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Ultrasound Imaging

An ultrasound examination, also commonly referred to as a sonogram, is a painless, diagnostic technique that makes use of the behavior of sound waves in the human body. When these sound waves are transmitted into the body, they are reflected in specific ways by specific tissues and organs. These reflected waves can be used to produce images of internal organs without harm or exposure to radiation.

Depending on the reason for the study and the circumstances, ultrasound imaging may be performed in the urologist's office, in the hospital or in an outpatient facility.

In most cases, very little preparation is needed for an ultrasound examination. Some examinations, such as a bladder scan for residual urine, require limited experience while others, such as ultrasound examinations of the kidneys, testicles or prostate, require more experience or expertise.

The patient will be asked to lie down on the examination table. A clear, water-based gel is applied to the skin over the area to be examined. This gel helps with the transmission of the sound waves. A transducer, which is a hand-held probe, is then moved over that area. Prostate ultrasound examinations are performed by placing a specially designed probe into the rectum.

There is no risk of radiation with this study and the patient can resume their daily activities immediately following this test.

What can be expected with a bladder ultrasound?
The bladder is an organ made of smooth muscle that stores urine until ready for release. The most common reason for bladder ultrasound is to assess bladder emptying by measuring residual urine after urination. Many conditions may result in disorders of bladder emptying and these include an enlarged prostate, urethral stricture or bladder dysfunction. Bladder ultrasound may also provide information about the bladder wall, the presence of diverticula of the bladder, the size of the prostate, the presence of stones or large tumors in the bladder. Bladder ultrasound as performed for urologic purposes usually does not assess the ovaries, uterus or colon.

Bladder ultrasound does not require fasting or bowel preparation. For diagnostic purposes other than measuring for post void residuals, a full bladder is required. Drinking several glasses of water one hour prior to the exam is the usual preparation for adequate bladder filling.

The patient should not empty their bladder prior to arriving at the physician's office for a full bladder is essential for the examination.

The examination is performed with the patient lying on his/her back on the examination table. A conducting gel is placed on the skin to facilitate transmission of the sound waves. The transducer is placed on the lower abdomen between the umbilicus and the pubic bone. The image is viewed on a monitor and interpreted in real time. To assess bladder emptying, the patient is asked to void and the bladder is imaged a second time.

What can be expected with a kidney ultrasound?
The kidneys are fist-sized organs located in the retroperitoneum—the space behind the intestines and other abdominal organs. They are responsible for cleansing the blood of waste products and producing urine. They also balance electrolytes in the body, such as sodium and potassium, while providing hormones necessary to regulate blood pressure and red blood cell production.

There may be many indications for a renal ultrasound examination. Renal ultrasound studies are useful for demonstrating the size and position of the kidneys and are helpful in identifying obstruction of the kidney, kidney stones or masses in the kidney.

Renal ultrasound does not require fasting, bowel preparation or a full bladder. The test is performed with the patient lying on their back on the examination table and a conducting gel is placed on the skin to facilitate transmission of the sound waves. The kidneys are imaged by placing the transducer over both flanks of the upper abdomen.

What can be expected with a scrotum ultrasound?
The testicles (testes) are contained in a skin-covered muscular sac called the scrotum. The testicles manufacture sperm cells for reproduction and also produce testosterone. The primary indication for scrotal ultrasound is the evaluation of swelling or pain of the scrotum, as well as masses in the scrotum or in the testes themselves. The most common anomaly in the scrotum is a benign collection of fluid around the testis called a hydrocele. Other common conditions include the formation of a cyst in the epididymis called a spermatocele, and an abnormal enlargement of veins within the scrotum called a varicocele. Ultrasound studies are also very helpful in investigating solid masses within the testes, which may represent testicular cancer.

A scrotal ultrasound examination does not require fasting, bowel preparation or a full bladder. The test is performed with the patient lying on his back. The scrotum is elevated on a towel and warm gel is applied to the scrotum to help conduct the sound waves.

What can be expected with a prostate ultrasound and biopsy?
The prostate is located at the base of the bladder and encircles the urethra like a napkin ring. The prostate provides a portion of ejaculatory fluid, which is important for reproduction. Enlargement of the prostate may cause obstruction of the bladder. The most common indication for a prostate ultrasound (also known as a transrectal ultrasound) is to evaluate men considered at risk for prostate cancer (see prostate cancer screening). Because early prostate cancer cannot be reliably diagnosed by the ultrasound appearance of the prostate alone, the study is usually performed in association with a simultaneous prostate biopsy (see biopsy).

Another common indication for ultrasound is obtaining the volume or size of the prostate for treatment planning purposes. Patients being considered for radioactive seed implantation to treat prostate cancer (brachytherapy) undergo transrectal ultrasound of the prostate to determine prostatic volume. This is necessary to plan the distribution and number of radioactive seeds needed for treatment of the tumor. Transrectal ultrasound may also be performed when transurethral resection of the prostate or thermal therapies of the prostate are planned. Finally, the study may be used to determine prostate specific antigen density.

The patient may be asked to use an enema prior to the procedure to better facilitate an adequate examination. The procedure is performed with the patient lying on his side on the examination table.

The ultrasound probe (transducer) is inserted into the rectum to obtain the image of the prostate. Local anesthesia may or may not be used when performing a biopsy. After measuring the prostate volume and identifying any suspicious areas, biopsies are obtained by inserting a special needle through a channel on the transducer. The needle is inserted and the biopsy is obtained quickly. The number of biopsy "cores" obtained is variable but averages six to eight.

The procedure requires 10 to 20 minutes and the main risks are infection and bleeding from the rectum or bladder. Patients are asked to refrain from heavy physical activity for 24 to 48 hours after the procedure. Oral antibiotics are administered prior to and after the biopsy to reduce the likelihood of infection. Some patients may notice blood in their ejaculate for several weeks after the procedure. This is common and not a cause for concern.

Results of the biopsy often take several days. It is important for patients to discuss the results of the biopsy with their urologist. If cancer is diagnosed, a discussion of treatment options is needed. If the biopsy shows no cancer, a strategy for follow up will be discussed. The pathologist may report a precancerous condition on the biopsy that may prompt more frequent follow up or even repeat biopsy.

What are some additional uses of urologic ultrasound?
Evaluation of infertility: Under some circumstances, transrectal ultrasound may be useful in demonstrating the presence of abnormalities of the seminal vesicles and prostate. Examination of the testes may also be of value.

Evaluation of the female urethra: Transvaginal ultrasound may be useful in demonstrating a urethral diverticulum. A urethral diverticulum may be associated with urethral pain and recurrent urinary tract infection.

Pediatric urology: The painless and noninvasive nature of ultrasound and the immediacy of the results make it ideal for working with children. Ultrasound is particularly well suited to pediatric patients. Ultrasound provides excellent images of the kidneys and bladder. It is useful in the evaluation of congenital abnormalities of the urinary tract, the evaluation of problems with urination and the workup of recurrent urinary tract infections.

Evaluation of blood flow: A Doppler ultrasound may be used to determine blood flow in urologic organs especially the testes and kidneys.



Reviewed January 2011

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Ultrasound Imaging Glossary
  • abdomen: Also referred to as the belly. It is the part of the body that contains all of the internal structures between the chest and the pelvis.

  • abdominal: in the abdomen, the cavity of this part of the body containing the stomach, intestines and bladder.

  • anesthesia: Loss of sensation in any part of the body induced by a numbing or paralyzing agent. Often used during surgery to put a person to sleep.

  • antibiotic: Drug that kills bacteria or prevents them from multiplying.

  • benign: Not malignant; not cancerous.

  • biopsies: Tiny pieces of body parts are removed with a needle or during surgery and examined under a microscope to determine if cancer or other abnormal cells are present.

  • biopsy: A procedure in which a tiny piece of a body part (tissue sample), such as the kidney or bladder, is removed (with a needle or during surgery) for examination under a microscope; to determine if cancer or other abnormal cells are present.

  • bladder: The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.

  • bladder ultrasound: Also referred to as bladder scan. A method of measuring the urine that remains in the bladder. This is a test that is used to diagnose incomplete bladder emptying. An ultrasound uses sound waves to measure the urine volume--its painless and doesn't involve the use of radiation like X-rays.

  • bowel: Another word for intestines or colon.

  • brachytherapy: Treatment for prostate cancer that involves the placement of tiny radioactive pellets into the prostate by utilizing ultrasound.

  • cancer: An abnormal growth that can invade nearby structures and spread to other parts of the body and may be a threat to life.

  • colon: Large intestine.

  • congenital: Present at birth.

  • congenital abnormalities: Abnormalities present at birth.

  • cyst: An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.

  • diverticula: Plural of diverticulum. A pouch or sac in the lining of the mucous membrane of an organ.

  • diverticulum: A pouch or sac in the lining of the mucous membrane of an organ.

  • ejaculate: The fluid that is expelled from a man's penis during sexual climax (orgasm). To release semen from the penis during an orgasm.

  • ejaculatory: Involved in or related to the structure involved in the release of semen from the penis during orgasm.

  • ejaculatory fluid: Semen.

  • electrolytes: Chemicals in the body fluids that result from the breakdown of salts, including sodium, potassium, magnesium and chloride. The kidneys control the amount of electrolytes in the body. When the kidneys fail, electrolytes get out of balance, causing potentially serious health problems. Dialysis can correct this problem.

  • enema: Insertion of liquid into the intestine via the rectum as a treatment for constipation.

  • epididymis: A coiled tube attached to the back and upper side of the testicle that stores sperm and is connected to the vas deferens

  • fertility: The ability to conceive and have children.

  • flank: The area on the side of the body between the rib and hip.

  • hormone: A natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. Antidiuretic hormone tells the kidneys to slow down urine production.

  • hydrocele: A painless swelling of the scrotum caused by collection of fluid around the testicle.

  • infection: A condition resulting from the presence of bacteria or other microorganisms.

  • infertility: The diminished ability or the inability to conceive and have offspring.

  • intestine: The part of the digestive system between the stomach and the anus that digests and absorbs food and water.

  • intestines: the portion of the alimentary canal extending from the stomach to the anus consisting of two segments, the small intestine and the large intestine.

  • invasive: Having or showing a tendency to spread from the point of origin to adjacent tissue, as some cancers do. Involving cutting or puncturing the skin or inserting instruments into the body.

  • invasive: Not just on the surface; with regard to bladder cancer, a tumor that has grown into the bladder wall.

  • ions: Electrically charged atoms.

  • kidney: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis or in the ureters. (Also see nephrolithiasis.)

  • kidneys: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • obstruction: something that obstructs, blocks, or closes up with an obstacle

  • ovaries: Female reproductive organs that produce eggs and also produce the sex hormones estrogen and progesterone.

  • pathologist: A physician who interprets and diagnoses the changes caused by disease in tissues and body fluids.

  • peritoneum: Strong, smooth, colorless membrane that lines the walls of the abdomen and covers numerous body organs including the bladder.

  • potassium: An alkali element.

  • probe: Small device for measuring and testing.

  • prostate: A walnut-shaped gland in men that surrounds the urethra at the neck of the bladder. The prostate supplies fluid that goes into semen.

  • prostatic: Pertaining to the prostate.

  • pubic bone: Also referred to as the pubis. Lower front of the hip bone.

  • radiation: Also referred to as radiotherapy. X-rays or radioactive substances used in treatment of cancer.

  • radioactive: Relating to or making use of radioactive substances or the radiation they emit.

  • radioactive seed implant: Tiny pellets of radioactive medication.

  • rectal: Relating to, involving or in the rectum.

  • rectal ultrasound: A diagnostic test that uses very high frequency sound waves to produce an image of the rectum.

  • rectum: The lower part of the large intestine, ending in the anal opening.

  • renal: Pertaining to the kidneys.

  • resection: The surgical removal of a portion of a body part.

  • residual urine: Amount of urine remaining in the bladder after urination.

  • retroperitoneum: Behind abdominal lining.

  • scrotal: Relating to the scrotum, the sac of tissue that hangs below the penis and contains the testicles.

  • scrotal: Relating to the scrotum, the sac of tissue that hangs below the penis and contains the testicles.

  • scrotum: Also referred to as the scrotal sac. The sac of tissue that hangs below the penis and contains the testicles.

  • seminal vesicle: Two pouch-like glands behind the bladder. They produce a sugar-rich fluid called fructose that provides sperm with a source of energy that helps sperm move. The fluid of the seminal vesicles makes up most of the volume of a man's ejaculatory fluid, or ejaculate.

  • sonogram: Also referred to as a ultrasound. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.

  • sperm: Also referred to as spermatozoa. Male germ cells (gametes or reproductive cells) that are produced by the testicles and that are capable of fertilizing the female partner's eggs. Cells resemble tadpoles if seen by the naked eye.

  • spermatocele: Cystic swelling in the scrotum containing sperm.

  • stone: Small hard mass of mineral material formed in an organ.

  • stricture: Abnormal narrowing of a body passage.

  • testes: Also known as testicles. Paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • testicle: Also known as testis. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • testicular: Relating to the testicle (testis).

  • testicular cancer: Cancer of the testis.

  • testis: Also known as testicle. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • testosterone: Male hormone responsible for sexual desire and for regulating a number of body functions.

  • tissue: Group of cells in an organism that are similar in form and function.

  • transducer: Converter of energy.

  • transrectal ultrasound: Also referred to as TRUS. This is a special kind of ultrasound test in which the sound waves are produced by a probe inserted into the rectum. In men, the structures most commonly examined with this test are the prostate, bladder, seminal vesicles and ejaculatory ducts.

  • transurethral: Through the urethra. Several transurethral procedures are used for treatment of BPH. (See TUIP, TUMT, TUNA or TURP.)

  • transurethral resection: Surgery performed with a special instrument inserted through the urethra.

  • transurethral resection of the prostate: Also referred to as TURP. Surgical procedure where a lighted tube with an attached electrical loop is inserted through the urethra into the prostate. Serves as a diagnostic and therapeutic role in the treatment of bladder cancer.

  • tumor: An abnormal mass of tissue or growth of cells.

  • ultrasound: Also referred to as a sonogram. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.

  • umbilicus: Navel or belly button.

  • urethra: A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.

  • urethral: Relating to the urethra, the tube tha carries urine from the bladder to outside the body.

  • urethral diverticulum: A sac-like or tubular growth caused by a weakened area in the urethra.

  • urethral stricture: Scarring of tissue that causes narrowing or blockage of the canal leading from the bladder, discharging the urine externally.

  • urinary: Relating to urine.

  • urinary tract: The system that takes wastes from the blood and carries them out of the body in the form of urine. Passageway from the kidneys to the ureters, bladder and urethra.

  • urinary tract infection: Also referred to as UTI. An illness caused by harmful bacteria, viruses or yeast growing in the urinary tract.

  • urination: The passing of urine.

  • urine: Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.

  • urologist: A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

  • uterus: A hallow, muscular organ in the pelvis cavity of females in which the embryo is nourished and develops before birth.

  • vagina: The tube in a woman's body that runs beside the urethra and connects the uterus (womb)to the outside of the body. Sometimes called the birth canal. Sexual intercourse, the outflow of blood during menstruation and the birth of a baby all take place through the vagina.

  • vas: Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

  • vein: Blood vessel that drains blood away from an organ or tissue.

  • void: To urinate, empty the bladder.

Ultrasound Imaging Anatomical Drawings

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