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101 Cards in this Set

  • Front
  • Back
In males, the bladder is _____ to the rectum and _____ to the prostate gland.
anterior; superior
In females, the bladder is ___ to the vagina and _____ to the uterus.
anterior; inferior
the apex, the anterior portion of the bladder, is connected to what ligament?
medial umbilical ligament (urachus cyst remnants- most common cause of bladder adenocarcinoma)
the superior surface of the bladder is covered with what?
name the area of the bladder where the ureters enter?
ureters enter through the internal ureteric orifices at the posteriolateral angles of the TRIGONE (posterior base of the bladder)
Name the three ureteral areas of constriction where calculi commonly get stuck.
1) ureteropelvic junction; 2)pelvic inlet (over the iliacs); 3) entrance to bladder
what are the advantages of retrograde imaging techniques?
have control over the contrast amount injection and pressure; don't have to wait on contrast to go through blood and be excreted by the kidneys; with the retrograde pyelogram, the ureter is typically seen in its entirety; with retro cystography, abnormal vesicoureteral reflux can be seen if present
what is the difference in retrograde pyelography vs cystography vs urethrography?
Pyelography images the ureters and kidney collecting system; cystography images the bladder; urethrography images the urethra
what is the significance of extravasation of contrast dye?
extravasation may occur normally in a retrograde pyelogram study; you must control the amount of pressure used when injecting dye; if there is an allergy to the dye, it may be apparent if the dye gets out of the urinary system (extravasates)
when doing a cystogram, contrast is optimally injected under what type of observation?
ideally under fluoroscopic observation, more recently with CT; but occasionally with normal radiographs (esp. in trauma setting)
This procedure is commonly done after a cystogram to view the urethra in action.
voiding cystourethrogram (VCUG)
name the 4 portions of the male urethra. from proximal to distal and separate into posterior and anterior.
Posterior: Prostatic -> Membranous -> Anterior: Bulbous -> Pendulous (penile)
why would you order a retrograde urethrogram?
in males, mainly to detect injury (also for filing defects, masses, strictures and fistulas); in females: mainly for diverticula (need a special cath)
name this pathology. On contrasted CT, it looks like a cobra head; herniation of the dilated distal ureter bulging into the bladder.
name this pathology. A micturition problem caused by neurologic dysfunction. Can be overactive or underactive; motor or sensory, etc.
Neurogenic Bladder
How are neurogenic bladders diagnosed?
Accurate and thorough voiding history with urodynamics and selective radiographic imaging studies. - seen alot in diabetics and spinal injuries
what is a common shape of a neurogenic bladder?
conical shape (not round)
If you see a filling defect in the bladder during a cystogram, what are the common causes?
neoplasm, stone, blood clot, enlarged prostate
If you see a filling defect in the bladder during a cystogram, what are the UNcommon causes?
focal cystitis, ureterocele, benign neoplasms, endometriosis, fungus ball
If you see a filling defect in the bladder during a cystogram, what do you want to exclude?
90% of bladder carcinomas are this type?
transitional cell carcinoma - (EXTRA INFO causes:SMOKING!)
Of this 90%, what are the common microscopic findings?
75% are papillary - recur but aren't as problematic, 25% are infiltrative
Name some other (less common) malignant neoplasms of the bladder.
Squamous Cell Carcinoma (after schistosomiasis infection after vacationing in egypt), adenocarcinoma(*urachal cyst remnants), leiomyosarcoma, lymphoma, embryonal rhabdomyosarcoma (<6 -*sarcoma botryoides)
Name some benign lesions of the bladder.
leiomyoma, fibroepithelial polyp, hemangioma, pheochromocytoma, adenoma
Who and at what age do people get diagnosed with TCC? Name the risk factors.
Men (3xs as high as women); (peak age 50-69); RISKS: SMOKING!, analgesics (*esp. cyclophosamide - used in RA Tx); chemical carcinogens (*aniline dyes)
Infiltrative TCC is more likely to _____, and papillary TCC are often _______ with high recurrence rates.
metastasize; multi-focal
A Polypoid (mass)TCC will show up on contrasted CT as a ____ ____.
filling defect
when viewing a contrasted ureter, what is the difference in an IVP and a retrograde pyelogram?
with normal ureters = IVP: should see peristalsis (it is abnormal to see the ureter in its entirety); Retrograde Pyelogram: it is normal to the entire ureter
If you are viewing a convential IVP and you can see the entire ureter as well as a masslike filling defect in the bladder, what is your differential?
carcinoma, tumor, blood clot, fungus ball - requires cystocopy with possible biopsy for further evaluation
Bladder Diverticula occur as a result of focal herniations of the ____ and _____ and usually occur in the setting of chronic elevation of ____ ____.
urothelium and submucosa; intravesical pressure
Bladder diverticuli tend to occur near the ureteral orfices and are an important cause of what?
urinary stasis (higher chance of infection); ureteral obstruction, and vesicoureteral reflux
Name the pathology. An large outpouching close in proximity to the ureterovesicular junction that may lead to vesicoureteral reflux.
Hutch Diverticulum
Urethral diverticula possible arise from an obstructed/infected ___ ___.
paraurethral glands - the glands become enlarged and inflammed forming a retention cyst and then abscess
Urethral strictures occur secondary to ___, ___, or ____ and lead to a reduced flow of antegrade urine.
inflammatory, ischemic, or traumatic process
What is the purpose of the corpus spongiosum in erection?
it prevents the urethra from pinching closed and maintains a canal for ejaculate to travel out of the body
The posterior urethral strictures arise usually secondary to what?
trauma or surgery, ie radical prostatectomy
If a patient has recurrent gonococcal urethritis, what is he at risk for?
infectious urethral strictures
name the pathology. a protrusion of the bladder into the vagina due to defects in pelvic support.
cystocele is defined radiographically by:
the descent of the bladder base is below the inferior margin of the symphysis pubis
name the type of bladder dysfunction. the bladder base extends below the pubic symphsis and leaks urine while straining or sneezing.
Stress Incontinence
Bladder fistulas are commonly caused by what?
bladder catheterizations or instrumentation
what are the most common causes of vesicoenteric fistulas (bladder connected to bowel)?
Chron's Dz and Diverticulitis
what is the best imaging method to locate bladder fistulas? What are the findings?
Voiding cystourethrogram; find AIR within the bladder, (non-specifically: focal mural irregularity, or extrinsic mass effect
If you order an oral and rectal contrast it would demonstrate what with a vesicoenteric fistula?
AIR within the Bladder; Nonspecifically: focal bladder wall thickening; contiguous bowel wall thickening, and presence of air-containing paravesical soft-tissue mass
Name and describe another test done to find a vesicoenteric fistula?
Bourne Test - give oral barium, then get a urine sample, centrifuge it and look for barium
This fistula would present with clear fluid leaking out of the vagina. Causes include: iatrogenic, cervical or bladder carcinoma, obstetric injury, radiation, foreign body.
Vesicovaginal fistula - presents with continous urinary incontinence
Give the differential dx of the abnormal finding of air in the bladder.
vesicovaginal fistula, vesicoenteric fistula, infection, recent cath
This pathogen causes a rare form of bacterial cystistis called ____ that occurs in patients iwht poorly controlled diabetes.
e.coli; emphysematous cyctitis
what does the previous pathology look like on CT?
E.coli produce gas; see the abnormal air-fluid level; see gas within the wall of the bladder in a linear, streaky, or multi-cystic pattern
Bladder stones are usually due to ____ or ____.
urinary stasis or infection
If the patient has BPH, what type of stones predominate?
uric acid stones predominate in bladder outlet obstructions such as BPH
If the patient has a UTI (esp. with Proteus) what types of stones predominate?
magnesium ammonium phosphate and apatite stones
normally bladder stones are asymptomatic, however, if your patient does have symptoms what are they most likely going to be?
MICROSCOPIC painless HEMATURIA, suprapubic pain, interruption of urine stream
if the stones are calcified, what imaging modalities are used?
plain films and CT
if stones are present and utilizing cystograms or IVUs, they appear as ____.
filling defects because they are usually less dense than contrast
A bladder may rupture (usually due to trauma) and is classified as either ___ or ___.
intraperitoneal or extraperitoneal.
If this bone is fractured you should suspect bladder trauma (and urethral injury in males).
pubic rami with separation of the symphysis - fractured anterior pelvic ring
the very rare spontaneous bladder rupture may occur by what means?
an lesion that can weaken the bladder wall: tumor, cystitis, perivesical inflammation, bladder outlet obstruction, neurogenic bladder or radiation injury
How could urine get into the intraperitoneal space?
since the superior dome of the bladder is covered by peritoneum, if it gets punctured or ruptures it would be possible for urine to get into the intraperitoneal space and cause peritonitis
name a common place in females to find extravasated urine?
pouch of douglas - midline and posterior to the bladder and anterior to the rectosigmoid colon
name the space located behind the pubic symphysis. it is also a common area to collect extravasated urine.
Space of Retzius
this is another name for "abdominal film" used in urology studies.
KUB - Kidney, ureter, bladder
name the fibrous capsule that surrounds the penis and testes and may "fracture".
tunica albuginea - needs surgical intervention
the ____ ___ enters the testis along the posterosuperior margin known as the mediastinum testes.
spermatic cord
the testis is divided into lobules composed of branching ____.
seminiferous tubules
The ____ is where sperm mature and achieve the ability to swim; it turns into the the vas deferens.
the vas deferens joins the seminal vesicles to form the ______.
ejaculatory duct
This is the area between the internal and external urethral sphincters where the prostate fluids dump into the urethra.
Name the 3 zones of the prostate.
Peripheral, Central, and Transitional
This view shows both testicles on a grey scale ultrasound.
Dolly Parton View - helpful in excluding a focal process
This imaging technique is able to color-label arteries and veins are reveal normal or abnormal blood flow. It is used to detect testicular torsions.
Duplex (doppler) ultrasound
BPH is more common in who?
blacks, diabetics, and hypertensive males
Name the symptoms of BPH.
hesitancy, decreased force of urine stream, dribbling, retention (incomplete emptying)
Why do these symptoms occur?
uninhibitied contractions of a hypertrophied detrusor muscle due to obstruction of the prostatic urethra b/c of its enlargement
When a male comes in with symptoms like hesitancy, decreased force of urine stream, dribbling, retention (incomplete emptying) what should you look for on imaging?
evaluate the upper urinary tract for ureteral obstruction and obstructive nephropathy; evaluate bladder size, and estimate post-void residual volume (PVR), bladder wall thickness, presence of trabeculation, and formation of diverticula
what is the finding you are looking for on CT IVU (intra-venous urogram)?
dome-like indentation along the floor of the bladder caused by an enlarged prostate gland
From anterior to posterior, what do you see when looking inferior into the male pelvis.
pubic symphysis -> space of retzius -> prostate -> rectum (bladder is superior to the prostate)
BPH tends to be in what area of the gland? Carcinoma tends to be in what area of the gland?
BPH: transitional zone; Prosate CA: Peripheral Zone
Can you diagnose prostate cancer on ultrasound or CT?
there are NO SPECIFIC FINDINGS OF CARCINOMA on US or CT; you'd have to biopsy
what appears as a bowtie below the bladder?
seminal vesicles
what is the relationship of a PSA (prostate specific antigen) and prostate cancer?
serum PSA levels may be elevated with BPH, infection, irritation, recent ejaculation, ect. - it is a better test when done year to year and note changes in PSA; normal is 0-4ng/mL; 4-10(get US -> then biopsied if indicated)
Name the gold-standard in diagnosing prostate CA.
Trans-rectal biopsy
Spread of Prostatic Ca may spread by direct extension to what?
seminal vesicles, bladder base, perivesical fat
CT and MRI evaluate nodal metastases. If the nodes are >__mm they get _____.
10; biopsied - if +, 80% will have bone mets within 5 years
Name the most common lesions of the scrotum that may require imaging.
epididymitis, testicular torsion, hydrocele, testicular tumors
what imaging study can help differentiate epididymitis from testicular torsion?
Doppler ultrasound; Epididymitis: see hyperemia on the affected side(INCREASED B.Flow); Acute torsion: decreased blood flow on affected (painful) side
Torsions occur because of an abnormal configuration of the testicle on its pedicle (bell clapper deformity). Name the 2 types and what age group this is more common in.
COmplete >360 (80% salvage rate if reversed in <5hours; MC in adult males) and Incomplete <360; more common in adolescents and infants
Under doppler study, if there is no flow after __ minutes; diagnosis is testicular torsion.
1 minute
how does a twisted testicle look on ultrasound?
Epididymitis is usually caused by a spread of infection from the urethra or prostate (usually STD) that will look how on Doppler?
hyperemic - lots of flow; 90% of pts have pyuria
Name the most frequent causes of the parenchymal infection, orchitis.
Mumps, echovirus, group B arboviruses, lymphocytic choriomeningitis virus
what is a varicocele of the testes and why is it important to study?
distended pampiniform venous plexus due to incompetent valves of the spermatic vein; 95% of the time is left-sided (feels like a bag of worms); most common cause of male infertility
How does a varicocele look on ultrasound?
will see cystic spaces - multiple serpiginous anechoic spaces of similar size
what is a hydrocele and where is it?
accumulation of fluid between the visceral and parietal tunica vaginalis - start looking for epididymitis, orchitis, torsion, trauma, tumor
in testicular trauma, when is surgical exploration and debridment needed?
if the tunica albuginea has been violated and semifierous tubules have extruded or if there is a large scrotal hematoma
name the term that means hidden or obscure testis. incidence is 3-5% in full term boys.
cryptorchidism - usually descend by themselves by one year of age
Testicles that do not naturally descend into the scrotum are considered ___ throughout the patient's life.
abnormal; increased risk for developing cancer regardless of if they are surgically dropped
any mass within the testicle should be considered _____ and will be removed.
malignant; extratesticular tumors are usually benign
95% of testicular tumors are of this type?
Germ Cell Tumors - seminoma is most common (other germ: embyronal carcinoma, choriocarcinoma, and teratoma)
Cryptorchidism, maternal DES use, and testicular atrophy are risk factors for this most common malignancy of males age 15-30.
Seminoma - presents as a painless mass
how will a seminoma appear on ultrasound?
show areas of hypoechonicity