11 — The Lower Urinary System
Answers: Chapter 11
Matching
11. Verumontanum; outlet obstruction; prostatic;
thickened
12. Ectopic; upper; duplicated; lower; medially
13. Ureterocele; megaureter; hydronephrosis; bladder
outlet obstruction
14. Urachus; infection; adenocarcinoma; calculi
15. Cystitis; E. coli; pyeloneprhitis
16. Concentration; infection; obstruction; stasis
17. Neurogenic; overactive; underactive
18. Bladder flap; hematoma; infected
19. Painless hematuria; irregular; cervix; uterus;
prostate; rectum
20. Calculi; infection
1. g
2. c
3. f
4. a
5. b
6. d
7. e
Image Labeling
1A. Bladder
1B. Pubic symphysis
1C. Uterus
1D. Ovary
1E. Spine
1F. Rectum
1G. Vagina
1H. Urethra
2A. Pubic symphysis
2B. Bladder
2C. Spine
2D. Rectum
2E. Prostate gland
2F. Scrotum
2G. Urethra
2H. Penis
3A. Urachus
3B. Ureter
3C. Trigone
3D. Ureteral orifice
3E. Prostate gland
3F. Urethra
4A. Ureteral jet
Short Answer
1. In order to evaluate the urinary bladder with a
transabdominal approach, the patient needs to have
a full bladder. The most common way to accomplish
this is to have the patient drink approximately 16
ounces of liquid 1 hour prior to the examination and
not void until after the examination is completed.
If the patient is unable to drink fluids or maintain
a full bladder, retrograde filling of the bladder is
possible through a Foley catheter. The endovaginal,
transperineal, or endorectal methods may be used
to evaluate the female urethra or evaluate for stress
incontinence. The endorectal approach can also be
used to evaluate the male urethra.
Multiple Choice
1. b
2. d
3. b
4. c
5. c
6. c
7. d
8. a
9. d
10. b
11. a
12. d
13. c
14. a
15. b
16. b
17. d
18. c
19. a
20. d
Fill-in-the-blank
1. Ureters; bladder; urethra
2. Allantois; urachus; umbilicus
3. Submucosa; detrusor; adventitia
4. Ureteropelvic; iliac; ureterovesical
5. Urethra; internal urethral sphincter; involuntary;
opens; relaxation
6. 3 mm; 5 mm
7. Rounded; square; triangular
8. Posterior; transverse
9. Ellipsoid; transverse (width); AP (height); length; 0.52
10. Transperineal; transvaginal; diverticula
2. Color Doppler can be used to evaluate a number
of conditions. Color Doppler is used routinely
to visualize ureteral jets and evaluate for
ureteral obstruction. Color Doppler may also
be used to confirm the presence of a bladder
diverticulum. When slight pressure is applied to the
abdomen, reversed flow can be seen through the
communication between the diverticulum and the
bladder. Color Doppler may also be used to evaluate
a suspected bladder mass and to differentiate a
bladder mass from a blood clot.
3. An ectopic ureterocele occurs when a duplicated
kidney is present. Typically, the upper pole ureter
inserts into an ectopic location within the bladder
trigone. If the ectopic ureter is obstructed where it
enters the bladder, the anterior wall of the ureter
will balloon into the bladder, forming a ureterocele
and obstructing the flow of urine from the ureter
into the bladder. The ureter may be massively
dilated and may mimic a cystic mass on ultrasound.
Sonographically, a round, thin-walled cystic structure
is seen along the posterior wall of the urinary
bladder. The ureter may be dilated and severe
hydronephrosis may be present.
4. The distal ureter enters the bladder obliquely
through slit-like openings. As the bladder fills, the
increase in pressure causes the walls of the ureter
Part 1 — Abdominal Sonography
to press together, preventing a backflow of urine
from the bladder to the kidneys. This forms a valve
of sorts. If this mechanism fails, high-pressure urine
can reflux into the ureters and kidneys. Bacteria
also have the opportunity to travel to the kidneys.
Hydronephrosis can occur and high-pressure reflux
can cause significant kidney damage and can lead to
chronic renal failure.
5. In cases of neurogenic bladder, the bladder becomes
trabeculated. The bladder wall is typically thickened
and irregular. Diverticula are typically present. A
significant post-void residual may be present. These
changes are caused by consistently high pressure
within the bladder and chronic infection.
Image Evaluation/Pathology
1. Foley catheter within the urinary bladder
2. Bladder wall that appears thickened and irregular.
Thickening of the bladder wall can be caused by
cystitis or inflammation of the wall. Bladder outlet
obstruction can cause thickening of the wall, as can
a neurogenic bladder, bladder tumor, or radiation
therapy.
3. Calculus within the bladder. Predisposing factors
include increased concentration of salts in the urine,
infection, and obstruction or stasis of the urinary
tract. Complications include inflammatory changes
and acute bladder outlet obstruction.
4. In this image, the bladder wall appears thickened
and irregular all along the posterior wall. An
irregular echogenic mass is seen protruding into the
bladder lumen from the posterior wall. The likely
diagnosis is a bladder tumor. Blood clots, benign
prostatic hypertrophy, cystitis, fungal balls, and
stones may mimic a bladder tumor.
Case Study
1. This image shows the urinary bladder with two
diverticula. A connection is seen between the urinary
bladder and each of the diverticula. Debris is seen
within the diverticula. Diverticula may not empty
completely when the patient voids. This stasis of
urine predisposes a person to infection as well as
stone formation.