1. Bladder Diverticuli May be congenital May be congenital Usually secondary to chronic obstruction of bladder outflow. Usually secondary to chronic obstruction of bladder outflow. There will be urinary stasis: There will be urinary stasis: - infection. - infection. - stone formation. - stone formation. - tumor. - tumor. Readily seen on all imaging, may deform the adjacent bladder or ureter. Readily seen on all imaging, may deform the adjacent bladder or ureter.

3. Bladder calcification

4. Bladder Calcification Most are bladder calculi. Most are bladder calculi. Usually large and laminated. Usually large and laminated. Rarely calcification seen in the wall : Rarely calcification seen in the wall : -Schistosomiasis -Schistosomiasis -Bladder tuumour -Bladder tuumour

6. Neurogenic bladder

7. 2 type : The atonic type: large, smooth-walled baladder, poor or absent contraction and large residual volume. The atonic type: large, smooth-walled baladder, poor or absent contraction and large residual volume. The Hypertrophic type : regarded as neurologically induced bladder outflow obstruction. The Hypertrophic type : regarded as neurologically induced bladder outflow obstruction. small volume, very thick, grossly trabeculated wall and marked sacculation, ureter and PCS may be dilated small volume, very thick, grossly trabeculated wall and marked sacculation, ureter and PCS may be dilated Full assessment is by videourodynamics. Full assessment is by videourodynamics.

8. Trauma to the Bladder and urethra

11. Intraperitoneal rupture: Intraperitoneal rupture: - direct blow to the distended UB. - direct blow to the distended UB. - contrast will leak out into peritoneal cavity. - contrast will leak out into peritoneal cavity. Extraperitoneal rupture: Extraperitoneal rupture: - as part of an extensive injury of fracture of pelvis. - as part of an extensive injury of fracture of pelvis. - usually in the bladder base. - usually in the bladder base. - contrast and hematoma accumulated outside peritoneal cavity and may elevate and compress bladder base - contrast and hematoma accumulated outside peritoneal cavity and may elevate and compress bladder base

12. US may show perivesical fluid collection. US may show perivesical fluid collection. Cystography remains the best way of demonstrating actual site of leakage. Cystography remains the best way of demonstrating actual site of leakage. If urethral injury suspected, ascending urethrogram should be done before passing any catheter. If urethral injury suspected, ascending urethrogram should be done before passing any catheter. CT : demonstrate fresh hematomas or urine collection, and associated fracture. CT : demonstrate fresh hematomas or urine collection, and associated fracture.

13. Prostate and Urethra

15. Prostatic enlargement Very common in elderly man Very common in elderly man Usually benign hypertrophy but may be CA. Usually benign hypertrophy but may be CA. Prostatic US: Prostatic US: -Transrectal Ultrasound ( TRUS) : can measure the volume and detect relatively small mass. -Transrectal Ultrasound ( TRUS) : can measure the volume and detect relatively small mass. - masses in peripheral zone are usually malignant and in central zone are benign - masses in peripheral zone are usually malignant and in central zone are benign

16. Transrectal ultrasound guided biopsy is used for diagnoses of prostatic CA. Transrectal ultrasound guided biopsy is used for diagnoses of prostatic CA. CT can't demonstrate internal structure, its used for assessing local spread and LNs CT can't demonstrate internal structure, its used for assessing local spread and LNs

17. MRI : in assessment of early stage of prostatic cancer. MRI : in assessment of early stage of prostatic cancer. Tumor appear as low signal in the peripheral zone which is high signal on T2. Tumor appear as low signal in the peripheral zone which is high signal on T2. It shows extracapsular spread, seminal vesicle invasion and LN metastases It shows extracapsular spread, seminal vesicle invasion and LN metastases

19. Prostatic calcificaiton Numerous prostatic claculi. Numerous prostatic claculi. Very common, that it can be regarded as a normal finding in older men. Very common, that it can be regarded as a normal finding in older men. No relation to symptoms of BPH or prostatic carcinoma. No relation to symptoms of BPH or prostatic carcinoma.

21. Bladder outflow obstruction Commonest cause of BPH Commonest cause of BPH Other cause : Other cause : - tumors - tumors - Urethral strictures - Urethral strictures - posterior urethral valve (male infants) - posterior urethral valve (male infants) - neurogenic obstruction. - neurogenic obstruction.

22. US in bladder outflow obstruction Increased trabeculation and thickness of the bladder wall, with diverticula formation. Increased trabeculation and thickness of the bladder wall, with diverticula formation. PVRU ( residual urine). PVRU ( residual urine). Dilatation of collecting system. Dilatation of collecting system.

24. Urethral stricture Usually due to previous trauma or infection Usually due to previous trauma or infection Imaging is by urethrography. Imaging is by urethrography. Traumatic stricture : Traumatic stricture : - usually in proximal penile urethra - usually in proximal penile urethra - smooth in outline, relatively short. - smooth in outline, relatively short. Inflammatory stricture ( gonococcal) : Inflammatory stricture ( gonococcal) : - may be seen in any portion of urthera. - may be seen in any portion of urthera. - usually in anterior urethra - usually in anterior urethra

26. Posterior urethral valve Commonest cause of BOO in male children. Commonest cause of BOO in male children. May be seen antenatally(bilateral hydronephrosis) May be seen antenatally(bilateral hydronephrosis) US show bilateral hydronephrosis and hydroureter with thick wall bladder. US show bilateral hydronephrosis and hydroureter with thick wall bladder. Can not be diagnoses by retrograde rethrography. Can not be diagnoses by retrograde rethrography. Easily seen on micturating cystourethrography, Easily seen on micturating cystourethrography, as dilatation of posterior urethra terminates abruptly in a convex border formed by the valve as dilatation of posterior urethra terminates abruptly in a convex border formed by the valve

28. Scrotum and testes

29. Usually imaging by US, some times MRI. Usually imaging by US, some times MRI. Scrotal US is done for : Scrotal US is done for : > scrotal swelling : > scrotal swelling : - intratesticular ( tumor ) - intratesticular ( tumor ) - extratesticular - extratesticular varicocele varicocele hydrocele hydrocele infection (epididymitis,epididmoorchitis) infection (epididymitis,epididmoorchitis) benign epididymal cyst ( common) benign epididymal cyst ( common)

30. Acute testicualr pain and/or swelling: Acute testicualr pain and/or swelling: - testicular torsion : dramatic reduction in perfusion on Doppler - testicular torsion : dramatic reduction in perfusion on Doppler - acute epididymitis/orchitis: normal or increased perfusion - acute epididymitis/orchitis: normal or increased perfusion

31. Ectopic testis ( undescended testis) : Ectopic testis ( undescended testis) : - commonest site is in the inguinal canal - commonest site is in the inguinal canal - MRI used if US inconclusive or ectopic testis lies within the abdomen. - MRI used if US inconclusive or ectopic testis lies within the abdomen. MRI produce highly detailed images of scrotal contents and is used in problem solving cases.

33. Questions