchyme caudal migration between the ectodermal and endodermal layers

Question 16

What antenatal ultrasound findings are present in bladder extrophy-epispadias?

Answer 16

low-set umbilical cord, lower abdominal wall mass, bladder not in the abdomen, weird genitalia

Question 17

What are variants of the bladder extrophy-epispadias complex?

Answer 17

Classic bladder extrophy (most common)
Cloacal extrophy (rare)
Epispadias covered extrophy (extremely rare)
Duplicate extrophy
Superior vesical fissure

Question 18

Describe classic bladder extrophy anomalies

Answer 18

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)

Question 19

Treatment of classic extrophy?

Answer 19

Immediate protection of mucosa with saline wrap

1st day of life closure without osteotomies if possible

Primary vs delayed epispadias repair

Question 20

What are the primary anomalies with cloacal extrophy?

Answer 20

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.

Question 21

Treatment of cloacal extrophy?

Answer 21

Immediate closure, genital repair

Question 22

Etiology of epispadias?

Answer 22

incomplete urethral tubularization

• dorsal drainage in boys
• females drain between clitoris and labia

Question 23

When do you repair isolate epispadias

Answer 23

6 months