ABSENT FETAL URINARY BLADDER 

BLADDER AGENESIS

 

The bladder may be seen as early as 10 weeks of gestation but it is not reliably visualized until 13 weeks.

If the bladder is not visualized during a 30 min. examination a repeat scan at 60 and 90 minutes should be obtained.

FREQUENCY OF VISUALIZATION

 Frequency of Visualization of the Bladder VS Gestational Age

 

TRANSIENT NON-VISULAIZATION

 

 

Non- visualization is usually a transient finding, especially in the presence of normal amniotic fluid volume. These patients should be rescanned in a few day to confirm a normal bladder is present. It is always important to exclude bladder exstrophy when the bladder is persistently not visualized in the presence of normal non obstructed kidneys and normal amniotic fluid volume.

 

 

Absent bladder at 18 wks 5 days during the entire scan. Normal

amniotic fluid volume.

Normal bladder between the umbilical arteries at 20 wks 5 days.
 
 

 

 

 

 

 

 


PERSISTENT NON-VISUALIZATION

 

 

  1. Bladder agenesis – The bladder develops from the vesical portion of the urogenital sinus and the trigone from the inferior ends of the mesonephric ducts. Bladder absence is rare and incompatible with life. If seen, it is often part of a complex anomaly in a stillborn fetus. Cloacal development is possibly disturbed by lack of a bladder distended by urine and results in failure of incorporation of ducts and ureters into the trigone. Fetal bladder absence may be simulated by recent emptying requiring follow-up imaging for confirmation of bladder absence. An axial US image of the umbilical arteries as they course lateral to the bladder can help point out where the bladder should be imaged in the fetus (1,2).
  2. Bilateral renal agenesis.
  3. Bilateral multicystic renal dysplasia.
  4. Unilateral renal agenesis + contralateral multicystic renal dysplasia.
  5. Unilateral renal agenesis or multicystic renal dysplasia + contralateral severe renal obstruction or dysplasia.
  6. Severe bilateral renal obstruction or dysplasia.
  7. Severe autosomal recessive polycystic disease of the kidney.
  8. Severe IUGR.
  9. Persistent cloaca.
  10. Cloacal exstrophy.
  11. Bladder exstrophy.

 

REFERENCES

 

  1. K.L. Moore and T.V.N. Persaud. The Developing Human. Clinically Oriented Embryology (ed 7.), Saunders, Philadelphia, PA (2003).
  2. T. Berrocal, P. Lopez-Pereira, A. Arjonilla et al., Anomalies of the distal ureter, bladder and urethra in children: Embryologic, radiologic and pathologic features. Radiographics 22 (2002), pp. 1139–1164.