Unit 9- Congenital Anomalies-Lower Urinary Tract (Elie)

In duplication of ureters, what is the prevalence?

Females > Males

Duplication of Ureters can be ______ or _______

Unilateral or bilateral

In a complete duplication of ureters, what is the draining like?

Separate draining of upper and lower poles

How do the ureters enter the bladder in a complete duplication of ureters?

Separately

In a complete duplication of ureters the upper is more ______ than the lower pole ureter

Caudal

In an incomplete duplication of ureters how do the ureters join?

• Ureters join together & enter bladder as 1

What are these images showing?

Duplication of ureters

What is this image showing?

Duplication of ureters- 2 ureteral jets confirm complete duplication

A stricture or narrowing of the ureters is caused by what?

Due to internal and external causes

What is a Ureterocele?

Cyst like enlargement of lower end of ureter

Ureteroceles are most common in?

Adults > children

What is a ureterocele caused by?

Congenital or Acquired Stenosis

US appearance of Ureterocele:

• Small & Asymptomatic

  • May cause obstruction & infection of upper urinary tract

  • May cause bladder outlet obstruction if large

What is this image showing?

Ureterocele

What are these images demonstrating?

Ureterocele

An Ectopic Ureterocele is considered:

Rare

Who is most likely to have an ectopic Ureterocele?

•Female children greatest incidence

What is an Ectopic Ureterocele?

• Complete ureteral duplication

• Ureters inserts low in bladder near neck

In an ectopic ureterocele, what does a stenotic ureter cause:

• Obstruction

  • Hydroureter

  • Hydronephrosis

  • Bladder outlet obstruction or prolapse

  • “Foley Catheter” appearance

What is this image showing?

Ureterocele in utero

What is this image showing?

“ Foley catheter” appearance

What is used as direct evaluation of bladder?

• Cystoscopy

  • Best to evaluate early CA

Ultrasound visualizes lesions greater than?

5mm

US appearance for a distended bladder:

• Smooth walls – not irregular or with asymmetrical indentations

• Wall mass or thickening (3-6 mm is normal)

• Midline – not deviated or asymmetric indentations

• Calculi

• Debris

• Diverticula

• Ureteral Jets

• Ureterocele

What is the normal size for a wall mass or thickening in the bladder?

3-6mm

When scanning the bladder movement of the patient is necessary to evaluate what?

• Stones

• Debris vs mass(attached)

What other organs should the sonographer look for when scanning the bladder?

Look for enlarged prostate, uterus, or pelvic mass which may indent & displace the bladder

What are these images showing?

Bladder Tumors

Residual Bladder volume is used when?

If there is outflow obstruction

How do you calculate residual bladder volume?

• Post void – Long & Trans.

• Measure Length, Transverse, & AP at largest dimensions

• Calculate volume

  • L x W x H x 0.625 = cc’s for adults

  • L x W x H x 0.5233 = cc’s for peds

What is the normal residual measurement for adults?

< 20 cc’s