Ultrasound signs of bladder pathology

Bladder pathology

It is important to determine whether:

1. Changes in wall thickness and trabecularity.
2. Asymmetry of the bladder.
3. Cystic structures in the cavity of the bladder (ureterocele or diverticula).
4. Tumor structures in the cavity of the bladder or at the base of the bladder.

General thickening of the bladder wall

• In men, the general thickening of the wall of the bladder occurs most often in the presence of obstruction at the level of the prostate gland. If suspected obstruction at this level, examine the prostate gland; it is also necessary to exclude hydronephrosis, for this purpose it is necessary to carry out a study of ureters and kidneys. Look also for the diverticula of the bladder: they protrude outward, however, visualization of the diverticulum is possible only with its diameter of at least 1 cm. Diverticula are usually anechogenous, with good sound conductivity. In some cases, the diverticulum neck is visualized: diverticulum may subside or increase during urination.
• Pronounced chronic inflammation / cystitis. The wall of the bladder can be thickened and has an uneven contour. Examine the rest of the urinary tract for dilations.
• Schistosomiasis. The wall of the bladder can be thickened, its echogenicity can be increased with local hyperechogenic inclusions due to the presence of calcinates. Calcification of the wall may be local or general, the thickness of the calcification zone may also be different. Calcification usually affects the intramural spaces and does not interfere with the normal contraction of the bladder.

Poor emptying of the bladder means the presence of an acute inflammatory process, as well as a long-existing or recurrent infection. The prevalence of calcification does not correlate with the activity of schistosomiasis infection, while calcification may decrease in the late stages of the disease. Nevertheless, the wall of the bladder remains thickened and poorly stretched. This may reveal hydronephrosis.

• A very thick trabecular wall of the bladder in children is determined by external obstruction due to the posterior urethral valve or the presence of an urogenital diaphragm.
• A very thick wall can be detected in the presence of a non-irogenic bladder, and this is usually combined with ureterohydronephrosis.

Local thickening of the bladder wall

If there is a suspicion of a local thickening of the bladder wall, it is necessary to conduct polypositional sections, especially to exclude the tumor. A change in the position of the patient's body or additional filling of the bladder will help differentiate the pathology and normal folding of the bladder. (The folds disappear when the bladder stretches.) If there are any doubts, repeat the test after 1-2 hours: do not allow the patient to urinate before re-examining.

Thickening of the wall of the bladder? Give the patient more fluid

Local thickening of the wall of the bladder can be determined when:

1. Folding due to insufficient filling.
2. Tumors: on a wide base or on a thin pedicle, single or multiple.
3. Bladder involvement in tuberculosis or schistosomiasis (with granuloma formation).
4. Acute reaction in schistosomiasis infection in children.
5. Hematoma as a result of trauma.

Differential diagnosis of local thickening of the bladder wall

1. Most tumors of the bladder are multiple, but localized in one zone. Some tumors cause only local wall thickening, but most of them also contribute to the appearance of polyposic growths. It is important to determine whether or not the germination of the bladder wall is present. Calcification of the tumor structure or wall as a result of schistosomiasis causes the appearance of hyperechoic structures.
2. Polyps of the bladder are more mobile and have a thin leg, but there are polyps on a thick base, especially developed against the background of inflammation, which are difficult to differentiate with malignant tumors.
3. Granulomas (eg, tuberculosis) cause multiple local wall thickenings. A small bladder is often formed with tenderness when stretching, which leads to rapid urination. Tumor lesion of the bladder is not accompanied by soreness in tension. Schistosomiasis can produce the formation of multiple flat plaques or polypous structures. Any chronic infection reduces the capacity of the bladder.
4. Injury. If, after trauma, a local thickening of the bladder wall is determined, perform a small pelvic examination to exclude fluid (blood or urine from the bladder) from the outside of the bladder. Repeat the test after 10-14 days. If the thickening is caused by a hematoma, the swelling will decrease.
5. Schistosomiasis. Reinfected children may have a sharp "urticar" reaction, causing a sharp local thickening of the mucous membrane of the bladder. It takes place with appropriate therapy or independently in a few weeks.

Blood clots and swelling look identical; both can be combined with hematuria.

Echogenic formations in the bladder

1. Wall-bound
   • Polyp. The polyp on the long leg can be mobile. Change the position of the patient and repeat the test.
   • "Soldered" stones. Stones can be single or multiple, small or large: they usually have an acoustic shadow, some of them are soldered to the mucous membrane, especially against the background of inflammation: scan in different positions in order to catch the displacement of the calculi.
   • Ureterocele. Ureterocele is represented by a cystic structure in the bladder cavity, in the projection of the ureteral orifice. Ureterocele can change its shape. In children, the ureterocele sometimes reaches such a size that the contralateral ureter can also be blocked. A ureterocele can be bilateral, but, as a rule, not symmetrical. If you suspect a ureterocele, examine the kidneys and ureters for asymmetric hydronephrosis, as well as doubling the ureter.
   • Enlarged prostate gland. The appearance of an echogenic, non-displaced structure located centrally at the bottom of the bladder in men is most likely due to an increase in the prostate gland. In women, the enlarged uterus can also move the bladder.
2. Movable echogenic formation in the bladder cavity
   • Stones. Most stones are displaced in the bladder, if it is not giant stones. Nevertheless, the stones can be fixed in the diverticulum or have such large dimensions that they seem to completely fill the bladder: the ability of the urinary bladder to retain urine decreases with large stones. When you doubt the presence of stones, then change the position of the patient and repeat the study. The smallest and medium-sized stones will change their position, but large stones may not move.
   • Foreign body. Catheters are often visualized. Very rarely, foreign bodies introduced into the bladder are visualized. If there is a suspicion of the presence of foreign bodies, it is necessary to carefully collect the anamnesis. It can be useful radiography.
   • Blood clot. A thrombus can look like a stone or a foreign body: not all blood clots move freely.
   • Air. Introduced into the bladder through a catheter or formed during inflammation, or caught in the bladder through the phistle, the air looks like echogenic mobile floating structures.

Enlarged (overgrown) bladder

When the bladder overflows, the walls will be smooth and even overstretched, with or without diverticula. Perform measurements to confirm the presence of bladder overflow.

Always examine the ureters and kidneys for hydronephrosis. Ask the patient to empty the bladder and repeat the test to determine how completely it is emptied.

The most common causes of overgrowth of the bladder are:

1. Enlargement of the prostate gland.
2. Striations of the urethra in men.
3. Stones in the urethra in men.
4. Trauma of the female urethra (the so-called "urethritis of the newlyweds").
5. Neurogenic bladder in case of spinal cord injury.
6. Valves of the urethra or diaphragm in newborns.
7. Cystocele in some patients.

Small bladder

The bladder can be small with cystitis, while the patient can not hold the urine for a long time, it is troubled by frequent painful urination. The bladder can also be small as a result of damage or fibrosing of the wall, which greatly reduces the capacity of the bladder. Urination will be rapid, but not painful.

If you have any doubts, then give the patient more fluid and ask him or her not to urinate; repeat the test after 1-2 hours.

A small bladder can result from:

1. Schistosomiasis (late stage). As a rule, there are bright hyperechoic structures as a result of calcification of the wall.
2. Recurrent cystitis, especially with tuberculosis. The thickening of the wall will be determined.
3. Rarely occurring infiltrating tumors. In the presence of a tumor, the bladder is always asymmetric.
4. Radiation therapy or surgery for malignant tumors. Collect anamnestic data.

Before you diagnose a small bladder, ask the patient to drink more water and repeat the test after 1 -2 hours.