Neurogenic bladder

Case contributed by Dr Ian Bickle

Presentation

Teenage boy with a history of urogenital problems, including previous surgery, since childhood.

Patient Data

Age: 18 years
Gender: Male
CT

Gross left nephrohydroureter down to the VUJ.

Left sided renal cortical thinning.

Trabeculated urinary bladder.

Undescended left testis in the inguinal canal.

MRI

Enlarged elongated trabeculated urinary bladder.

Left severe chronic nephrohydroureter.

Undescended left testis - in the groin.

The urinary catheter is inflated in the posterior urethra.

Fluoroscopy

Usual elongated appearance to the bladder, with trabeculation.

The appearances are those of a pine or Christmas tree.

Diagram

Illustrated by Dr Matt Skalski.

Case Discussion

Multimodality appearances of a neurogenic bladder. The bladder becomes elongated as opposed to its normal 'ball-like' appearance, with an apex in the cranial direction. In addition the bladder wall becomes trabeculated - the combined appearances give the distinct Aunt Minnie appearance of a Christmas tree bladder.

In this case a number of other interesting additional findings are present:

- left sided undescended testis

- chronic right hydronephrosis

- iatrogenic abnormality of a urethral catheter balloon inflated in the posterior urethra - this may be possible depending on the patient's neurogenic status. Inflate a balloon in the posterior urethra beyond 2-3 mL in a normal patient and they/you will know it!

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