Approach to Minimally Trabeculated Bladder with Large PVR and Bilateral Renal Cysts

Initial Assessment

• For patients with minimally trabeculated bladder, large post-void residual (PVR) without identified cause, and small simple cortical renal cysts, a comprehensive urological evaluation with appropriate imaging is recommended to rule out bladder outlet obstruction and assess for potential urological malignancy, as recommended by the American College of Radiology 1
• Voiding Cystourethrography (VCUG) is recommended as the initial imaging test for evaluation of patients with urinary dysfunction when deemed necessary after appropriate clinical evaluation, according to the American College of Radiology 1

Diagnostic Workup

Imaging Studies

• VCUG can demonstrate cystocele, urethral hypermobility, and urethral narrowing with or without upstream dilatation, as noted by the American College of Radiology 1
• CT Urography (CTU) without and with IV contrast provides comprehensive evaluation of the genitourinary tract, allows assessment of retroperitoneal and pelvic lymph nodes, and can identify potential causes of hydronephrosis or obstruction, as recommended by the American College of Radiology 2
• MR Defecography or Dynamic Pelvic Floor MRI provides global functional and anatomic assessment of the pelvic floor, can depict cystoceles, urethrovesical junction position, and urethral hypermobility, and has high soft-tissue contrast resolution for evaluation of pelvic organs and structures, according to the American College of Radiology 1

Functional Studies

• Urodynamic testing should be considered to assess bladder contractility, evaluate for detrusor underactivity, and measure post-void residual volumes, as recommended by the American College of Radiology 1

Management Considerations

For Large PVR Without Identified Cause

• Rule out neurogenic bladder causes, as recommended by the American College of Radiology 1

For Minimally Trabeculated Bladder

• Consider urodynamic studies to assess bladder function and outlet resistance, according to the American College of Radiology 1

For Simple Renal Cysts

• Small simple cortical cysts are generally benign and common findings, as noted by the American College of Radiology 3

Special Considerations

• False-positive results on imaging can occur due to benign prostatic hypertrophy mimicking bladder lesions, and intravesical blood clots, as reported by the American College of Radiology 2

Follow-up Recommendations

• Periodic reassessment of renal function is recommended, as noted by the American College of Radiology 3
• Consider repeat urodynamic studies if symptoms worsen or PVR increases, according to the American College of Radiology 1