URINARY Section 11: Bladder Flashcards
Prune Belly (Eagle Barrett Syndrome)
Shaped like a pear (big wide bell).
Prune Belly (Eagle Barrett Syndrome) Triad
Deficiency of abdominal musculature + Hydroureteronephrosis + Cryptorchidism (bladder distension interferes with testicular descent)
Midline mass + calcification in any urachal tissue =
Carcinoma
Priamary concern of Urachus
Development of a midline adenoCA
Bladder Diverticula can be acquired secondary to
Chronic outlet obstruction (Big prostate)
congenital bladder diverticula, seen at the vesicoureteric junction, NOT associated with posterior urethral valves or neurogenic bladder
“Hutch Diverticulum”
bilateral Hutch diverticula
Bladder diverticula associated syndrome
Ehlers Danlos Syndrome
Bladder Diverticula typically arise from
the lateral walls or near the ureteral orifices
Urachal diverticula
Anterior + Superior
Most Diverticula are
Acquired
Ureters deviate medially adjacent to a?
diverticula
“Transitory extraperitoneal herniation of the bladder”
Bladder Ears
Bladder Ears
This is not a diverticulum. Instead, it’s transient lateral protrusion of the bladder into the inguinal canal.
Smooth walls, and usually wide necks can help distinguish them from diverticula.
If the cquestion header specifically indicates “GROSS” hematuria =
Think bladder CA first
Gross hematura + > 50 y.o. = next step?
CT hematuria protocol / Urography (pre and post, with delays), cystoscopy
soft tissue in the bladder + focal wall thickening / nodules
diffuse circumferential bladder wall thickening =
Inflammation
infection
Chronic partial outlet obstruction if with enlarged prostate
most important phase for identifying bladder cancers
Delayed - white background of contrast makes soft tissue masses easier to see
This is the most common bladder cancer in humans less than 10 years of age.
Rhabdomyosarcoma
“Paratesticular Mass”
Rhabdomyosarcoma
Botryoid Rhabdomyosarcoma
“polypod mass, looks like a bunch of grapes”
most common TCC bladder subtype.
Superficial papillary
When I say Squamous Cell Bladder
you say Schistosomiasis
Squamous Cell Ca
“heavily calcified bladder and distal ureters (usually shown on plain film, but could also be on CT).
ongstanding Suprapubic catheter
Squamous Cell Ca
When I say Adenocarcinoma of the Bladder,
you say Urachus
associated with an increased risk of adenocarcinoma.
Bladder Exstrophy
Most common benign bladder tumor
Leiomyoma (Bladder fibroid)
“urinary hesitancy” or “dribbling” =
Leiomyoma
This isn’t a bladder surgery but rather a surgical “complication” from a c-section.
Bladder flap hematoma
Bladder flap hematoma
blood (hematoma) that drapes over the top and back of the bladder after a c-section performed with the common technique of a lower uterine incision.
The general idea is that a piece of bowel is made into either a conduit or reservoir, and then the ureters are attached to it.
Diversion Surgery
the most common early complication of diversion surgery
Adynamic ileus
Early complications of Diversion Surgery
Alteration in bowel function
Urinary Leakage
Fistula
Late complications (>30 days) of Diversion Surgery
Urinary infection
Stones
Parastomal Herniation
Urinary Stricture
Tumor recurrence
Which side is the urinary stricture more common?
The left side, secondary to angulation
Psoas Hitch
The “hitched” side has an upward projection towards the psoas muscle.
This procedure is done in the situation where you have had an injury or pathology (stricture, cancer, etc…) involving a long segment of the distal ureter
Psoas Hitch
stretch the ipsilateral portion of the bladder towards the short ureter and sew it (“hitch it”) to the psoas muscle.
Psoas Hitch
you stretched the bladder to bridge the gap.
Why is psoas hitch done?
Used for people with long segment distal ureter injury / disease
Gas forming organism in the wall of the bladder.
Emphysematous Cystitis
Common in diabetics
E. COli - most common
Bladder tuberculosis
“thimble” bladder
calcifications might be present
Bladder schistosoma = Squamous cell Ca
Bladder fistula occurs in 3 conditions:
- Diverticulitis
- Crohns
- Cancer
Colovesical fistula =
Diverticular disease
Ileovesical fistula =
Crohns
Rectovesical Fistula =
Neoplasm or Trauma
Neurogenic bladder
“pine cone bladder”
trabeculated
2 flavors of Neurogenic bladder
a. small contracted bladder
b. atonic large bladder
acquired bladder diverticula is mainly from
Outlet obstruction (PGE)
Most common at the UVJ = stasis = bladder CA, stones and infection
Bladder stones can be from
- from kidney
- develop secondary to stasis (outlet obstruction) or neurogenic bladder
RIsk factor for TCC and SCC
“PearShapedBladder” is from
- Pelvic lipomatosis
- HEmatoma
gold standard in bladder trauma
Cystography - Fluoro or CT
Inadequate bladder distension in Cystography =
loss of sensitivity
Cystography in bladder tauma - bladder must be distended with _ ml of diluted water soluble contrast
300-400 ml
Best test for extra vs intra peritoneal ruptur in bladder trauma
CT cystography (cotntrast distending bladder) - 300-400 ml
More common bladder ruprue
Extraperitoneal (89-90%) - pelvic fracture
If there is a pelvic fracture, then the chance of a bladder rupture
10%
If there is a bladder rupture, there is almost always a
pelvic fracture
Bladder ruprue
“Molar tooh appearance”
Contrast from the Bladder filling the Prevesicle Space (Rezius)
A direct blow to a full bladder, basically pops the balloon and blows the top off (bladder dome is the weakest part).
Intraperitoneal bladder rupture
the dude will have contrast outlining bowel loops and in the paracolic gutters. This requires surgery.
“Pseudo Azotemia” (Pseudo Renal Failure) =
bladder rupture = creatinine absorbed via peritoneal lining = elevate creatinine = making it seem like the patient is in acute renla failure. kidneys are normal
