Ultrasound (ultrasound) of the bladder is a kind of instrumental diagnostics This organ, based on obtaining images of various tissues from ultrasonic waves.
Bladder ultrasound – the essence and principles of the diagnostic method
Ultrasound procedure Bladder, As is clear from the name of the method, it is based on the possibility of obtaining an image of an organ on a monitor by passing ultrasonic waves through it. That is, a special sensor emits ultrasonic waves with a high oscillation frequency, which are not caught by the human ear. These waves pass through various tissues, are partially absorbed by them, partially reflected and refracted. The reflected ultrasonic waves come back and are captured by the same sensor that emits them. Next, the captured reflected ultrasonic waves are amplified by the device, automatically processed, and an image of the internal organs and tissues gets onto the ultrasound unit monitor.
Depending on the properties of the biological structure, it absorbs a greater or lesser number of ultrasonic waves, due to which a different number of waves are returned back to the sensor. It is the uneven absorption and reflectivity of tissues that allows you to create an image of various objects on the monitor.
Ultrasound The bladder is a highly informative study that allows to assess the general condition of the organ and determine the nature of the pathological changes in it, since the contents of the bladder and its walls reflect different numbers of ultrasound waves, making the picture on the monitor clear and easy to analyze.
Ultrasound allows you to evaluate the structure of the bladder walls, determine its volume and shape, identify stones, diverticula, tumors, the descent of the ureters into the bladder, etc. In addition, ultrasound allows to assess the condition of the bladder wall and obtain additional information after cystoscopy, urography and computed tomography. During the ultrasound of the bladder can not detect only tumors of small size, located at the initial stage of growth, as well as tumors located in the dome of the bladder.
Ultrasound of the bladder is a safe and painless manipulation that does not cause discomfort to the person during its implementation. Usually ultrasound lasts about 15 minutes, during which the doctor drives the sensor through the stomach and examines the picture that appears on the monitor in order to identify the existing pathological changes. Ultrasound of the bladder, compared with other methods of instrumental examination of this organ, has an undeniable advantage – for its implementation it is not necessary to put a urinary catheter and inject fluid into the bladder, which naturally reduces the chance of injury and infection, and does not give the patient any noticeable discomfort.
Indications for ultrasound of the bladder
Ultrasound of the bladder is a simple, relatively cheap and not uncomfortable to the patient study, which, due to these features, is used quite widely. Due to the relatively high informativeness of ultrasound in the detection of various diseases of the bladder, this diagnostic method is prescribed and used for a very wide range of indications. One can conditionally say that ultrasound of the bladder is a screening study, the indication for which is the slightest suspicion of the presence of diseases of this organ.
Nevertheless, despite the widespread use of bladder ultrasound in clinical practice, it is possible to identify the conditions in which this study is clearly shown to conduct. Thus, the indications for the mandatory production of ultrasound of the bladder are the following conditions and diseases:
one. Suspected congenital abnormalities of the urinary system (e.g., polycystic kidney, horseshoe kidney, megakaliksa, lack kidneys, omissions kidney) which is shown discomfort during urination, urinary retention, frequent inflammatory processes in urogenital organs, episodes of urinary fever (where body temperature suddenly rises , stubbornly holds, does not get off with medicines, and then independently normalizes), etc.
2 Any diseases of the organs of the urinary system (for example, pyelonephritis, cystitis, glomerulonephritis, tubulo-interstitial nephritis, etc.) that were carried over in the past.
3 Suspicion of the presence of diseases of the urinary and reproductive organs in the present, which is based on the presence in humans of any of the following symptoms:
- Frequent urination
- Retention of urine (no urination or discharge of a small volume of urine) for 6 to 12 hours
- Feeling of incomplete emptying of the bladder after urination
- Pain, burning, cracking, or any feeling of discomfort when urinating
- Difficulty urinating (in order to urinate, you have to strain, etc.)
- Blood, turbidity or urine flakes
- The presence of red blood cells, white blood cells, cylinders or bacteria in a general urine test
- Lower abdominal pain and / or in the perineum, and / or above the pubis, and / or in the lumbar region
- Previously established diagnosis of urolithiasis or suspicion of it.
four. Suspected traumatic damage to the bladder (for example, after a strong blow to the stomach, perineum, rape, etc.).
five. Suspected tumors in the bladder or pelvic organs (may manifest as pains in the lower abdomen, blood in the urine, urinary retention, difficulty urinating, etc.).
6 Frequent cystitis.
7 Before and after operations or instrumental diagnostic manipulations on the organs of the urinary system.
Not in all of the above cases, ultrasound of the bladder allows you to accurately make a diagnosis, but its conduct is shown in order to distinguish from each other various pathologies that manifest similar symptoms.
Contraindications for ultrasound of the bladder
There are practically no contraindications for bladder ultrasound, as the examination method is simple and does not involve performing any complicated manipulations associated with the introduction of various substances, sensors, etc. into the natural openings of the body. However, despite the simplicity and safety of ultrasound of the bladder, the following contraindications still exist for this study:
- The presence of dermatitis or inflammation on the skin of the abdomen or sides (since a special gel is applied to the skin to conduct an ultrasound to improve image quality on the monitor, there is a possibility (albeit low) of inflammatory exacerbation on the background of dermatitis)
- Allergic reaction to the gel applied to the skin for ultrasound, which appeared during the production of ultrasound diagnostics last time (in this case, you should either use another means or refuse to ultrasound)
- An overflowing bladder (when a person has not urinated for more than 4 hours intentionally or due to illness)
- The impossibility of filling the bladder to the required volume (for example, due to injury, established drainage in the abdominal cavity, against the background of chronic urinary incontinence or in patients on hemodialysis).
The above contraindications to the production of ultrasound of the bladder are relative, that is, if they are present, it is undesirable to conduct a study, but if it is absolutely necessary, then you can still do an ultrasound with caution.
Preparation for ultrasound of the bladder (before ultrasound of the bladder)
In addition, you should take a towel or dry wipes with you to the doctor for an ultrasound scan in order to wipe the gel from the abdominal skin after the examination. For the convenience of the procedure and comfortable feeling on the ultrasound of the bladder, it is desirable to wear a sports suit or dress like a robe, in general, such clothes in which it is not difficult to expose the lower abdomen.
In addition to the transabdominal method, ultrasound of the bladder can also be performed transrectally (through the rectum) or transvaginally (through the vagina in women). If a bladder ultrasound is prescribed transrectally or transvaginally, then it is also necessary to drink the liquid 1.5 to 2 hours before the test. And, besides, on the day of the ultrasound (a few hours before the test) clean the intestines with an enema, glycerin suppositories, etc.
Bladder ultrasound training in men and women
Preparation for the examination is carried out by men and women equally, since there are no fundamental differences in the conduct of the procedure in both sexes.
How to do a bladder ultrasound?
Depending on where the sensor of the device is placed, there are four options for ultrasound of the bladder – through transabdominal, transrectal, transvaginal and transurethral access. Transabdominal access is the placement of an ultrasound probe on a patient’s abdomen. With transrectal access, the sensor of the apparatus is inserted into the rectum, with transvaginal – into the vagina, and with transurethral – into the urethra.
Transabdominal access for ultrasound of the bladder is the most simple, convenient and safe, as a result of which at present the lion’s share of organ research is performed in this way. Transvaginal and transrectal approaches provide more information about the bladder, but they are used less often only when it is necessary to obtain comprehensive and as detailed information as possible. Transrectal access is also often used in men when it is necessary to assess the condition of not only the bladder, but also the prostate gland, seminal vesicles and other genital organs. Transvaginal access for bladder ultrasound is used only for women, and transrectal access is used mainly for men and young girls (virgins). Transrectal ultrasound of the bladder in adult women is rarely performed, preferring, if necessary, to obtain detailed data on the state of the organ transvaginal access. Transurethral access for the production of ultrasound of the bladder is rarely used, since it requires special expensive equipment and the need for anesthesia. Consider how bladder ultrasound is done in transabdominal, transvaginal and transrectal ways.
In order to conduct ultrasound transabdominal access, the patient must lie on his back on the couch and expose the lower part of the abdomen (from the pubis to the navel). The doctor will apply a special gel on the abdomen, which is necessary to improve the quality of the image obtained on the monitor. The gel is usually cold, so in the first few seconds after its application, discomfort may occur, but they will quickly pass. After that, the doctor tightly presses the ultrasound machine sensor to the stomach and guides them along the skin surface with gentle pressure, receiving bladder images on the screen from various angles. The procedure is completely painless, and usually lasts from 5 to 15 minutes. After completion of the ultrasound, the doctor will remove the sensor from the abdomen, and the patient will need to wipe the skin and get dressed.
In some cases, when a bladder ultrasound is prescribed by transabdominal access to determine the volume of residual urine, after the production of the main study, the doctor asks the patient to urinate, and then puts the sensor to the stomach, measures the necessary parameters and determines how many milliliters of urine is left in the organ after urination.
To perform an ultrasound of the bladder with a transvaginal approach, the woman is placed on a couch lying on her back with her legs bent at the knees and spread to the sides. It will be necessary to remove clothes from the lower half of the body, including underwear. Next, the doctor lubricates the sensor with a special gel, puts a condom or a sterilized rubber cap on it and inserts the device into the vagina. Turning the sensor into the vagina from different angles, the doctor sees on the monitor an image of the bladder from different angles, which allows us to diagnose various pathologies. After completing the study, the doctor removes the sensor from the vagina, and the woman can dress and leave.
For transrectal bladder ultrasound, the patient should lie on the couch on his side, pull his knees bent to the abdomen, after removing the clothes from the lower abdomen. The doctor lubricates the sensor with gel, puts a special sterile cap or condom on it and inserts the instrument into the rectum by 5-6 cm. Further, by changing the position of the sensor, the doctor receives bladder images on the monitor from different angles. After completing the study, the doctor removes the instrument from the rectum, after which the patient can dress and leave.
Ultrasound of the bladder in women and men
There are no fundamental differences in the ultrasound of the bladder in men and women, but there are a number of features that should be mentioned. So, men are usually prescribed ultrasound of the bladder with the determination of the volume of residual urine, which is caused, firstly, by the need to diagnose the pathology not only of the bladder, but also of the genital organs located next to it (prostate, seminal vesicles). And secondly, in men, simple ultrasound of the bladder is less informative than in women, therefore for a qualitative diagnosis it is necessary to determine a greater number of parameters, one of the most important of which is the volume of residual urine. If a man only suspects the pathology of the urinary system, then transabdominal ultrasound is usually prescribed. But if a man suspects pathology not only urinary, but also the reproductive system, or it is necessary to distinguish bladder and prostate / seminal vesicle diseases from each other, then transrectal ultrasound is prescribed. Since men often have situations in which the doctor needs to accurately determine whether the existing symptoms are due to pathology of the urinary or reproductive system, in practice, the stronger sex is usually prescribed transrectal ultrasound of the bladder.
Women are usually prescribed transabdominal ultrasound of the bladder without determining the volume of residual urine, since this test is sufficient for diagnosis. If the doctor needs the most accurate data, then women are usually prescribed transvaginal ultrasound of the bladder, which allows not only to increase the information content of the diagnosis of bladder diseases, but also to distinguish them from the possible pathology of the genital organs (adnexitis, salpingitis, etc.).
There are no other fundamental differences in ultrasound of the bladder in women and men.
What parameters are evaluated by ultrasound of the bladder?
When performing ultrasound, the following parameters are necessarily evaluated:
- The location of the bladder relative to neighboring organs and tissues
- Triangle condition Lietho and bladder neck
- Bladder size (three sizes measured – width, length and depth)
- Bladder shape (normally round, oval or slightly triangular, always symmetrical)
- The contours of the bladder (smooth, bumpy, scalloped, etc.)
- The condition and thickness of the bladder wall
- Bladder volume
- Ejection from the ureters and the rate of urinary bladder filling
- The presence of tumors in the bladder (if they are detected, then their shape, size, growth pattern)
- The presence of suspension (pus, blood, sand, etc.) and stones in the contents of the bladder
- The state of the ureters.
The doctor must take two pictures of the bladder – transverse with the ureter and longitudinal. A comprehensive assessment of the above parameters, reflecting the state of the bladder, allows the physician to diagnose various organ pathologies.
Bladder ultrasound transcript
Normally, the bladder should be round, oval, or slightly triangular in shape, with clear, even outlines. Normally, the bladder wall thickness is 2–5 mm, and the inside of the organ must be hollow (echo negative) without suspension, point inclusions (stones, blood clots), etc. The doctor also assesses the discharge from the ureters into the bladder, which is normally visible on the monitor, and its speed is up to 14.5 cm / s. The rate of filling the urine of the bladder is normally 50 ml per hour, and the volume of the body for women ranges from 250 to 550 ml, and for men – from 350 to 750 ml.
A sign of pathology is a thickening of the wall of the bladder more than 5 mm, which may indicate an inflammatory process, closing the lumen of an organ with a stone or a tumor.
If the contour of the bladder is scalloped, cysts or a forked wall are visualized around it, this indicates diverticula, ureterotsel, etc.
If the bladder volume is greater than normal, then this may be a sign of a narrowing, a stone or injury to the urethra, an enlarged prostate in men, a cystocele, a neurogenic bladder. If the volume of the bladder is less than normal, then this may indicate cystitis, schistosomiasis or a tumor.
Small, multiple hyperechoic / hypoechoic lesions in the bladder cavity may indicate cystitis or sand. If hyperechoic / hypoechoic formations are larger, then this may be a sign of stones, cysts, polyps, or bladder tumors. Polyps, cysts and tumors usually look like immobile hyperechoic inclusions in the cavity of the bladder, and stones and sand – as mobile.
If the doctor records the return of urine from the bladder to the ureters, this may indicate neoplasms, stones, sand, or abnormalities in the structure of the urinary organs.
The volume of residual urine is normally less than 50 ml, and if it is more, it can be a sign of inflammation, stones, tumors (and in men also pathologies of the prostate gland, seminal vesicles).
We have indicated the main ultrasound indications of the norm and pathology of the bladder, on the basis of which it is possible only approximately to orient oneself regarding the general condition of the organ. But a full-fledged transcript of the ultrasound data can only be carried out by a doctor taking into account the person’s clinical symptoms and other examinations (tests, probing, etc.).
Price Bladder Ultrasound
Currently, the cost of ultrasound of the bladder transabdominal access varies in the approximate range from 500 to 3500 rubles. The cost of research is somewhat cheaper in public health facilities and more expensive in private centers. In addition, the cost of the study depends on whether it includes the determination of the volume of residual urine. If such a parameter is included in the study, then it is approximately twice as expensive as simply ultrasound of the bladder without determining the amount of residual urine.
Bladder Ultrasound – Video
Author: Nasedkina A.K. Specialist in conducting research on biomedical problems.