A pine cone bladder or Christmas tree bladder is a cystographic appearance in which the bladder is elongated and pointed with a 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).

However, these findings are 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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