URINARY Section 11: Bladder

Question 1

Answer 1

Prune Belly (Eagle Barrett Syndrome)

Shaped like a pear (big wide bell).

Question 2

Prune Belly (Eagle Barrett Syndrome) Triad

Answer 2

Deficiency of abdominal musculature + Hydroureteronephrosis + Cryptorchidism (bladder distension interferes with testicular descent)

Question 3

Midline mass + calcification in any urachal tissue =

Answer 3

Carcinoma

Question 4

Priamary concern of Urachus

Answer 4

Development of a midline adenoCA

Question 5

Bladder Diverticula can be acquired secondary to

Answer 5

Chronic outlet obstruction (Big prostate)

Question 6

congenital bladder diverticula, seen at the vesicoureteric junction, NOT associated with posterior urethral valves or neurogenic bladder

Answer 6

“Hutch Diverticulum”

Question 7

Answer 7

bilateral Hutch diverticula

Question 8

Bladder diverticula associated syndrome

Answer 8

Ehlers Danlos Syndrome

Question 9

Bladder Diverticula typically arise from

Answer 9

the lateral walls or near the ureteral orifices

Question 10

Urachal diverticula

Answer 10

Anterior + Superior

Question 11

Most Diverticula are

Answer 11

Acquired

Question 12

Ureters deviate medially adjacent to a?

Answer 12

diverticula

Question 13

“Transitory extraperitoneal herniation of the bladder”

Answer 13

Bladder Ears

Question 14

Answer 14

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.

Question 15

If the cquestion header specifically indicates “GROSS” hematuria =

Answer 15

Think bladder CA first

Question 16

Gross hematura + > 50 y.o. = next step?

Answer 16

CT hematuria protocol / Urography (pre and post, with delays), cystoscopy

Question 17

Answer 17

soft tissue in the bladder + focal wall thickening / nodules

Question 18

diffuse circumferential bladder wall thickening =

Answer 18

Inflammation
infection
Chronic partial outlet obstruction if with enlarged prostate

Question 19

most important phase for identifying bladder cancers

Answer 19

Delayed - white background of contrast makes soft tissue masses easier to see

Question 20

This is the most common bladder cancer in humans less than 10 years of age.

Answer 20

Rhabdomyosarcoma

Question 21

“Paratesticular Mass”

Answer 21

Rhabdomyosarcoma

Question 22

Answer 22

Botryoid Rhabdomyosarcoma

“polypod mass, looks like a bunch of grapes”

Question 23

most common TCC bladder subtype.

Answer 23

Superficial papillary

Question 24

When I say Squamous Cell Bladder

Answer 24

you say Schistosomiasis

Question 25

Answer 25

Squamous Cell Ca "heavily calcified bladder and distal ureters (usually shown on plain film, but could also be on CT).

Question 26

ongstanding Suprapubic catheter

Answer 26

Squamous Cell Ca

Question 27

When I say Adenocarcinoma of the Bladder,

Answer 27

you say Urachus

Question 28

associated with an increased risk of adenocarcinoma.

Answer 28

Bladder Exstrophy

Question 29

Most common benign bladder tumor

Answer 29

Leiomyoma (Bladder fibroid)

Question 30

"urinary hesitancy" or "dribbling" =

Answer 30

Leiomyoma

Question 31

This isn’t a bladder surgery but rather a surgical “complication” from a c-section.

Answer 31

Bladder flap hematoma

Question 32

Answer 32

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.

Question 33

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.

Answer 33

Diversion Surgery

Question 34

the most common early complication of diversion surgery

Answer 34

Adynamic ileus

Question 35

Early complications of Diversion Surgery

Answer 35

Alteration in bowel function Urinary Leakage Fistula

Question 36

Late complications (>30 days) of Diversion Surgery

Answer 36

Urinary infection Stones Parastomal Herniation Urinary Stricture Tumor recurrence

Question 37

Which side is the urinary stricture more common?

Answer 37

The left side, secondary to angulation

Question 38

Answer 38

Psoas Hitch The “hitched” side has an upward projection towards the psoas muscle.

Question 39

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

Answer 39

Psoas Hitch

Question 40

stretch the ipsilateral portion of the bladder towards the short ureter and sew it (“hitch it”) to the psoas muscle.

Answer 40

Psoas Hitch you stretched the bladder to bridge the gap.

Question 41

Why is psoas hitch done?

Answer 41

Used for people with long segment distal ureter injury / disease

Question 42

Gas forming organism in the wall of the bladder.

Answer 42

Emphysematous Cystitis Common in diabetics E. COli - most common

Question 43

Answer 43

Bladder tuberculosis "thimble" bladder calcifications might be present

Question 44

Answer 44

Bladder schistosoma = Squamous cell Ca

Question 45

Bladder fistula occurs in 3 conditions:

Answer 45

1. Diverticulitis 2. Crohns 3. Cancer

Question 46

Colovesical fistula =

Answer 46

Diverticular disease

Question 47

Ileovesical fistula =

Answer 47

Crohns

Question 48

Rectovesical Fistula =

Answer 48

Neoplasm or Trauma

Question 49

Answer 49

Neurogenic bladder "pine cone bladder" trabeculated

Question 50

2 flavors of Neurogenic bladder

Answer 50

a. small contracted bladder b. atonic large bladder

Question 51

acquired bladder diverticula is mainly from

Answer 51

Outlet obstruction (PGE) Most common at the UVJ = stasis = bladder CA, stones and infection

Question 52

Bladder stones can be from

Answer 52

1. from kidney 2. develop secondary to stasis (outlet obstruction) or neurogenic bladder RIsk factor for TCC and SCC

Question 53

“PearShapedBladder” is from

Answer 53

1. Pelvic lipomatosis 2. HEmatoma

Question 54

gold standard in bladder trauma

Answer 54

Cystography - Fluoro or CT

Question 55

Inadequate bladder distension in Cystography =

Answer 55

loss of sensitivity

Question 56

Cystography in bladder tauma - bladder must be distended with _ ml of diluted water soluble contrast

Answer 56

300-400 ml

Question 57

Best test for extra vs intra peritoneal ruptur in bladder trauma

Answer 57

CT cystography (cotntrast distending bladder) - 300-400 ml

Question 58

More common bladder ruprue

Answer 58

Extraperitoneal (89-90%) - pelvic fracture

Question 59

If there is a pelvic fracture, then the chance of a bladder rupture

Answer 59

10%

Question 60

If there is a bladder rupture, there is almost always a

Answer 60

pelvic fracture

Question 61

Answer 61

Bladder ruprue "Molar tooh appearance" Contrast from the Bladder filling the Prevesicle Space (Rezius)

Question 62

A direct blow to a full bladder, basically pops the balloon and blows the top off (bladder dome is the weakest part).

Answer 62

Intraperitoneal bladder rupture the dude will have contrast outlining bowel loops and in the paracolic gutters. This requires surgery.

Question 63

“Pseudo Azotemia” (Pseudo Renal Failure) =

Answer 63

bladder rupture = creatinine absorbed via peritoneal lining = elevate creatinine = making it seem like the patient is in acute renla failure. kidneys are normal