Bladder Diverticuli

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Bladder Diverticuli

• May be congenital
• Usually secondary to chronic obstruction of
  bladder outflow.
• There will be urinary stasis
• - infection.
• - stone formation.
• - tumor.
• Readily seen on all imaging , may deform the
  adjacent bladder or ureter.

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Bladder calcification
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Bladder Calcification

• Most are bladder calculi.
• Usually large and laminated.
• Rarely calcification seen in the wall
• -Schistosomiasis
• -Bladder tuumour

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Neurogenic bladder
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Neurogenic bladder

• 2 type
• The atonic type large, smooth-walled baladder ,
  poor or absent contraction and large residual
  volume.
• The Hypertrophic type regarded as
  neurologically induced bladder outflow
  obstruction.
• small volume, very thick , grossly
  trabeculated wall and marked sacculation , ureter
  and PCS may be dilated
• Full assessment is by videourodynamics.

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Trauma to the Bladder and urethra
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• Intraperitoneal rupture
• - direct blow to the distended UB .
• - contrast will leak out into peritoneal
  cavity.
• Extraperitoneal rupture
• - as part of an extensive injury of fracture
  of pelvis.
• - usually in the bladder base.
• - contrast and hematoma accumulated outside
  peritoneal cavity and may elevate and compress
  bladder base

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• US may show perivesical fluid collection .
• Cystography remains the best way of
  demonstrating actual site of leakage.
• If urethral injury suspected , ascending
  urethrogram should be done before passing any
  catheter.
• CT demonstrate fresh hematomas or urine
  collection , and associated fracture.

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Prostate and Urethra
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Prostatic enlargement

• Very common in elderly man
• Usually benign hypertrophy but may be CA.
• Prostatic US
• -Transrectal Ultrasound ( TRUS) can measure
  the volume and detect relatively small mass.
• - masses in peripheral zone are usually
  malignant and in central zone are benign

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• Transrectal ultrasound guided biopsy is used for
  diagnoses of prostatic CA.
• CT can't demonstrate internal structure , its
  used for assessing local spread and LNs

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• MRI in assessment of early stage of prostatic
  cancer.
• Tumor appear as low signal in the peripheral zone
  which is high signal on T2 .
• It shows extracapsular spread , seminal vesicle
  invasion and LN metastases

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Prostatic calcificaiton

• Numerous prostatic claculi.
• Very common , that it can be regarded as a normal
  finding in older men.
• No relation to symptoms of BPH or prostatic
  carcinoma.

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Bladder outflow obstruction

• Commonest cause of BPH
• Other cause
• - tumors
• - Urethral strictures
• - posterior urethral valve (male infants)
• - neurogenic obstruction.

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US in bladder outflow obstruction

• Increased trabeculation and thickness of the
  bladder wall , with diverticula formation.
• PVRU ( residual urine).
• Dilatation of collecting system.

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Urethral stricture

• Usually due to previous trauma or infection
• Imaging is by urethrography .
• Traumatic stricture
• - usually in proximal penile urethra
• - smooth in outline, relatively short.
• Inflammatory stricture ( gonococcal)
• - may be seen in any portion of urthera.
• - usually in anterior urethra

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Posterior urethral valve

• Commonest cause of BOO in male children .
• May be seen antenatally(bilateral hydronephrosis)
  
• US show bilateral hydronephrosis and hydroureter
  with thick wall bladder.
• Can not be diagnoses by retrograde rethrography.
• Easily seen on micturating cystourethrography,
• as dilatation of posterior urethra terminates
  abruptly in a convex border formed by the valve

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Scrotum and testes
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• Usually imaging by US , some times MRI.
• Scrotal US is done for
• gt scrotal swelling
• - intratesticular ( tumor )
• - extratesticular
• varicocele
• hydrocele
• infection (epididymitis,epididmoorchitis
  )
• benign epididymal cyst ( common)

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• Acute testicualr pain and/or swelling
• - testicular torsion dramatic reduction in
  perfusion on Doppler
• - acute epididymitis/orchitis normal or
  increased perfusion

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• Ectopic testis ( undescended testis)
• - commonest site is in the inguinal canal
• - MRI used if US inconclusive or ectopic
  testis lies within the abdomen.
• MRI produce highly detailed images of scrotal
  contents and is used in problem solving cases.

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Questions