Pine Cone Appearance in Neurogenic Bladder

PINE CONE BLADDER

45 year old female presented with past history of trauma to spine and complain of difficulty in micturition. MCU was performed which showed presence of pine cone bladder and B/l Grade V reflux. DIAGNOSIS -- NEUROGENIC BLADDER.

A pine cone bladder or christmas tree bladder is a cystogram appearance in which the bladder is elongated and pointed with thickened trabeculated wall. It is typically seen in severe neurogenic bladder with increased sphincter tone (detrusor sphincter dyssynergia) due to suprasacral lesions (above S2-S4) or epiconal lesions (in and around S2-S4).

It is however not pathognomonic of a neurogenic bladder and can be seen in patients with lesions anywhere along the sacral reflex arc leading to poor detrusor compliance. Occasionally it is also seen in bladder neck obstruction of a non-neurogenic cause.