Urinary Bladder, Urethral Pathologies, and Lower Urinary Tract Trauma — WACS Viva & Clinical Scenarios (Genitourinary and Retroperitoneal Imaging)

Exam-style urinary bladder, urethral pathologies, and lower urinary tract trauma viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: Contrast Urethrography Technique and Interpretation in Anterior Versus Posterior Urethral Stricture Disease: A 32-year-old male with a history of recurrent gonococcal urethritis and previous straddle injury presents with severe straining, poor urinary stream, and a palpable perineal induration. Detail the radiographic technique, patient positioning, and radiation safety protocols required for executing combined Ascending Urethrography (ASU/RUG) and Micturating Cystourethrography (MCU/VCUG). Provide the criteria for determining exact stricture length, location, caliber, and associated spongiofi
• SCENARIO 2: Diagnostic Workup and Protocoling in Suspected Bladder Rupture Following Blunt Pelvic Trauma: A 26-year-old motor vehicle crash victim sustains unstable pelvic fractures with gross hematuria and suprapubic peritonism. Describe the standard diagnostic imaging protocol, emphasizing why passive excretory-phase CT is insufficient compared to dedicated retrograde CT cystography. Formulate the imaging features that definitively differentiate intraperitoneal from extraperitoneal bladder rupture, and explain how pelvic fracture urethral injuries are categorized using the Goldman-modified Colapinto-McC
• SCENARIO 3: Multiparametric MRI (VI-RADS) and Multi-Detector CT Evaluation of Urinary Bladder Neoplasms: A 68-year-old chronic smoker presents with painless gross total hematuria. Discuss the imaging role of multi-detector CT urography and multiparametric MRI in detecting, characterizing, and staging urothelial neoplasms. Detail the application of the Vesical Imaging-Reporting and Data System (VI-RADS) across T2-weighted, diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) sequences to differentiate non-muscle-invasive bladder cancer from muscle-invasive bladder cancer.
• SCENARIO 4: Imaging Spectrum and Neoplastic Complications of Urinary Schistosomiasis: A 45-year-old farmer from a Schistosoma haematobium endemic region presents with chronic dysuria, terminal hematuria, and a palpable hypogastric mass. Describe the typical plain radiograph, ultrasound, and CT manifestations of chronic bilharzial cystitis and ureteritis. Provide the differential diagnosis for curvilinear bladder wall calcification and explain the imaging features that alert the radiologist to malignant transformation into squamous cell carcinoma.
• SCENARIO 5: Pediatric Voiding Cystourethrography and Assessment of Congenital Urethral Anomalies: A 2-week-old male infant presents with poor urinary stream, bilateral palpable flank masses, and recurrent urinary tract infections. Outline the procedural execution of MCU/VCUG in neonates and describe the classic fluoroscopic findings of Posterior Urethral Valves (PUV). Detail the International Reflux Study grading system for associated vesicoureteric reflux and outline secondary upper urinary tract changes visible on sonography.