Sonography of the Urinary

Bladder
Sarah E. McAchran, MD
David M. Hartke, MD,
Dean A. Nakamoto, MD
Martin I. Resnick, MD
- Embryology
- Sonographic technique
Transabdominal scanning
Transrectal scanning
Transurethral scanning
Transvaginal scanning
- Normal anatomy
- Measurement of bladder wall thickness
- Residual urine volume
- Congenital abnormalities
- Acquired abnormalities
Bladder diverticula
Calculi, clots, and other debris
Cystitis
Masses
Extrinsic masses
Suprapubic aspiration
The retained Foley
Urodynamics
- New frontiers
- Summary
- References
Fig. 1. Urogenital embryology. Division
of the cloaca into the urogenital sinus
and rectum and development of
the urinary bladder, urethra, and
urachus. (A) Lateral view of the caudal
half of a 5-week embryo. (B, D, F) Dorsal
views. (C, E, G, H) Lateral views. The
stages shown in G and H are reached by
the 12th week. (From Moore KL,
Persaud TVN. The developing human:
clinically oriented embryology. 6th
edition. Philadelphia: WB Saunders;
1998. p. 303–47; with permission.)
Fig. 3. Bilateral crossing
ureteral jets are well Fig. 2. High-frequency
visualized using color ultrasound of a normal bladder
Doppler ultrasonography. in a thin patient. The bladder is
lined by echogenic mucosa
and layers of detrusor muscle.

Fig. 4. A Foley catheter is demonstrated

as an echogenic circle with an anechoic
interior in a moderately filled
bladder (A). A Foley catheter balloon is
inflated in a decompressed bladder (B).

Fig. 5. The normal bladder wall appears thinner in a
filled state (A) compared with the postvoid state
(B).
Fig. 7. An ureterocele is
demonstrated as an echogenic
ring protruding into the bladder. A
dilated ureter (marked, A) is well
visualized because of obstruction
caused by the ureterocele.
Fig. 6. A urachal cyst (marked, A) is an oval-
shaped,
midline, sonolucent structure just anterior to the
bladder.
Fig. 8. Several bladder diverticula are
visualized as sonolucent structures
adjacent to the bladder. They represent
out-pouchings of bladder mucosa between
hypertrophied bundles of detrusor muscle.
The bladder wall is diffusely thickened,
but the diverticula are devoid of muscle.

Fig. 9. An echogenic calculus
(marked, A) is well visualized
at the ureterovesical junction
with a line of posterior acoustic
shadowing. The shadowing
occurs as a result of the
inability of ultrasound to
penetrate
beyond the dense calculus.
Fig. 10. An echogenic mass
projects from the left
bladder wall and represents a
superficial papillary
transitional cell carcinoma.
Fig. 11. A sessile mass at the right lateral
bladder wall that was later confirmed to be
muscle-invasive transitional cell carcinoma.
Color Doppler ultrasonography helps
differentiate the mass as perfused tissue from
echogenic clot, which would not demonstrate
blood-flow.
Fig. 12. A large hematoma in the
right hemipelvis displaces an
otherwise normal bladder laterally.
This is demonstrated on a coronal
CT with the bladder filled with
contrast (A) and also on ultrasound
(B) as an echogenic hematoma
displacing a sonolucent bladder.
Ultrasonography of the bladder and using
the bladder
as an acoustic window are diagnostic tools
adaptable to various clinical settings.
Because bladder
US noninvasive and does not require
ionizing
radiation, the range of its clinical
usefulness will
continue to be investigated and broadened.