Bladder Diverticuli Bladder Diverticuli May be congenital May be congenital Usually secondary to chronic obstruction of Usually secondary to chronic obstruction of

bladder outflow.bladder outflow. There will be urinary stasis: There will be urinary stasis:

- infection.- infection.

- stone formation.- stone formation.

- tumor.- tumor. Readily seen on all imaging , may deform the Readily seen on all imaging , may deform the

adjacent bladder or ureter.adjacent bladder or ureter.

Bladder calcification Bladder calcification

Bladder Calcification Bladder Calcification

Most are bladder calculi.Most are bladder calculi.Usually large and laminated.Usually large and laminated.

Rarely calcification seen in the wall :Rarely calcification seen in the wall :

-Schistosomiasis -Schistosomiasis

-Bladder tuumour-Bladder tuumour

Neurogenic bladder Neurogenic bladder

Neurogenic bladderNeurogenic bladder2 type :2 type : The The atonicatonic type: large, smooth-walled baladder , type: large, smooth-walled baladder ,

poor or absent contraction and large residual poor or absent contraction and large residual volume.volume.

The The HypertrophicHypertrophic type : regarded as neurologically type : regarded as neurologically induced bladder outflow obstruction.induced bladder outflow obstruction.

small volume, very thick , grossly trabeculated wall small volume, very thick , grossly trabeculated wall and marked sacculation , ureter and PCS may be and marked sacculation , ureter and PCS may be dilated dilated

Full assessment is by videourodynamics. Full assessment is by videourodynamics.

Trauma to the Bladder and Trauma to the Bladder and urethraurethra

Intraperitoneal rupture: Intraperitoneal rupture:

- direct blow to the distended UB . - direct blow to the distended UB .

- contrast will leak out into peritoneal cavity.- contrast will leak out into peritoneal cavity.Extraperitoneal rupture: Extraperitoneal rupture:

- as part of an extensive injury of fracture of pelvis.- as part of an extensive injury of fracture of pelvis.

- usually in the bladder base.- usually in the bladder base.

- contrast and hematoma accumulated outside - contrast and hematoma accumulated outside peritoneal cavity and may elevate and compress peritoneal cavity and may elevate and compress bladder base bladder base

US may show perivesical fluid collection .US may show perivesical fluid collection .

Cystography remains the best way of Cystography remains the best way of demonstrating actual site of leakage.demonstrating actual site of leakage.

If urethral injury suspected , ascending If urethral injury suspected , ascending urethrogram should be done before passing urethrogram should be done before passing any catheter.any catheter.

CT : demonstrate fresh hematomas or urine CT : demonstrate fresh hematomas or urine collection , and associated fracture. collection , and associated fracture.

Prostate and UrethraProstate and Urethra

Prostatic enlargementProstatic enlargementVery common in elderly manVery common in elderly manUsually benign hypertrophy but may be CA.Usually benign hypertrophy but may be CA.

Prostatic US: Prostatic US:

-Transrectal Ultrasound ( TRUS) : can -Transrectal Ultrasound ( TRUS) : can measure the volume and detect relatively small measure the volume and detect relatively small mass.mass.

- masses in peripheral zone are usually - masses in peripheral zone are usually malignant and in central zone are benign malignant and in central zone are benign

Transrectal ultrasound guided biopsy is used Transrectal ultrasound guided biopsy is used for diagnoses of prostatic CA.for diagnoses of prostatic CA.

CTCT can't demonstrate internal structure , its can't demonstrate internal structure , its used for assessing local spread and LNsused for assessing local spread and LNs

MRIMRI : in assessment of early stage of : in assessment of early stage of prostatic cancer.prostatic cancer.

Tumor appear as low signal in the Tumor appear as low signal in the peripheral zone which is high signal on peripheral zone which is high signal on T2 .T2 .

It shows extracapsular spread , seminal It shows extracapsular spread , seminal vesicle invasion and LN metastasesvesicle invasion and LN metastases

Prostatic calcificaiton Prostatic calcificaiton

Numerous prostatic claculi.Numerous prostatic claculi.Very common , that it can be regarded as Very common , that it can be regarded as

a normal finding in older men.a normal finding in older men.

No relation to symptoms of BPH or No relation to symptoms of BPH or prostatic carcinoma.prostatic carcinoma.

Bladder outflow obstruction Bladder outflow obstruction

Commonest cause of BPH Commonest cause of BPH Other cause : Other cause :

- tumors- tumors

- Urethral strictures- Urethral strictures

- posterior urethral valve (male infants)- posterior urethral valve (male infants)

- neurogenic obstruction.- neurogenic obstruction.

US in bladder outflow obstruction US in bladder outflow obstruction

Increased trabeculation and thickness of Increased trabeculation and thickness of the bladder wall , with diverticula formation.the bladder wall , with diverticula formation.

PVRU ( residual urine).PVRU ( residual urine).

Dilatation of collecting system.Dilatation of collecting system.

Urethral stricture Urethral stricture Usually due to previous trauma or infectionUsually due to previous trauma or infection Imaging is by urethrography .Imaging is by urethrography .

Traumatic stricture : Traumatic stricture :

- usually in proximal penile urethra- usually in proximal penile urethra

- smooth in outline, relatively short.- smooth in outline, relatively short. Inflammatory stricture ( gonococcal) :Inflammatory stricture ( gonococcal) :

- may be seen in any portion of urthera.- may be seen in any portion of urthera.

- usually in anterior urethra- usually in anterior urethra

Posterior urethral valvePosterior urethral valve Commonest cause of BOO in male children .Commonest cause of BOO in male children . May be seen antenatally(bilateral hydronephrosis) May be seen antenatally(bilateral hydronephrosis) US show bilateral hydronephrosis and hydroureter US show bilateral hydronephrosis and hydroureter

with thick wall bladder.with thick wall bladder. Can not be diagnoses by retrograde rethrography.Can not be diagnoses by retrograde rethrography.

Easily seen on micturating cystourethrography,Easily seen on micturating cystourethrography,

as dilatation of posterior urethra terminates as dilatation of posterior urethra terminates abruptly in a convex border formed by the valve abruptly in a convex border formed by the valve

Scrotum and testesScrotum and testes

Usually imaging by US , some times MRI.Usually imaging by US , some times MRI. Scrotal US is done for : Scrotal US is done for :

> scrotal swelling :> scrotal swelling :

- intratesticular ( tumor )- intratesticular ( tumor )

- extratesticular - extratesticular

varicocelevaricocele

hydrocelehydrocele

infection (epididymitis,epididmoorchitis) infection (epididymitis,epididmoorchitis)

benign epididymal cyst ( common) benign epididymal cyst ( common)

Acute testicualr pain and/or swelling: Acute testicualr pain and/or swelling:

- testicular torsion : dramatic reduction in - testicular torsion : dramatic reduction in perfusion on Doppler perfusion on Doppler

- acute epididymitis/orchitis: normal or - acute epididymitis/orchitis: normal or increased perfusion increased perfusion

Ectopic testis ( undescended testis) : Ectopic testis ( undescended testis) :

- commonest site is in the inguinal canal - commonest site is in the inguinal canal

- MRI used if US inconclusive or ectopic - MRI used if US inconclusive or ectopic testis lies within the abdomen.testis lies within the abdomen.

MRI produce highly detailed images of MRI produce highly detailed images of scrotal contents and is used in problem scrotal contents and is used in problem solving casessolving cases..

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