ULTRASOUND - URINARY BLADDER

Alternative Names:  bladder ultrasound, bladder sonography, ultrasound of the bladder

ROLE OF ULTRASOUND FOR BLADDER

• Assesses the bladder wall for wall thickening

• Trabeculation

• Masses and diverticulae

• Pre and post micturition volumes

• Vesico-ureteric junctions also can be visualised

• Bladder calculi & foreign bodies

• Use the full bladder as an acoustic window to assess the prostate in males and gynaecological structures in females.

PATIENT PREPARATION

• The patient must present with a full bladder.

• 2hrs prior to the appointment, the patient should empty their bladder.

• Over the next hour they should drink at least 1 litre of water. This allows time for the water to reach the bladder.

• Do not go to the toilet until instructed by the Sonographer.

EQUIPMENT SELECTION AND TECHNIQUE

• Use of a curvilinear probe (3-5MHZ).

SCANNING TECHNIQUE

• Patient supine with suprapubic area exposed

• Examine the bladder sagittally in the midline

• Now angle laterally & sweep the probe both left and right to check the lateral margins

• Rotate 90degrees into the axial(transverse) plane

• Sweep through from the superior dome to the bladder base

• Look for ureteric jets at the bladder base

• Do this, in transverse angle inferiorly using power doppler (or colour doppler with low PRF & wall filter settings)

• Document the normal anatomy and any pathology found (including measurements and vascularity if indicated)

• Measure the bladder volume pre and post micturition. As a rule of thumb, the bladder should empty to approximately 10% of the pre-micturition volume

• If the initial post-void volume is greater than 100mL, encourage the patient to try again because a large residual volume may be artefactual following a very full bladder.

PROSTATE

Whilst the bladder is full, angle inferiorly in sagittal and transverse. Note the shape of the prostate, whether it bulges into the bladder and measure the volume.

UTERUS AND OVARIES

Be aware that gynaecological pathology may contribute to pelvic/urinary symptoms and may also require investigation.

BLADDER ULTRASOUND SAMPLE PROTOCAL (TYPICALLY)

This sample protocol is meant for educational purposes and the exact technique will depend on the patient's clinical indication for the examination and the radiologist's guidance.

1. Prevoid Longitudinal/CC, ML, and AP measurement of the bladder with bladder volume calculation

2. If there is wall thickening, wall measurement at point of maximal thickness.

3. Transverse urinary bladder with color doppler to see urinary jets from the ureters.

4. If there is any pathology at the distal ureterovesical junctions, additional images should be acquired.

5. Ask the patient to void and empty out their bladder.

6. Postvoid Longitudinal/CC, ML, and AP measurement of the bladder with bladder volume calculation.

7. If there is any pathology at the prostate, take a three dimensional measurement. 

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