Am I seeing two urinary bladders?

We previously talked about the double bladder sign in female patients indicative of ovarian torsion. Here are images from a middle-aged gentleman, where the suprapubic scan revealed two anechoic structures, only one of which is the urinary bladder. While pelvic ascites can look similar, the two structures are well defined and moreover, the patient did not have any ascites in other abdominal scan zones.

The diagnosis is penile prosthesis. If you closely observe, one of these structures contains reverberation artefacts. That structure is the reservoir of the inflatable penile prosthesis and the artefacts are from check-valve apparatus. Below is an illustration that helps understand the anatomic relations better.

This case highlights the importance of integrating patients’ history with POCUS findings. In addition, not every anechoic thing in the suprapubic region is urinary bladder. Pelvic ascites, fresh blood, a large ovarian or seminal vesicle cyst, implant reservoir all should be considered depending on the clinical context.

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