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Developmental anomalies

• Prenatal bladder normally visible in 50% by 10 weeks, 100% by 13 weeks
• Bladder agenesis: can only be diagnosed after 15-20 minutes visualization to make sure bladder is not just empty, compatible with life only if ureters drain into mullerian structures (female) or rectum (male), treat with ureterosigmoidostomy
• Megacystis: prenatally dilated bladder, spontaneously resolves if no obstructive uropathy and normal karyotype
• Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS): presents prenatally with distended bladder, presents postnatally with abdominal distension and inability to pass meconium, managed with ileostomy + Gtube + TPN, may require small intestine transplant, most will require CIC +/- vesicostomy
• Duplication: can be complete or incomplete, 90% have external genital abnormalities, 42% have GI abnormalities, goals are removing obstruction and preserving renal function

Bladder diverticula

• VCUG provides best imaging to confirm diagnosis
• Primary Hutch: otherwise smooth-walled bladder, no other diverticula, no evidence obstruction
• Secondary Hutch: other diverticula present in trabeculated bladder, caused by infravesical obstruction
• Asymptomatic diverticula can be treated conservatively
• Surgical intervention warranted if VUR, stones, UTI

Acquired bladder conditions

• Hemangiomas: seen with syndromes, may cause hematuria/dysuria, manage with biopsy/fulguration or partial cystectomy (if large)
• Polyps: may present with hematuria/dysuria or obstruction, manage with resection
• Nephrogenic adenoma: manage with resection, 80% recurrence rates
• Eosinophilic cystitis: present with hematuria/dysuria, retention, and SP pain, biopsy shows eosinophils throughout specimen, manage with combination of steroids + antihistamines + antibiotics once diagnosed via biopsy
• Hemorrhagic cystitis: related to either cyclophosphamide/ifosfamide, viral infection, or radiation

Urachal anomalies

• Patent urachus: urachal canal fails to obliterate, only 14% have some form of bladder obstruction, may have persistent drainage via umbilicus, diagnose with fistulogram or VCUG, drain if infected
• Urachal sinus: obliterated at bladder but open to umbilicus, diagnose with fistulogram (negative VCUG findings)
• Urachal cyst: no clear communication with bladder/umbilicus, but may drain intermittently, can become infected, diagnose with US/CT/MR
• Urachal diverticulum: urachus obliterates except at bladder apex, may cause stones or UTI
• Management: urachal remnant should be completely excised, include bladder cuff if attached