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DOI: 10.1148/radiol.2291030461
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(Radiology 2003;229:291.)

Letters to the Editor

Urinary Bladder Pseudomass as a Postoperative US Finding [letter]

James Bradley Summers, MS, MD,*

Department of Diagnostic Radiology, University of South Alabama Medical Center, PO Box 16343, Mobile, AL 36616*. e-mail: orotic@scubadiving.com

Joseph Kaminski, MD{dagger}

Department of Radiology, Medical College of Georgia, Augusta{dagger}

Editor:

We read with interest the article by Drs Halpern and Gomella in the March 2003 issue of Radiology (1). They report finding postprostatectomy pseudomass of the posterior urinary bladder neck as a normal ultrasonographic (US) finding after radical prostatectomy for cancer in two patients, which was heretofore unreported in the literature. They hypothesize that infolding of redundant mucosa in the area of the bladder neck and vesicourethral anastomosis may explain this phenomenon. Their report also emphasizes the difficulty in distinguishing a pseudomass in the bladder neck from recurrent neoplasm, since cancer is known to recur in this area. These authors rightly suggest that a review of the surgical details, magnetic resonance imaging, and cystography may be useful to make this determination and minimize unnecessary biopsies.

Investigators in another study also involving bladder manipulation reported postprocedure pseudomass (2). After endoscopic repair of 15 ureteroceles in 14 pediatric patients, pseudomass was seen postoperatively at US in five of 15 incised ureteroceles. These authors similarly postulated that redundant uroepithelium resulting from collapse of the ureterocele and bladder mucosa following endoscopic incision promoted pseudomass formation.

Results of these two studies suggest that procedures involving the bladder that produce redundant uroepithelium may result in pseudomass formation. Radiologists need to be familiar with the range of postsurgical appearances of the urinary bladder and related structures to delineate benign pseudomass from cancer occurrence and/or regrowth or other bladder abnormality.

REFERENCES

  1. Halpern EJ, Gomella LG. Pseudomass of the bladder neck after prostatectomy: report of two cases. Radiology 2003; 226:833-835.[Abstract/Free Full Text]
  2. Keesling CA, O’Hara SM, Chavez DR, King LR. Sonographic appearance of the bladder after endoscopic incision of ureteroceles. AJR Am J Roentgenol 1998; 170:759-763.[Abstract/Free Full Text]

Drs Halpern and Gomella respond:

Ethan J. Halpern, MD and Leonard Gomella, MD

Department of Radiology, Thomas Jefferson University Hospital, Jefferson Prostate Diagnostic Center, 132 South 10th Street, Philadelphia, PA 19107-5244. e-mail: ethan.halpern@jefferson.edu

We thank Drs Summers and Kaminski for their insightful comments, and we hope that this finding will now be recognized by more of those who perform US of the prostate and bladder.




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