14. Kidney - Cystic masses.
Renal cysts can be classified according to the Bosniak
classification depending on their features.
Type I cysts are simple cysts.
Type II are the minimally complicated cysts.
Type I and II can be ignored.
Type II F are probably benign, but need to be followed.
Type III and IV both are surgical lesions.
Type IV is inevitably malignant and in the type III group about
80-90% turn out to be malignant as well.
34. Transitional cell carcinoma of the renal pelvis.
Transitional cell carcinoma of the renal pelvis is
uncommon compared to renal cell carcinoma, and can be
challenging to identify on routine imaging when small.
Transitional cell carcinomas account for 85 % of all uroepithelial
tumors of the renal pelvis (the remaining 5 % being made up of
squamous cell carcinoma (the majority) and adenocarcinoma
(rare)1. They have one of two main morphologic patterns:
papillary
account for >85% tumors 1
multiple frondlike papillary projections
tend to be low grade and invasion beyond the mucosa is a
late feature
non-papillary
sessile or nodular tumors
tend to be high grade with early invasion beyond mucosa.
40. A bladder exstrophy (also known as Ectopia vesicae) refers
to a herniation of the urinary bladder through an anterior
abdominal wall defect. It can occur to variable severity.
41. Vesicoureteral Reflux.
Backwash” or retrograde flow of urine from the
bladder into the ureters, and usually up to the
kidneys.
VUR is a risk factor for upper tract
infection=Pyelonephritis.
VUR found in 50% of children with UTI.
Affects 1% of all children.
Boys typically dx with higher grades than girls.
Female to Male ratio is 6:1
10 times more common in whites vs blacks
Hereditary components / Family history !
parent: 50% / sibling 33-45%
44. The urachus is a fibrous remnant of the allantois,
a canal that drains the urinary bladder of the fetus
that joins and runs within the umbilical cord.
Infected urachal cyst.
45. Fistula.
Vesico-vaginal fistula (VVF) is a subtype of female
urogenital fistula (UGF). VVF is an abnormal fistulous
tract extending between the bladder and the vagina that
allows the continuous involuntary discharge of urine into
the vaginal vault.
colovesical fistula (abnormal connection between colon
and bladder) may develop in men or women with
inflammatory bowel disease or diverticulitis and can
result in passage of gas or stool in the urine, frequent
UTI's and even sepsis (severe infection that enters the
bloodstream).
47. Bladder stones.
Bladder stones are hard buildups of minerals that form in the
urinary bladder.
Causes
Bladder stones are usually caused by another urinary system
problem, such as:
Bladder diverticulum
Enlarged prostate
Neurogenic bladder
Urinary tract infection
Almost all bladder stones occur in men. Bladder stones are much
less common than kidney stones.
Bladder stones may occur when urine in the bladder is
concentrated and materials crystallize. Bladder stones may also
result from foreign objects in the bladder.
49. Urinary tract infection.
A urinary tract infection (UTI) (also known as acute cystitis or
bladder infection) is an infection that affects part of the urinary
tract. When it affects the lower urinary tract it is known as a
simple cystitis (a bladder infection)
Urinary tract infections occur more commonly in women than
men, with half of women having at least one infection at some
point in their lives. Recurrences are common. Risk factors
include female anatomy, sexual intercourse and family history.
The main causal agent of both types is Escherichia coli, though
other bacteria, viruses or fungi may rarely be the cause.
50. Neoplasm of the urinary bladder.
Benign Tumors of the Bladder.
There are numerous benign tumors of the bladder, but the more common ones include epithelial
metaplasia, leukoplakia, inverted papilloma, nephrogenic adenoma, leiomyoma, cystitis cystica,
cystitis glandularis and hemangioma .
Malignant tumour of the urinary bladder.
Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue
layer of the bladder. Most bladder cancers begin in the transitional cells.
Transitional cell carcinoma can be low-grade or high-grade:
Low-grade transitional cell carcinoma often recurs (comes back) after
treatment, but rarely spreads into the muscle layer of the bladder or to other
parts of the body.
High-grade transitional cell carcinoma often recurs (comes back) after
treatment and often spreads into the muscle layer of the bladder, to other
parts of the body, and to lymph nodes. Almost all deaths from bladder cancer
are due to high-grade disease.
Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin,
flat cells that may form in the bladder after long-term infection or irritation.
Adenocarcinoma: Cancer that begins in glandular (secretory) cells that are found
in the lining of the bladder. This is a very rare type of bladder cancer.
52. Hemangioma. Axial CT image shows an intramural
bladder mass (arrow) with marked enhancement.
53. Squamous cell carcinoma in a paraplegic patient. Axial unenhanced
CT image of the bladder shows calcifications (arrow) encrusting a
tumor. Axial contrast material–enhanced CT cystogram shows the
tumor (arrow) more clearly. Note the loss of trabecular structure in
the bones and the fatty infiltration of the muscles.
57. Retrograde Urethrography.
Retrograde urethrography is considered to be the best
initial study for urethral and periurethral imaging in men
and is indicated in the evaluation of urethral injuries,
strictures, and fistulas. Retrograde urethrography is a
straightforward, readily available, cost-effective
examination.
Voiding Cystourethrography.
Voiding cystourethrography is currently the most
commonly used imaging method in the evaluation of the
female urethra and male posterior urethra. Voiding
urethrography is usually performed after the bladder is
filled with contrast material via a transurethral or
suprapubic catheter.
58. Gonococcal urethral stricture. Retrograde urethrogram reveals
a segment of irregular, beaded narrowing in the distal bulbous
urethra with opacification of the left Cowper duct (arrow).
59. Female urethral diverticulum. Post-voiding image
obtained during excretory urography demonstrates a
contrast material-filled urethral diverticulum (arrow).
