Ultrasound of the genitourinary system in men preparation. How is a pelvic ultrasound done in men: what is included and how to properly prepare

Thanks to ultrasound examination of the urinary system, a lot of urological diseases can be detected. The examination does not harm the body and can be carried out by absolutely everyone: men, women and children, regardless of age. Experts say that various pathological processes of the urinary system are much easier to completely eliminate in the first stages of development. In order to prevent complications, as a preventive measure, it is recommended to do an ultrasound examination of the organs of the urinary system once a year.

What is included in the survey

The urinary system includes the kidneys, bladder, ureters, and adrenal glands. All these organs are examined during an ultrasound examination. If you do not want to wait in line for an examination at a municipal clinic, ultrasounds can be done at private diagnostic clinics for a fee.

Indications

As a rule, a comprehensive diagnosis of the urinary system is prescribed in the following cases:

• Urinary retention
• Urinary incontinence
• Injuries
• Pain in the lower abdomen
• Having stones in the kidney or ureter
• Inflammatory or infectious diseases
• Pain while urinating
• Blood or pus in the urine

The child is prescribed a diagnostic procedure in the presence of a poor urine test of unclear etiology. Often this procedure is carried out for pregnant women in the first trimester in order to exclude diseases of the urinary system.

Contraindications and possible risks

Side effects are completely excluded, there is no negative effect on the body. Of the contraindications, it is worth noting only injuries, injuries, deep abrasions or severe burns of the area under study. Ultrasound is not recommended until complete healing of the skin.

How to prepare for an ultrasound

A comprehensive examination of the urinary system requires special preparation. Only in this case, you can find out the exact diagnosis and find out detailed information about the organs. Despite the fact that the urinary system is in no way connected with the digestive organs, it is necessary to follow a dietary diet in order to prevent increased gas formation, which can interfere with the study.

• For two days, you need to stop eating black bread, whole milk, cabbage, fresh vegetables and fruits, pickled foods.
• Drink enough water every day, up to 2.5 liters, if there are no contraindications.
• In the evening, before the ultrasound, have a light dinner around 19-20 hours.
• If there are problems with the stool, you need to do a cleansing enema. If the study is carried out through the rectum - this item is mandatory.
• With flatulence, drink carminative preparations for a couple of days.
• Come for an ultrasound on an empty stomach.
• Take a bottle of clean water with you. Drink about 700 ml of water in about 30 minutes and do not empty your bladder until the specialist requires it.
• Strictly avoid alcoholic beverages.

The doctor who ordered the study will tell you more about the preparation. Don't forget to bring your passport and specialist referral. If there are pictures from the last ultrasound, it is also desirable to have them with you.

How is an ultrasound of the urinary system performed?

Let us consider in more detail how ultrasound of the urinary system is performed.

Ultrasound of the kidneys

Depending on the patient's complaints and specific diagnoses, the examination of the kidneys can be carried out in various positions. Up to 40 years of age, a routine ultrasound examination is performed; older people are shown an additional examination with a Doppler, which evaluates blood flow and possible problems with blood vessels in the kidney area.

A special gel is applied to the lumbar region for better glide of the sensor. The study takes no more than 20 minutes.

Ultrasound of the ureters

Separate ultrasound of the ureter is not performed, only in combination with other organs of the urinary system. This is due to the fact that using this diagnostic method it is practically impossible to detect the patency of the ureter.

Note that ultrasound is not entirely informative in this case, since the ureters are poorly visualized by ultrasound. For a more detailed study of the organ, other methods of examining the ureter are used.

Inspection is also carried out with a full bladder. The sensor is installed in the area of ​​the anterior abdominal wall, on average, the study takes 10-15 minutes.

bladder ultrasound

The diagnostic procedure can be determined in various ways, most often through the abdominal wall. In women, a transvaginal ultrasound is possible, and in men, through the rectum. Note that this is practiced extremely rarely, for example, with an extreme degree of obesity.

For an adequate diagnosis, the organ is examined in two states: full and empty. First, before the ultrasound, the patient drinks a liter of water. The specialist conducts research in a standard way. Then it is necessary to empty the bladder, after which the condition of the bladder is re-evaluated.

Due to the good mobility of the organ, the study of the bladder is as informative as possible. With the help of such an examination, it is possible to identify various diseases, even oncological ailments at the earliest stages.

Kidneys not visible on ultrasound

It often happens that on ultrasound, the doctor cannot “see” the kidneys. What is it? According to statistics, this happens in 20% of cases. Sometimes this is associated with increased echogenicity. In this case, it is necessary to replace ultrasound with magnetic resonance imaging. Also, the following ailments can serve as a cause:

• Ectopia - non-standard localization of the body.
• Atrophy - in this case we are talking about a reduced size of the kidney compared to normal.
• Lack of one organ - sometimes children are born with only one kidney.

Deciphering the results

The result is interpreted by a nephrologist or urologist. The specialist evaluates the size of the kidneys and bladder, the structure and the presence of defects. Depending on the diagnosis, the patient is prescribed appropriate treatment. Please note that most pathologies are treated with medication. Only with critical diagnoses can surgery be prescribed.

Norms of the urinary system by ultrasound

Each body has its own indicators of the norm:

• Length up to 13 centimeters
• Width no more than 6 centimeters
• Thickness should not exceed 5 centimeters
• Parenchyma wall thickness up to 25 mm

Bladder

• The shape is round
• Localized symmetrically
• Wall thickness from 0.3 to 0.5 centimeters
• Urine flow rate not more than 14.5 cm/s
• The residual amount of urine is not more than 40 ml

Ureters:

• Fabrics are homogeneous
• No defects or anomalies
• Permeability is normal

As a rule, diseases of the urinary system are accompanied by acute pain, which is difficult to miss. It is very important to perform diagnostic manipulation in a timely manner so as not to start the pathological process and avoid serious complications. Thanks to early diagnosis, you will get rid of unpleasant symptoms and eliminate the risk of the disease becoming chronic.

The advantage of pelvic ultrasound in men is that, along with safety and ease of implementation, this method is also quite highly informative in the diagnosis of diseases of the prostate gland, lower urinary tract and seminal vesicles.

Due to the growth of malignant degeneration of the prostate gland, each member of the stronger sex over 45 years of age must perform an annual screening ultrasound examination of this organ, as well as donate blood for the level of prostate-specific antigen.

The essence of the method

Urological ultrasound is a special diagnostic method with high reliability and universal availability. Its indisputable advantage is that the procedure does not cause any harm to the human body. Also, this type of ultrasound examination allows you to detect even minimal pathological processes in the internal organs and structures of the small pelvis of a man. This means that the doctor will be able to establish the correct diagnosis in time and prescribe adequate therapy for a particular case.

Ultrasonography for men performs two main functions:

• Diagnostic, that is, in this case, a search for a definitely suspected pathology is carried out and dynamic monitoring of the state of the body and its response to therapy is carried out.
• Preventive, which consists in an annual mandatory screening examination for a specific group of the population due to high oncological alertness (men whose age has exceeded 45 years).

With the help of ultrasound of the pelvic organs in men, a comprehensive diagnosis of the condition of the walls and cavity of the bladder, echostructure and dimensional indicators of the prostate gland with the surrounding lymph nodes is carried out, and the condition of the seminal vesicles is also assessed.

Indications for the procedure

Ultrasound in urology has many indications. For example, during palpation of the prostate gland, the doctor can only note its enlarged size, soreness and tuberosity of the surface. While the seminal vesicles and the bladder are completely inaccessible to palpation.

The most common reasons for the appointment of a pelvic ultrasound in men:

• changes in the act of urination (the appearance of pain or pain, increased frequency, discomfort, difficulty, the appearance of an intermittent stream of urine, a feeling of incomplete emptying of the bladder);
• discomfort and pain in the lower abdomen, lumbar region, perineum, rectum or scrotum;
• the appearance of an admixture of scarlet or dark blood in semen or urine;
• diagnosing malformations of the male genitourinary system;
• recurring attacks of renal colic in the pelvic area of ​​unspecified origin;
• suspicion of injury or pathology of the seminal vesicles, prostate, urethra and bladder;
• also, ultrasound in urology is performed to determine the cause of male infertility or erectile dysfunction;
• planned comprehensive examination immediately before surgery;
• control in order to identify possible complications of operations on the colon, pelvic organs and urinary system;
• control over the effectiveness of the prescribed therapy in dynamics;
• as a preventive examination necessary for dispensary registration, sanatorium treatment, etc.;
• with suspicion of malignant neoplasms in MPS men;
• to clarify the type and nature of pathological changes in the structures of the small pelvis that were detected during other diagnostic methods (general urinalysis, clinical or biochemical blood tests, digital rectal examination, radiography, scintigraphy, etc.).

Training

Like any other examination, urological ultrasound requires special preparation, which will depend on the method of the procedure. It is important to remember that a transabdominal ultrasound examination is performed strictly on an empty stomach, so the last meal should be at least 8-9 hours before the scheduled procedure.

In addition, the doctor prescribes a special diet for three days, which is aimed at reducing gas formation in the intestines. The pelvic organs are located near the large intestine, that is, on the border of two environments, which can create additional artifacts and non-existent formations. Thus, in order to obtain accurate data, the following foods should be excluded or limited in the diet:

• raw fruits and vegetables;
• legumes;
• highly mineralized waters;
• white bread, as well as confectionery.

To improve digestion and prevent flatulence, pancreatic enzymes (Mikrazim or Pancreatin) and defoamers (Espumizan are the best choice) are prescribed without fail. Another important point in preparing for a pelvic ultrasound is the filling of the bladder, without which it will simply not be possible to visualize the prostate gland. A man needs to drink at least 1000 ml of pure water 1.5 or 2 hours before the diagnosis.

If the doctor decided to prescribe transrectal ultrasonography (), then in this case, in addition to diet and water load, a thorough bowel movement is required in the evening and in the morning on the day of the study. You can use both physical methods (in particular, a cleansing enema) and medication (Picolax or Lactulose). Preparation for ultrasound through the rectum is an important stage that allows the diagnostician to get the most reliable picture of the state of the internal organs.

TRUS Advantages:

• easily detects small formations like stones, small cysts and microabscesses, which are often missed during examination through the abdominal wall;
• excellent for confirming the diagnosis of prostate adenoma;
• helps to conduct an in-depth and more detailed assessment of the seminal vesicles and ducts;
• clearly defines the functional state of the genital organs;
• transrectal urological ultrasound allows you to immediately take a piece of prostate tissue for further histological examination.

Methodology

The technique of the transabdominal method is quite simple: the patient takes the correct position on the couch (lying on his back with his trousers lowered), and the doctor places the convex probe on the groin and starts the diagnosis. An experienced ultrasound doctor performs a polypositional examination, which allows him to view all the structures and make the correct measurements.

For the transrectal method, the patient must lie on his left side and bend the lower limbs at the knee and hip joints. A special disposable condom is put on the transducer, after which the gel is applied. The sensor should be inserted carefully to a depth of no more than 5-6 cm. Usually, the procedure is painless, although it causes some discomfort to the man.

However, transrectal ultrasound of the genitourinary system in men is contraindicated in case of anal fissures, active hemorrhoids, and in the presence of tumor formation in the lumen of the rectum.

Data interpretation and normal indicators

Urological ultrasound primarily evaluates the echostructure and size of the prostate gland and adjacent seminal vesicles. Along with these organs look bladder and blood flow criteria. An analysis of the data obtained can be obtained from a urologist.

A healthy prostate has a homogeneous mid-echoic structure and is not enlarged:

• Anteroposterior - from 15 to 22 mm.
• Upper front - from 25 to 42 mm.
• Transverse - from 28 to 44 mm.
• The volume of the organ normally does not exceed 29 cm 3.

With an increase in the size of the prostate gland, first of all, it is necessary to think about its benign hyperplasia, which is otherwise called adenoma. If the structure is heterogeneous, with various inclusions and hypo- or hyperechoic formations against the background of an increase, then an oncological process should be excluded.

Ultrasound in urology can also detect small cysts and calcifications in the tissue of this organ. The former are thin-walled anechoic round formations, while the latter have the form of hyperechoic scattered inclusions.

Ultrasound diagnostics of the pelvic organs in males is an informative method for detecting pathologies. Ultrasound is highly reliable and accessible, so it allows you to identify diseases at the very beginning of their development.

Ultrasound of the small pelvis in men with the use of ultrasound is performed both for the diagnosis of abnormalities and for the prevention of diseases.

As part of prevention, prevention of pathologies is carried out, monitoring that existing diseases do not worsen and preventing their possible complications. According to the results of ultrasound, the doctor makes a diagnosis and prescribes adequate treatment to the patient. Ultrasound diagnostics helps to identify pathological processes and diseases and monitor the course of the disease. In addition, by means of ultrasound, you can see how successful the treatment is.

When is an ultrasound indicated?

Ultrasound of the pelvic organs is a complex urological ultrasound, it includes an examination of the seminal vesicles, bladder and prostate. When examining the bladder, the volume of urine remaining after its emptying is obligatorily determined. Examination of the prostate involves the study of the structure of tissues and lymph nodes. The seminal vesicles are examined for sperm viability.

Ultrasound of the genitourinary system in men is a comprehensive examination: it includes an examination of the prostate, bladder and seminal vesicles

Indications for referring men to ultrasound of the pelvic organs are:

• disturbed process of emptying the bladder;
• urination with pain;
• false night calls;
• discomfort in the lower abdomen;
• detection of blood or pus in the urine;
• injuries of the genitourinary system;
• infertility;
• erectile dysfunction;
• detection of neoplasms in the pelvic organs.

In case of a planned surgical intervention, a preliminary ultrasound examination is required to study the features necessary for a successful operation. After such a medical manipulation, an ultrasound examination of the organs of the reproductive system can also be performed to evaluate its results and prevent possible complications.

Since ultrasound is a non-invasive and safe procedure, it does not have any absolute contraindications. There are only some limitations, for example, with significant damage to the skin in the area being examined. This applies to the transabdominal ultrasound method, since it involves the application of a special gel to the surface of the skin, which is designed to improve the permeability of ultrasonic waves. In this case, a study is performed with a rectal sensor, through the rectum.

Ultrasound is a safe non-invasive method, so it can be used an unlimited number of times. Often, ultrasound is performed not only for diagnostic purposes, but also to assess the surgical intervention or the course of drug treatment.

What pathologies does ultrasound of the genitourinary system reveal?

In the pelvic organs of men, many diseases and pathologies that require medical intervention can develop. They are diagnosed by ultrasound examination of the reproductive system. With ultrasound of the pelvic organs in men, the following diseases and pathologies can be detected:

• infectious and inflammatory processes;
• causes of male infertility;
• neoplasms of various origins - cysts, tumors;
• causes of urolithiasis - sand, stones.

The purpose of an ultrasound examination, as a diagnostic procedure, is to determine the causes that caused the dysfunction of the organs of the genitourinary system. In addition, the state of the organ with impaired functioning is assessed. Based on the study, the doctor must make a diagnosis and prescribe an effective treatment to eliminate the problems that have arisen. Ultrasound will also help determine what additional types of examinations may be required for each specific case of the disease. If the patient is to undergo a biopsy procedure, then with the help of ultrasound, the trajectory of the needle insertion is determined.

Preparation and conduct of transabdominal ultrasound

Transabdominal ultrasound is done with a special sensor along the anterior wall of the abdominal cavity. The sensor uses ultrasonic waves to display the internal organs on the device monitor screen.

With the help of a transabdominal sensor, you can determine:

• the size of the prostate, its shape and structure, as well as the existing disorders in the organ;
• the structure of the seminal vesicles;
• bladder pathology;
• formations of a different nature in the organs of the genitourinary system.

Ultrasound of the genitourinary system transabdominally allows you to see the pathology of the bladder, various formations in the organ

An important diagnostic value is such an indicator as the volume of urine that remains in the bladder after urination. To determine this indicator, it is necessary to fill the bladder, look at it through ultrasound, then release it from urine and look in the same way - this is how much urine is left after urination.

Urological ultrasound, like some types of diagnostic procedures, requires that special training be carried out for its implementation. Ultrasound is no exception: for example, for the behavior of abdominal ultrasound, it is necessary to fill the bladder. To do this, an hour before the study, a man must drink at least 1 liter of any liquid that does not contain gases. In addition, the preparation involves eliminating the symptoms of increased gas formation in the intestines. To do this, you need to follow a special diet for several days before the study, which involves the exclusion from the diet of foods that cause increased gas formation. It is advisable to take medications that help get rid of gases.

During the examination procedure, the patient should lie on the couch, in a supine position. A special gel is applied over the skin of the abdominal cavity, which contributes to better penetration of ultrasound into the tissues of the organs. Further, the sensor is driven at the place of application of the gel with light pressure movements. The procedure of such a study is not painful and takes about 20 minutes. After the end of the procedure, the indicators are recorded in the study protocol, where the norms and identified deviations are noted. The document is given into the hands of the patient and the doctor who sent him for an ultrasound scan will decipher it.

Features of the examination procedure with a rectal sensor

Ultrasound examination through the rectum is called transrectal. It is also used to examine the pelvic organs in men if examination is not otherwise possible. His help is resorted to in cases where it is necessary to detect small formations that do not show abdominal examination.

If there are doubts about the correctness of the diagnosis, and a more in-depth examination of the condition of the seminal vesicles and ducts is needed, a rectal examination will help. In addition, it allows you to identify prostate adenoma and dysfunction of the genital organs. When taking a biopsy of the prostate, transrectal ultrasound is also used.

A successful rectal examination also requires some preparation. Preparation is to free the rectum from the contents. This is done by applying a cleansing enema. This is a very desirable procedure, which is done so that the feces accumulated in the intestines do not interfere with the study. Thus, preparation for ultrasound is an important step in obtaining reliable results.

Urological ultrasound by the rectal method can cause minor pain and discomfort. The patient should lie on his side with his knees bent. Before starting the study, the doctor examines the rectum by palpation. Having lubricated the sensor with a special substance, the doctor inserts it into the rectum.

Many techniques are used to diagnose diseases of the urinary system. One of the first places among them is given to ultrasound diagnostics, which is assigned to study the urinary organs, the male genital area. Before conducting an ultrasound of the bladder in men, preparation is necessary to help obtain the most accurate result.

Types of diagnostics

The study of the bladder in men is done in the following ways:

• Transabdominally. The study by this method is carried out through the abdominal wall. Allows you to diagnose diseases of the bladder, prostate.
• Transrectal. Diagnosis is carried out through the anus using a special ultrasonic sensor. This type allows you to determine the presence of a connection between the pathologies of the prostate gland and the bladder. With it, it is possible to control the amount of residual urine. Allows biopsy.
• Transurethral. It is carried out in exceptional cases. Reveals the relationship between the urethra and the bladder. It is done with a urethral probe. This is a rather painful procedure, which is performed with local anesthesia. By doing it, there is a risk of damage to the urethra.

Indications for research

A urologist performs a study in the presence of the following indicators:

• frequent, painful urination;
• the presence of various impurities, precipitation in the urine;
• urinary retention;
• with suspicion of ICD;
• sharp pains of a pulling nature in the lower abdomen.

In addition, an ultrasound examination is prescribed after the following surgical interventions: after removal of tumor neoplasms of the bladder, crushing or removal of stones, removal of an adenoma through the bladder, surgery on the urethra, ureter. Bladder ultrasound for men is prescribed in the presence of organ tumors. Moreover, the diagnosis should be carried out both before the start of therapy and after it. It allows you to detect the presence of metastases.

This method is widely used to differentiate other diseases that have a similar clinical picture. Among them:

• inflammation of the prostate gland;
• inflammatory processes of the ureter;
• kidney pathology.

Conducting a transrectal examination

Contraindications

There are some contraindications for conducting an ultrasound examination of the bladder, which are associated with the diagnostic method. It is not indicated to conduct a transabdominal examination of the organ in the presence of urinary incontinence, since this study is carried out only with good filling of the bladder, overweight (since it is difficult to scan with subcutaneous fat), damage to the skin in the research area, scars and sutures on the bladder.

Transrectal diagnostics is not carried out in case of inflammatory processes of the rectum, absence of the rectum, intestinal obstruction, allergic reaction to latex. Transurethral examination is not done with intolerance to drugs that have analgesic effects, inflammatory processes of the urethra.

Preparatory activities

Preparation for the study also varies depending on the type of diagnostics. If the procedure is performed transabdominally, then you should come to it with a full bladder and empty intestines. To do this, you need to drink at least 1 liter of clean water within 2 hours. Before the procedure, take a diuretic, which is necessary for the accelerated outflow of urine by the kidneys. In addition, for 2 days it is necessary to adhere to a diet that reduces increased gas formation.

Diet food limits the use of:

• raw vegetables;
• juices;
• dairy products;
• alcohol;
• carbonated drinks;
• fresh baked goods;
• legumes;
• coffee.

The last meal should be no later than 7 pm. It is necessary to come to the diagnosis on an empty stomach. Also, the day before, you should put a cleansing microclyster. You can reduce the number of gases with activated charcoal, Espumizan. Prepare for a transrectal examination by cleansing the intestines, by using a mild herbal laxative, an enema.

If a patient needs to undergo a transurethral examination, then, due to the fact that it is performed under anesthesia, it is necessary:

• exclude the use of any alcoholic beverages, as they can interact in an unpredictable way with drugs;
• in the morning take a light breakfast. Within two hours before the procedure, it is necessary to exclude the ingress of nicotine. Since nicotine as a result of anesthesia can lead to nausea;
• warn the doctor about the presence of allergic reactions, diseases of the respiratory system, cardiovascular system.

How the study is done

If the diagnosis is carried out transabdominally, then the patient lies on the couch with the stomach freed from clothing. The doctor drives an ultrasonic sensor over the skin, scanning the bladder and nearby organs. To evaluate the work of the prostate gland during the procedure, the doctor asks to visit the toilet. Next, visualization is performed after emptying the bladder. Usually the procedure does not take more than 20 minutes. In transrectal ultrasound, an ultrasound probe is inserted into the rectum. During the diagnosis, the doctor may ask for a change in the location of the body.

A condom with applied gel is put on the sensor. During an internal examination, the distance between the bladder and the transducer is reduced. This allows you to see the body in detail.

Decryption

The bladder belongs to the category of hollow muscular organs, which are perfectly diagnosed using ultrasound. Doctors, evaluating his work, pay attention to the shape, volume, thickness, structure, filling of the organ, emptying, content, volume of residual urine. These parameters will allow the specialist to assess the condition and make an accurate diagnosis.

Normal indicators of the bladder in men are:

• rounded shape with clear and even contours;
• echogenic structure, which changes due to the age of the patient. In the elderly and those suffering from chronic diseases of the bladder, increased echogenicity is observed;
• volume from 350 to 750 ml;
• wall thickness varies from 2 to 4 mm. This is related to the fullness of the body. If a thickening or thinning is observed in any area, then this belongs to the category of pathologies;
• the volume of residual urine should not be more than 50 ml.

Diagnosable pathologies

As a result of the study, the following diagnoses are possible:

• cystitis;
• cancerous growths;
• the presence of a foreign body;
• vascular changes;
• reflux in the form of a reverse reflux of urine into the ureter from the bladder;
• inflammation;
• congenital pathologies;
• improving functionality;
• enuresis;
• diverticula.

An increase in the echogenicity of the organ occurs:

• with stones;
• cysts;
• polyps;
• narrowed size of the ureter;
• neoplasms.

Formations that cause an increase in echogenicity are mobile, for example, stones, and motionless, polyps. Neoplasms with a denser structure are visible on the apparatus as light spots, for example, stones. Polyps and cysts will appear as less light spots. The reflux of urine into the ureter from the bladder, which can reach the pelvis of the kidneys, leads to an anomaly of the urinary tract, sediment and stones, neoplasms.

In this case, dopplerography is performed, which determines the volume of cast and residual urine. It detects the direction of the current, assesses the degree of the disease. Ultrasound diagnosis of the bladder allows you to identify multiple pathologies at the very beginning of their development. This is a safe technique that can be carried out more than once to control the result of the prescribed treatment.