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 dysynergia) 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.
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