Pelvicalyceal System, Ureters, Bladder and Urethra

Question 1

This study, performed by cystoscopic catheterization of the ureteral orifice followed by injection of contrast, is independent of renal function, and provides high-quality images of the ureter and the collecting system.

Answer 1

Retrograde pyelography

When a percutaneous nephrostomy catheter has been placed in the collecting system, anterograde pyelography is an additional choice.

Question 2

This is the imaging method of choice for screening for hydronephrosis but is limited in its ability to demonstrate small uroepithelial tumors.

Answer 2

Ultrasound

Question 3

The collecting tubules of a medullary pyramid coalesce into a variable number of papillary ducts that pierce thee tip of the papilla and drain into the receptacle of the collecting system called what?

Answer 3

A minor calyx

Question 4

The sharp-edged portion of the minor calyx projecting around the sides of a pipilla is called what?

Answer 4

The fornix of the calyx

Question 5

This extend between the minor calyces and the renal pelvis.

Answer 5

Infundibula

Question 6

This is predominantly outside the renal sinus and is larger and more distensible than the more common intrarenal pelvis, which is surrounded by renal sinus fat and other structures.

Answer 6

Extrarenal pelvis

This is a normal variant that should not be confused with hydronephrosis.

Question 7

It is the mucosal lining of the entire pelvicalyceal system, ureters, and bladder.

Answer 7

Transitional epithelium

Question 8

What are the tree main points of ureteral narrowing, where calculi are likely to become impacted?

Answer 8

1. The ureteropelvic junction (UPJ)
2. The site at which the ureter crosses the pelvic brim
3. The ureterovesical junction (UVJ)

Question 9

The normal filled urinary bladder is oval, with the floor parallel to, and 5 to 10 mm above, what structure?

Answer 9

The superior aspect of the symphysis pubis

Question 10

What structures lie on top of the bladder and may cause impressions on the bladder dome?

Answer 10

Sigmoid colon and loops of small bowel, as well as the uterus in females

Question 11

Anteriorly, the bladder is separated from the symphysis pubis by fat in what space?

Answer 11

Extraperitoneal space of Retzius

Question 12

Posteriorly, the bladder from the uterus by what recess?

Answer 12

Uterovesical peritoneal recess

Question 13

Posteriorly, the bladder is separated from the rectum by what recess?

Answer 13

Rectovesical peritoneal recess

Question 14

The bladder wall has four layers. What are his layers?

Answer 14

An outer connective tissue adventitiia, smooth muscle consisting of circular muscle fibers sandwiched between inner and outer layers of longitudinal fibers, submucosal connective tissue (the lamina propria), and the mucosa of transitional epithelium.

Question 15

This is a triangle at the bladder floor formed by the two ureteral orifices and the internal urethral orifice.

Answer 15

Trigone

With voiding, the trigone descends 1 to 2 cm and transforms from a flat surface into a cone with the urethra at the apex.

Question 16

This is a simple study of the anterior male urethra.

Contrast medium is injected into the anterior urethra by means of a syringe or catheter that occludes the meatal orifice.

Answer 16

Retrograde urethrogram

Radiographs are exposed in the right posterior oblique projection.

The anterior urethra normally distends fully because of resistance of the external sphincter at the level of the urogenital diaphragm.

Complete filling of the posterior urethra is not possible because contrast runs freely into the bladder.

Question 17

This is performed by filling the bladder with contrast through a catheter.

The catheter is removed, and radiographs are obtained while the patient urinates into a basin on the fluoroscopy table.

Answer 17

Voiding cystourethrography

The voiding urethrogram demonstrates distension of both the posterior and anterior urethra.

Question 18

The male urethra is divided into posterior and anterior portions by what structure?

Answer 18

The inferior aspect of the urogenital diaphragm

Question 19

The posterior urethra consists of what urethral structures?

Answer 19

Prostatic urethra - within the prostatic gland, from bladder neck to urogenital diaphragm

Membranous urethra - which is totally contained within the 1-cm-thick urogenital diaphragm

Question 20

The anterior urethra extends from the urogenital diaphragm to the external urethral meatus.

It consists of what urethral structures?

Answer 20

Bulbous urethra - extending from the urogenital diaphragm to the penoscrotal junction

Penile urethra - extending to the urethral meatus

Question 21

The anterior urethra is entirely contained within the corpus spongiosum penis except for the proximal 2 cm of the bulbuous urethra, called what?

Answer 21

Pars nuda

This unprotected protion of the urethra is particularly susceptible to straddle injury.

Question 22

The prostatic urethra runs vertically through the prostate over a length of how many cm?

Answer 22

3 to 4 cm

Question 23

It is an oval filing defect in the mid portion of the posterior wall of the prostatic urethra.

Answer 23

Verumontanum

The ejaculatory ducts open into the urethra on either side of the verumontanum, and the prostatic glands empty into the urethra by multiple small openings that surround the verumontanum.

Question 24

This is a mullerian remnant, a small, saccular depression in the middle of the verumontanum.

Answer 24

Utricle

Question 25

This structure surrounds the membranous urethra.

Answer 25

The voluntary external urethral sphincter within the urogenital diaphragm

Question 26

These are pea-sized accessory sex glands within the urogenital diaphragm on either side of the membranous urethra.

Answer 26

Cowper glads

Their ducts empty into the bulbous urethra 2 cm distally.

Question 27

The penoscrotal junction that divides the bulbous and penile urethra is marked by what ligament?

Answer 27

Marked by the suspensory ligament of the penis

Which causes a normal bend in the urethra.

Question 28

The entire anterior urethra is lined by what glands?

Answer 28

Glands of Littre

Whose secretions lubricate the urethra

Visualization of the glands of Littre is always abnormal and associated with chronic inflammation and urethral stricture.

Question 29

The female urethra varies in length measuring how many cm?

Answer 29

2.5 to 4 cm

The urethra is embedded in the anterior wall of the vagina and is lined throughout by periurethral glands.