Lower urinary tract

Question 1

what is the cloaca?

Answer 1

• ventral part becomes urogenital sinus, which develops into bladder. prostate, urethra, and lower vagina

Question 2

allontois function?

Answer 2

connects cloaca to umbilical cord

Question 3

allontois closes by?

Answer 3

birth to become urachus (a fibrous tissue)

Question 4

what is the bladder?

Answer 4

• in infants and children it is an abdominal organ
• after puberty it becomes a pelvic structure
• acts as a reservoir
• retroperitneal
• posterior to pubic symphysis
• lined with mucous membrane which contains folds or rugae

Question 5

3 layers of the bladder wall?

Answer 5

• connective tissue submucosa (inner)
• muscle layer
• fibrous adventia (outer)

Question 6

bladder wall thickness?

Answer 6

distended state: <3mm

empty state: <5mm

Question 7

what are ureters?

Answer 7

• continuation of the renal pelvis that extent to the posterior bladder wall (trigone)
• usually not seen if normal

Question 8

ureters diameter?

Answer 8

up to 5mm

Question 9

the ureters are constricted in what 3 areas?

Answer 9

1. UPJ
2. as they cross iliac vessels
3. UVJ

Question 10

Prostate on u/s?

Answer 10

• ellipsoid in boys

- hypoechoic and homogenous

Question 11

seminal vesicle on u/s?

Answer 11

• best seen in TRV
• small, hypoechoic structure
• “wings of a seagull””

Question 12

trigone of the bladder are formed by?

Answer 12

• 2 ureteral orfices and internal urethral orfice

Question 13

what is Urachus?

Answer 13

• tubular structure continuous with anterior dome of the bladder and extends to the umbilicus
• Completely obliterated and fibrotic at or before birth or seals off in the neonatal period
• If urachus persists a cord can be sonographically visible

Question 14

4 types of urachal abnormalities?

Answer 14

1. patent urachus (completely open lumen)
2. Urachal sinus (opening to the umbilicus)
3. Urachal diverticulum (open to the bladder)
4. Urachal cyst (obliterated at both ends)

Question 15

urachal abnormalities sono features?

Answer 15

• cystic mass
• often internal echoes or septations caused by infection
• diverticulum like structure from bladder dome

Question 16

cystitis?

Answer 16

• common UTI in children

- girls 10x more likely than boys

Question 17

cystitis clinical presentation? (4)

Answer 17

• urinary frequency
• incontinence
• dysuria
• hematuria

Question 18

3 types of cystitis?

Answer 18

• bacterial: most common
• hemorrhagic: secondary to viral infection, chemo, or catheters
• granulomatous: in a patient with chronic granulomatous disorder

Question 19

what is cystits cystica?

Answer 19

• may mimic tumors

- rounded iso or hypo polyploid lesions protruding into lumen

Question 20

cystitis cono features?

Answer 20

• Bladder may appear normal with mild cystitis
• Diffuse or focal bladder wall thickening and irregularity
• Echogenic material in bladder-blood or purulent material
• Bladder stones are very rare

Question 21

Most common tumor of the lower urinary tract in children?

Answer 21

Rhabdomyosarcoma

Question 22

Rhabdomyosarcoma most common sites?

Answer 22

• trigone of bladder
• prostate
• Can arise from seminal vesicles, spermatic cord, uterus, vulva, vagina and pelvic musculature

Question 23

Rhabdomyosarcoma clinical presentation?

Answer 23

• acute urinary retention
• dysuria
• hematuria

Question 24

Rhabdomyosarcoma sono features?

Answer 24

• Homogenous polypoidal solid mass
• Masses arising from the prostate can have projections into the bladder
• Regional lymph node involvement is common

Question 25

Trauma sono?

Answer 25

demonstrates urinary ascites or urinoma (loculated urine collection)

Question 26

Answer 26

cystitis

Question 27

Answer 27

demonstrates urinary ascites or urinoma (loculated urine collection)