Bladder pathology
Haematuria
- Frank hematuria may be seen as mobile echogenic material within the bladder.
- Beware calling only fine particulate matter hemorrhage. More often, fine material is merely protenaceous material or concentrated urine.
Ultrasound image- Frank hematuria.
Ultrasound image- Ultrasound of haematuria in the bladder using high gain settings. By increasing the gain, particulate matter or haemorrhage is readily seen.
Ultrasound demonstrating gross frank haematuria with clot surrounding a catheter balloon.
Ultrasound- Ureteric jets into a bladder containing hematuria.
Bladder Diverticulae
- The out-pouching of bladder mucosa through the muscular bladder wall.
- May be congenital or acquired (most common).
Ultrasound image- Multiple bladder diverticulae.
Commonly seen with chronic urinary retention.
Ultrasound image- An incidentally detected large left sided bladder diverticulum. This was seen to persist post micturition. The patient was urologically assymptomatic.
Ultrasound image- A wide neck diverticulum of the bladder dome.
Ultrasound using colour doppler to show the relationship of this diverticulum to the vessico-ureteric junction.
Ultrasound image- A large posterior diverticulum arising from a chronically contracted, thick walled bladder that also contains a mass.
Debris can be seen as sediment in the diverticulum.
Large bladder diverticulum videos.
- Agitating the contents confirm mobility and n excludes wall masses such as urothelial carcinoma.
- Using colour doppler and applying/releasing transducer pressure demonstrates oscilation of urine between the bladder and the diverticulum.
Uretrocele
A prolapse or outpouching of the distal ureter into the bladder at the vessico-ureteric junction.
Ultrasound image- A ureterocoele (ureterocele) will be evident as a saccular dilatation of the distal ureter, into the bladder, .
Ensure the vesico-ureteric junction is in the appropriate position in the bladder.
Ureteroceles will vary in size (this being a large example) and are usually assymptomatic.
Ultrasound image- Using colour or power doppler, the ureteric jet can be seen exiting the ureterocele (ureterocele).
They can usually be seen to fill and empty with ureteric peristalsis.
Ultrasound image- Bilateral ureteroceles persisting post micturition.
Ultrasound image- Fig 1: A small ureterocele with a mildly dilated distal ureter.
Fig 2: During a wave of ureteric peristalsis the ureterocele dilates. The ureteric jet is visible with colour doppler.
Vesico Ureteric Reflux (VUR)
VUR involves the retrograde passage of urine from the bladder, up into the ureter. Degree of consequence is based upon how far up the reflux extends and whether it causes calycael dilatation in the kidney
Ultrasound image- The open vesico ureteric junction is readily seen, with associated mild dilatation of the distal ureter.
Ultrasound image- In this example the retrograde, refluxing urine is seen as blue through the ureteric orifice.
Video clip of ultrasound using colour doppler to demonstrate vesico ureteric reflux.
Transitional Cell Carcinoma (TCC)
- Also called urothelial cell carcinoma.
- Arises from the Transitional epithelium that lines hollow organs such as the bladder, ureter and renal pelvis.
- There is increased risk in smokers, excessive alcohol or analgesia intake and use of some dyes.
- May be flat or papillary.
Ultrasound image- Marked TCC almost filling the bladder.
Ultrasound image- Transitional cell carcinoma (TCC) of the bladder.
Flat type TCC
Ultrasound image- 2 masses at the bladder floor, one of which involves the left vesico-ureteric junction (see next image).
Ultrasound image- Using power doppler, the left ureteric jet is visible arising from the bladder mass, excluding complete ureteric obstruction.
Ultrasound image- You can faintly see material within the ureter at the vesico-ureteric junction.
But by slightly increasing the gain, the tumor is readily apparent.
Prominance of the epithelial lining of the ureter is a strong indicator of pathology. If combined with haematuria (micro or macro) and in the absence of infection, tumour must be strongly considered.
Non TCC Bladder carcinomas
Types:
- Adenocarcinoma
- Squamous cell carcinoma
- Sarcoma
- Small cell carcinoma
Ultrasound image- A bladder carcinoma. Debris (likely haematuria) is present adjacent to the mass.