Urinary Bladder Disorder ---ماجد اضغر

Question 1

whats the location of the bladder when its full or empty ?

Answer 1

• when its empty its lies behind the pubic symphesis

- when the bladder is full it lie above the symphesis so can be palpated and precussed

Question 2

how the ureter enter the bladder and how much the distance between both ureters ?

Answer 2

ureter enter posterioinferiorly in oblique maner

they re 5cm apart

Question 3

what the location of the bladder in the male and female ?

Answer 3

• in male it lie posteriorly to seminal vesicle ,vasa deferentia ,ureter and rectum
• in female the the uterus and vagina is located between the bladder and the rectum

Question 4

what happen if there is truma in the lower abdominal wall and the bladder is full ?

Answer 4

in both sexes when the bladder distended it will be in contact with the lower abdominal wall and cause truma as weel

Question 5

what the type of the mucosa of the bladder ?

Answer 5

is transitional

Question 6

what the muscle of the bladder ?

Answer 6

bundles are run longitudinally and circulary

Question 7

whats the blood supply of the bladder ?

Answer 7

• sup, med , inf vesical artery is branch from the internal illic trunk
• also from obterator artery and inferior gluteal artery
• in female uterine and vaginal branches

while the venous into the internal illiac artery

Question 8

where the lymphatic drainage of the bladder ?

Answer 8

vesical ,external , internal illiac and common iliac LN

Question 9

what’re the congenital anomalies of the bladder ?

Answer 9

1- extrophy of the bladder

2- persistant urachus

Question 10

whats the dystrophy of the bladder ?

Answer 10

• its ventral defect in the bladder where the inner surface of the post wall of the bladder appear exposed in the abdomen with defect in the skeletal muscle
• also the pubic bone is widely seperated
• epispadias (urethra ends in an opening on the upper aspect of the penis ,in females when the urethra develops too far anteriorly.)

Question 11

whatre the complication of the extrophy of the bladder ?

Answer 11

• renal infection is very common and hydronephrosis (kidney swells ) because of bstruction is uretrovesical junction
• have carcinoma (adenocarcioma)

Question 12

how to repair the extrophy of the bladder ?

Answer 12

by surgery done at 3 -18 month

-1st we do complete reconstruction (نعيده للوضع السابق ) to
the defect and close the bladder

• to fixed the seperation in the pubic bone we need to do sacral osteotomy
• bladder neck reconstruction and antiureteral reflex procedure
• also repair the epispadic penis
• if the bladder with small capacity need to do augmentation(زياده ) cyctoplasty

نعدل المثانه والعضم و اليورثرا

Question 13

whats the persistant urachus ?

Answer 13

(At birth the urachus attach the bladder to the umbilicus)

so if there is incomplete obliteration the urachus either open in umblicus or bladder or connect for both in this condition the urine drain by umblicus

-if the sup end still opened it cause umblical sinus
if the inf end remain opened cause comincation with bladder

• is both sup and inf end remain opened cause urine drainage from the umblicus
• if only the end obliterate it form urachal cyct

Question 14

what happen if the sup end still opened ?

Answer 14

cause umblical sinus

Question 15

what happen if the inf end remain opened ?

Answer 15

cause comincation with bladder

Question 16

what happen if both sup and inf end remain opened ?

Answer 16

cause urine drainage from the umblicus

Question 17

what happen if only the end obliterate ?

Answer 17

it form urachal cyct

Question 18

what the treatment of the persistant urachus ?

Answer 18

excision of the urachus

Question 19

what the internal vesical herniation ?

Answer 19

its aquired disease
when one side of bladder involve in
-the inguinal hernia in male
- femoral hernia in female

Question 20

what the treatment of the internal vesical herniation ?

Answer 20

laproscopic surgery with mesh

Question 21

whats the Enuresis?

Answer 21

bedwetting at age of 3 years in the 6 years happen about 10%

Question 22

whats the cause Enuresis?

Answer 22

• Gentic factor is primary cause of the enuresis
• 50% of them will have delay maturation in the maturation or interinsic myoneurogenic bladder dysfunction
• 30% is psychatric
• 20 % seconday to the other orgainc disease

Question 23

whats the clinical features of the Enuresis?

Answer 23

• bed wet regurally
• normal examination physical and urological
• no burning and all the lab investigation and imaging study is normal
• but the cyctometric studies show hyperirritable neuropathic bladder

Question 24

whats the differential diagnosis of Enuresis?

Answer 24

1- lower urinary tract obstrction
stricture or stenosis os some problem in the valve

2-or choronic urinary infection
3- neurogenic bladder

Question 25

whats the treatment of Enuresis?

Answer 25

general measures - ---------------------------- - limit fluid intake - empty bladder at bedtime and child should be awakened Drug therpy ---------- 1- impramine start with dose is 25mg befor dinner then 50mg 2- parasympathtic 3- sympathomimetic 4 desmopressin (anti diuretic) Pschotherpy ----------

Question 26

whats the acute cyctitis ?

Answer 26

inflamed bladder affcted highly sexul female because of short urethra -mot common cause is the accending infection -may be heamtogenous but the primary rout is the fecal -perinal -urethral rout 80 % Ecoli

Question 27

whats the clincal feature of acute cyctitis ?

Answer 27

- frequency , dysuria, urgency - pain in lower back and suprapubic - no systemic menfestation

Question 28

how to dignosis acute cyctitis ?

Answer 28

urinlysis , urine culture , urine dipstick

Question 29

whats the treatment of acute cyctitis ?

Answer 29

Trimethoprim/sulfamethoxazole. TMP-SMX nitrofurantoin flouroquinolone 3-5 day treatment

Question 30

whats the recurrent cyctitis ?

Answer 30

its infection either it persistant (with) or reinfection with (other organism)

Question 31

whats the investigation for recurrent cyctitis ?

Answer 31

``` 1- U/S 2- IVP (intraveous polygram radiological procedure used to visualize abnormalities of the urinary system, including the kidneys, ureters, and bladder.) 3-CT 4- cystoscpoy to see if there is stone ```

Question 32

whats the treatment for recurrent cyctitis ?

Answer 32

surgical to remove the stone -in most cases of the reinfection give prophylactic antibiotic then low dose continious antibiotiic - or use alternative to the antibiotic as lactobacillus vaginal suppositeries and canberry juice التوت البري

Question 33

what the vesical diverticula ?

Answer 33

when increase in the pressure intravesicaly the mocosa will herniate most common its secondary to obstruction so it will located distal to the bladder neck but may be because of neurogenic bladder (upper motor neuron)

Question 34

what the complication of vesical diverticula ?

Answer 34

1- residual urine may develop 2- may be there is reflex. when the diverticula located sup 3-infection 4- carcinoma

Question 35

what the treatment of vesical diverticula ?

Answer 35

resection of the diverticulum

Question 36

Dose the vesical fistula common ?

Answer 36

yes its common , may comunicate to the skin , intestine , or in female to the reproductive tract

Question 37

what the cause of vesical fistula?

Answer 37

1- primary intestinal disease 2- primary gyncolgical disease 3- after treatment of the gynological disease 4- trauma

Question 38

what the primary intestinal disease that can cause fistula ?

Answer 38

diverticulosis 60-50% colon cancer 20-25% crohn disease 10%

Question 39

what the primary gyncolgical disease that can cause fistula ?

Answer 39

- beacuse of the labor which cause pressure necrosis | - carcinoma in the cervix

Question 40

what the treatment of the gynological disease hat can cause fistula ?

Answer 40

hysterectomy (surgical removal of the uterus) low CS radiotherapy

Question 41

whats the clinical feature of the vesicointestinal fistula ?

Answer 41

- feces and gases pass throght the urine - urine is infected - change in the bowel habbit

Question 42

whats the investigation for vesicointestinal fistula ?

Answer 42

- barium enema - sigmodoscopy - cyctogram - cyctoscopy

Question 43

whats the treatment for vesicointestinal fistula ?

Answer 43

proximal colostomy and repair

Question 44

whats the clinical feature of the vesiecovaginal fistula ?

Answer 44

very common | -urine leak from vagina

Question 45

whats the investigation for vesicovaginal fistula ?

Answer 45

cyctoscopy and vagioscopy

Question 46

whats the treatment for vesicovaginal fistula ?

Answer 46

surgical repair