How is an ultrasound of the bladder performed in women? Ultrasound of the urinary system. Diseases of the bladder and its structures detected by ultrasound

Article under development.

Structure of the bladder

Urine is excreted by the kidney and sent through the ureters to the bladder. The ureter passes in the retroperitoneal space and has three physiological narrowings: at the point of transition of the pelvis into the ureter (pelvis-ureteric segment), at the point of intersection of the ureter with the iliac vessels (at the border of the middle and lower third) and at the place where it flows into the bladder.

The bladder is located behind the pubic bones: the empty one does not extend beyond the boundaries of the small pelvis, the filled one rises into the abdominal cavity. Above the bladder in men is the peritoneum and intestinal loops, in women - the uterus, peritoneum and intestinal loops. Behind the bladder in men are the seminal vesicles and rectum, in women the uterus, cervix and vagina. Below the bladder in men is the prostate gland, in women - the muscles of the perineum. From the sides - ischioanal fossa.

There are apex, body, bottom and neck of the bladder. The top is tilted forward, the bottom is at the back below, and the body is located between them. Tapering, the bladder passes into the neck, which ends with the urethra. The neck of the bladder is surrounded by a double circular muscle - the internal and external sphincter. The internal sphincter is composed of smooth muscle and works unconsciously, while the striated external sphincter can be influenced by muscle force.

The bladder is lined with transitional epithelium, which forms folds when the bladder is empty. The loose submucosal layer contains nerve endings, lymphatic and blood vessels. Three layers of smooth muscle unite to form the detrusor; near the orifices of the ureters, circular fibers form sphincters. The outside of the bladder is covered with adventitia, and in the body area with visceral peritoneum.

In the area of the bottom between the mouths of the ureters and the internal opening of the urethra, a vesical triangle is distinguished: the interureteric fold is the base, and the internal opening of the urethra is the apex. In the triangle, the mucosa is always smooth, the connective tissue of the submucosal layer is dense, and a powerful detrusor. This place is loved by inflammation and tumors.

Ultrasound of the bladder transabdominal

Transabdominal ultrasound shows the entire bladder and surrounding anatomy. A full bladder serves as an acoustic window for examining the prostate gland in men and the pelvic organs in women. We are interested in the volume, shape, thickness of the bladder wall, as well as the distal ureters before and after urination.

2 hours before the test, you should empty your bladder and drink at least 1 liter of water over the next hour (for children, 10 ml per kg of body weight). If the bladder is not stretched enough, the pathology may be hidden by folds.

The patient is in the supine position. A convex sensor of 3.5-6 MHz is used; a high-frequency linear sensor of 7 MHz and higher is suitable for children. Place the transducer sagittally in the midline just above the pubic symphysis and examine the right and left lateral fields. In the transverse plane, move from the apex to the base of the bladder.

A full bladder is a large anechoic formation in the pelvis. A full bubble has a round shape, while an empty one looks like a flat plate. In newborns, the bladder is spindle-shaped, in babies it is pear-shaped, at the age of 8-12 years it looks like an egg, in teenagers and adults it is spherical. The bladder is symmetrical in cross sections, has an even internal contour, and there is always a small amount of suspension in the lumen.

Drawing. The bladder of a woman and a man: filled and empty - uterus, vagina, ovary, prostate, seminal vesicles, rectum.

Between the openings of the ureters, the bladder muscle is hypertrophied and forms a ridge. By rotating the probe downwards, the bladder neck can be examined. The open neck has the shape of a funnel. You can ask the patient to close the bladder neck with muscle force.

In children, the absence of the urge to defecate with a rectal diameter of more than 29-35 mm may indicate a tendency to constipation.

Bladder volume on ultrasound

Bladder capacity is measured when you have the urge to urinate. On a longitudinal section, the maximum length from the neck to the bottom of the bladder is measured. On a cross section, the thickness is measured - the maximum anteroposterior dimension and width of the bladder. The volume is calculated using the formula for an ellipsoid of revolution: Length*Thickness*Width* 0,523.

Drawing. Bladder volume.

Bladder Volume Index: BVI= Length*Thickness*Width.

Expected bladder capacity for children of different ages (Neveus, 2006): EBC (ml) = 30 + (age per year × 30), for children over 12 years of age, FEMP is 390 ml.

Functional bladder capacity for children: FEMP = BVI/EBC. If FEMP<70%, говорят о сниженной емкости мочевого пузыря. Если ФЕМП >115% indicate an overstretched bladder.

Reduced bladder volume with recurrent cystitis, especially common with tuberculosis. In this case, the patient cannot hold urine for a long time, he is bothered by frequent and painful urination. With fibrosis of the bladder wall, urination will be frequent, but not painful. Bladder capacity may also decrease in rare cases of infiltrating tumors (bladder asymmetry is required), after radiation therapy for malignant tumors of the pelvis. With schistosomiasis in the late stage, “microcystis” can also form. Compression of the bladder from the outside with a decrease in its capacity can be caused by urohematoma, tumors, inflammatory infiltrates and other diseases in the pelvic area. Longitudinal sections in two planes show a small bladder with uneven contours and thickened walls as a result of fibrosis. It does not stretch even when re-examined after drinking liquid.

An enlarged (overstretched) bladder occurs with a prostate tumor, trauma and stricture of the urethra, stones in the urethra, neurogenic bladder. bladder, urethral valve (in children), cystocele. its walls will look smooth and thin, sometimes diverticula are visible. The ureters and kidneys are always examined for the presence of UGN. Reasons for overfilling of the wash bladder: It is necessary to measure the ROM.

Residual urine on ultrasound

Bladder volume is measured when the urge to urinate and immediately after urination. Normally, the residual volume is no more than 10% of the volume before urination. If the bladder is full, the residual volume may be large; ask the patient to try again. A significant residual volume indicates incomplete emptying due to obstruction or detrusor weakness.

Bladder wall thickness on ultrasound

On ultrasound, the thickness of the bladder wall includes a hyperechoic mucous and hypoechoic muscle layer. In adults, wall thickness with a full bladder<3 мм, а при пустом <5 мм. Толщина стенки зависит от наполнения мочевого пузыря, но она одинакова во всех отделах. Локальное утолщение стенки — патологическое явление.

Table. Bladder wall thickness in children (mm) depending on bladder filling according to Pykov

Table. On a cross section, the thickness of the bladder wall is measured at three points - bottom, side wall, base.

Sreedhar (2008) proposes a bladder wall thickness index using the formula BVWI=BVI/average wall thickness. Wall thickness is measured at the bottom, side and base of the bladder. Normal wall BVWI 70-130, thickened wall BVWI<70, стенка тонкая BVWI >130.

Detrusor hypertrophy is caused by an underlying obstruction. In children, this is the posterior urethral valve or urogenital diaphragm, in men - tumors and benign prostatic hypertrophy, in women - pelvic tumors. Once the obstructions are removed, the bladder wall becomes thinner.

Repeated contractions of the detrusor with a functional disorder of urination cause hypertrophy of the bladder wall. A wall thickness of more than 3.75 mm with a bladder volume of 50 ml with a sensitivity of 92% and specificity of 86% indicates detrusor overactivity.

If there is local thickening of the bladder wall, it is necessary to exclude a tumor. Changing the patient's position and varying degrees of filling will help differentiate pathology and normality - blood clots look like a tumor, but come off the wall and “float”, and the folds disappear with additional stretching.

Drawing. Local thickening of the bladder wall due to folding when it is insufficiently filled, which disappears when filled. Broad-based polyp in the bladder. Blood clot in the bladder.

Ureteral discharge on ultrasound

There are six different types of ureteric ejections, which are characterized by different physiological and pathological activity of the sphincters of the vesicoureteral junction. Among them, biphasic, triphasic and multiphasic waveforms are classified as mature sphincter activity, while monophasic waveforms are classified as immature waveforms, characteristic of younger children.

The ureteral openings are not visible, but their location can be guessed by the ureteral discharges during CDK. Sometimes you can notice an expansion of the ureter up to 3-4 mm during the passage of a portion of urine. The ureteral jets should be crossed strictly along the midline of the bladder. This confirms bilateral renal function and excludes complete but not partial ureteral obstruction. A “mature” vesicoureteral junction is characterized by a two- or three-wave curve.

Drawing. One-, two-, three-wave curve of ureteral ejection.

Table. Dopplerographic indicators of ureteral ejection (UEF) in healthy children (M±m) according to Pykov

Age	Vmax, cm/sec	Vmin, cm/sec	RI MB	PI MV	SD MV
7-30 days	6.1±0.03	2.3±0.02	0.62±0.01	1.03±0.02	2.63±0.03
1-6 months	13.7±0.02	3.8±0.02	0.72±0.02	1.27±0.02	3.57±0.02
6-12 months	17.5±0.03	5.3±0.03	0.70±0.02	1.16±0.02	3.33±0.03
1-3 years	18.2±0.03	5.5±0.03	0.70±0.02	1.19±0.03	3.33±0.03
3-5 years	19.4±0.02	6.0±0.03	0.69±0.03	1.22±0.03	3.23±0.03
6-10 years	26.1±0.02	9.1±0.03	0.65±0.02	1.23±0.02	2.86±0.03
11-13 years old	40.0±0.03	14.0±0.02	0.65±0.02	1.24±0.03	2.86±0.03
13-15 years old	51.0±0.03	17.9±0.02	0.65±0.03	1.24±0.02	2.86±0.03

Lasix test in children

Water load 10 ml/kg body weight. Lasix is administered intramuscularly at a dose of 0.5 mg/kg. The collecting system is measured every 15 minutes. In a healthy child, the size of the pelvis is maximum at the 15th minute and returns to its original state by the 30th minute. A later return to normal indicates functional obstruction. If the pelvis continues to enlarge after the 15th minute, this proves the organic nature of the obstruction.

Ultrasound of the bladder transperineal

Transperineal ultrasound allows you to assess the anatomical and functional state of the urethra and bladder neck. For adults, a 3.5-6 MHz convex sensor is used; for children, a linear high-frequency sensor 7.5-10 MHz is suitable. The patient is in the supine position, the bladder is moderately full. The sensor is placed on the urethra in women or behind the scrotum in men. Scanning is carried out in the sagittal plane.

Drawing. A standard sagittal section during transperineal ultrasound in women allows you to see (from front to back): the symphysis, urethra and bladder neck, vagina, anorectal junction. The hyperechoic space behind the anorectal junction represents the central part of the levator, i.e. muscle puborectalis.

The volume of residual urine A*B* 5.6 is measured, where A and B are perpendicular straight lines.

In perineal ultrasound, the pubic bone is used as a stable pelvic landmark to draw a reliable reference line (the central line of the symphysis). Qualitative parameters for which can be defined and described are the funnel of the blah-neck and the position and mobility (fixed, hypermobile) of the urethra and the base of the bladder (vertical, rotational or descending descent).

The distance between the bladder and the symphysis, as well as measurement of the length of the urethra at rest, with the Valsalva maneuver and compression are used to determine urethral mobility.

Bladder neck position and mobility can be assessed with a high degree of reliability.The reference centers are the central axis of the symphysis or its posterior-inferior edge.The former may be more accurate because the measurements are not dependent on the position or movement of the transducer;however, due to calcification of the interbibular disc, the central axis is often difficult to obtain in older women, transmission reliability.Imaging can be done with the patient supine or standing and with the bladder full or empty.A full bladder is less mobile and may prevent pelvic organ prolapse from fully developing.In the standing position, the bladder is positioned lower at rest, but lowers to that of the patient during the Valsalva maneuver.In any case, it is essential not to place undue pressure on the perineum to ensure full development of pelvic emptying, although this may be difficult in women with severe prolapse such as vaginal luxation or prolapse.

Measurements of bladder neck position are usually performed at rest and during the maximum Valsalva maneuver.The difference gives a numerical value for bladder neck descent.During the Valsalva maneuver, the proximal urethra may rotate in a posteroinferior direction.The degree of rotation can be measured by comparing the angle of the proximal urethra and any other fixed axis.Some investigators measure the retrovecial (or posterior urethrovesic) angle between the proximal urethra and the trigone.Others determine the angle γ between the central axis of the symphysis pubis and the line from the inferior symphyseal edge to the bladder neck.Of all the ultrasound parameters of hypermobility, cervical bladder descent may have the strongest association with stress urinary incontinence.

There is no definition of normal for bladder neck mobility, although cutoffs of 20 and 25 mm have been proposed to define hypermobility. Mean measurements in stress incontinent women have consistently been around 30 mm (HP Dietz, unpublished data). In Fig. Figure 9-4 shows a relatively immobile bladder neck before first delivery and a marked increase in bladder neck mobility after delivery. Figure 9-5 shows typical ultrasound findings in a stress incontinence patient with a grade 1 cystourethrocele, with 25.5 mm of bladder neck descent and funneling. It is likely that methodological differences such as patient positioning, bladder filling, and quality of the Valsalva maneuver (i.e., controlling for similar factors such as concomitant levator activation) account for measurement inconsistencies, with all known factors tending to reduce descent.

Typical findings in a patient with stress incontinence and soft anterior vaginal wall prolapse (i.e., class 1 cystourethrocele): posteroinferior rotation of the urethra, opening of the retrovecial angle, and proximal urethral infundibulum (arrow).

Color Doppler ultrasound has been used to demonstrate the flow of urine through the urethra during the Valsalva maneuver or coughing.

Drawing. Bladder neck height measurement with introatonic sonography. A horizontal line is drawn at the lower border of the symphysis. The height (H) of the bladder neck is defined as the distance between the bladder neck (BN) and this horizontal line. For reliable measurements at rest, during Valsalva and pelvic floor stresses, the position of the ultrasound probe cannot be changed.

Drawing. Methods for measuring the position of the bladder neck (BN) and for the retrovision angle b. On the left - measuring the position of the bladder neck at two distances. A rectangular coordinate system is established with the origin at the lower border of the symphysis. The x-axis is determined by the central line of the symphysis, which passes between its lower and upper boundaries. The y-axis is constructed perpendicular to the x-axis at the lower border of the symphysis. Dx is defined as the distance between the y-axis and the bladder neck, and Dy is defined as the distance between the x-axis and the bladder neck. For precise localization of the bladder neck, the upper and ventral point of the urethral wall at the direct transition to the bladder is used. That's right, measuring the position of the bladder neck with one distance and one angle. The distance between the bladder neck and the lower border of the symphysis and the angle between this distance line and the central line of the symphysis (pubic angle) are measured. The definition of the retrovision angle b is the same for these two methods. One side of the angle lies along the line connecting the dorsocaudal and proximal urethra, and the other side is formed tangently along the base of the bladder.

The length and width of the urethra, the shape and position of the bladder neck are assessed. The bladder neck is examined at rest, with pressure on the abdominal wall, coughing and straining (Valsalva maneuver), and relaxation (urination).

The open neck has the shape of a funnel. The neck closes when the bladder fills (support reflex), when pressing on the abdominal wall and coughing (holding reflex), when tapping on the abdominal wall (sacral reflex). In infants, when urination begins, the detrusor muscle contracts and the cervix closes (micturition reflex). Assess the ability to contract your pelvic floor muscles at will.

Bladder hypermobility is clearly visible during the Valsalva maneuver, as the pelvic floor muscles first relax and then tense. When the pelvic floor muscles are tense, the bladder neck rises.

Drawing. Diagram of the bladder at rest (1) and during straining (2). The posterior urethrovesical angle (the angle between the longitudinal axis of the neck and the posteroinferior wall of the bladder) approaches 100°; When urinating, this angle should increase significantly.

Table. Posterior ureterovesical angle and urethral length in healthy children aged 6-15 years according to Pykov

Index	Girls, years			Boys, years
Index	mean M (95% CI)	6-10	11-15	mean M (95% CI)	6-10	11-15
Length, mm	24,0(21,9-26,1)	22,8	27,6	23,8(21,8-25,8)	22,10	25,7
Width, mm	5,2 (4,7-5,6)	5,0	5,24	4,7 (4,3-5,2)	4,2	5,29
Posterior urethrovesical angle	112,6(109,8-115,4)	110	113	110,9(107,6-114,1)	110	111,7

A short urethra, open cervix, and bladder hypermobility are correlated with stress urinary incontinence. Pathology: deformity, stricture, valves, syringocele, utriculus cyst, diverticula, ectopic ureter insertion or ureterocele, arteriovenous fistula or aneurysm, polyps, stones, foreign body.

Take care of yourself, Your Diagnosticer!

Ultrasound of the bladder is one of the most common diagnostic methods. Its popularity is based on the fact that a full bladder serves as a “window” for.

Ultrasound of the bladder shows pathological changes, and interpretation of the study results helps to carry out a differential diagnosis of emergency conditions.

Indications for the study

Ultrasound of the bladder is performed for a number of indications, including:

dysuric disorders (impaired urination);
frequent urge to urinate;
impurities in the excreted urine (blood, flakes);
difficulty urinating, accompanied by pain;
inability to urinate independently;
pain in the suprapubic region.

The indication for an ultrasound of the bladder is not only the patient’s complaints, but also control over therapy. Using diagnostics, the dynamics of the disease after surgery are monitored. Surgical interventions controlled by ultrasound of the bladder are as follows:

oncology treatment (prostate cancer);
cystolithotripsy (crushing stones) or removing stones;
resection of prostate adenoma;
surgeries on the ureters.

Ultrasound of the bladder allows the doctor not only to identify pathological conditions, but also to exercise control over the therapy being carried out.

Often, the cause of the patient’s complaints is pathology of other pelvic organs. The explanation for this is the close anatomical location of the ureters, and. By interpreting the results of an ultrasound scan of the bladder, a diagnosis can be made.

Methods for diagnosing the bladder

There are several examination methods:

Transabdominal examination. It is done in a supine position, diagnosis is carried out through the abdominal wall. The condition for the study is that the bladder is full. Abdominal ultrasound allows you to determine the volume, size, and structure of the organ. Used in men and women.
Transrectal examination. It is done in a lateral position, and the organ is examined by inserting a sensor into the rectum. The technique is intended for men and girls. The method is highly informative compared to the transabdominal method.
Transvaginal examination. The method is applicable to women. It is carried out in a supine position, the sensor is inserted into the vagina. Advantages of the method: high information content and no need for preliminary preparation. The transvaginal method helps to identify diseases of the reproductive organs in women.
Transurethral examination. The examination is carried out in the supine position, with the sensor inserted into the urethra. The advantages of the method are the ability to assess the degree of damage to the urethra and visualize the urethra. Disadvantages of transurethral ultrasound of the bladder: pain relief and risk of complications (damage to the urinary tract by the sensor). The method is rarely used due to the above disadvantages.

Transrectal ultrasound is intended to examine the bladder in men and girls (transvaginal examination is prescribed only to those women who have already had sexual intercourse)

What does the study show?

Normally, an ultrasound of the bladder (together with determination of residual urine) shows:

shape: pear-shaped when the bladder is full and saucer-shaped after urination;
structure: echo-negative (on the monitor screen it is presented in the form of dark shades);
volume: from 250 to 550 ml. in women and from 350 to 750 ml. in men;
wall thickness: from 2 to 4 mm;
filling: normal, filling rate is 50 ml. at one o'clock;
volume of residual urine: no more than 50 ml.

Signs of pathology on an ultrasound picture

The data obtained from an ultrasound examination represent only preliminary information on the basis of which a diagnosis is made. The final analysis of diagnostic data may vary depending on the quality of the equipment, the method of scanning, and the qualifications of the specialist. Let's look at some ultrasound signs of pathological conditions.

An increase in the normal size of the bladder may be accompanied by an increased volume of residual urine. The main reason for the increase in the size of the organ is overstretching of its walls with urine. This symptom is observed when an obstacle to its outflow occurs.

Possible causes of difficulty in urine flow:

prostatic hyperplasia (pathological growth: due to anatomical features, the prostate compresses the urethra and impedes the outflow of urine);
pathology of organ innervation;
calculi in the bladder (stones and sediment);
urinary tract valves (more often - pathology in newborns).

A decrease in the normal size of the organ is observed due to congenital anomalies or in the last stages of nonspecific diseases of the bladder. The main indicator is a reduced volume of residual urine. Possible reasons for a decrease in organ size:

Sediment (flakes) in the bladder is observed with cystitis. The flakes are a mass of inflammatory cells (epithelial cells and leukocytes). Often, the sediment is formed by salts (phosphates), which is a prerequisite for the development of urolithiasis. Upon examination, flakes are identified as hyperechoic formations (i.e., in the form of light spots on a dark background).

Formations of increased echogenicity on ultrasound of the bladder:

stones;
cysts or polyps;
narrowing of the lumen of the ureter;

These formations can be immobile (for example, polyps, tumors) or, on the contrary, mobile (stones, flakes). When interpreting the results, it is taken into account that the degree of echogenicity depends on the density of the tissue: the denser it is, the lighter the areas on the ultrasound picture. For example, stones will appear as light spots, while cysts are less echogenic (and therefore less light).

Reverse reflux of urine from the bladder into the ureters, which can even reach the renal pelvis. Conditions leading to urine reflux:

urinary tract abnormalities;
stones and flakes (sediment) in the bladder cavity;
neoplasms of the urinary tract.

With this type of pathology, an ultrasound of the bladder is performed, which allows one to determine the quantitative volume of residual and thrown urine, the direction of its flow, and also allows one to assess the severity of the disease. The scope of the diagnosis is determined by the doctor. For an accurate diagnosis, not only ultrasound is used, but also laboratory and invasive methods for diagnosing the urinary tract.

Content

Ultrasound examination plays an important role in determining bladder diseases. This diagnostic method is prescribed in the presence of symptoms indicating pathology of the genitourinary system. To obtain reliable results, an ultrasound of the bladder should be taken seriously and prepared. All instructions regarding preparation for the examination are given by the doctor and it is very important to follow them. This method has no contraindications and is allowed even for children.

Indications for ultrasound examination

This examination method is distinguished by its simplicity, absence of contraindications, complications, and speed of obtaining results. A study is prescribed for the following symptoms:

frequent or difficulty urinating;
incontinence;
suspicion of kidney stones;
with cystitis;
urine laced with blood;
suspicion of vesicoureteral reflux.

Additionally, a study is prescribed to assess kidney function, diagnose cystitis (both chronic and acute), and pyelonephritis. If adenoma or inflammation is suspected in men, prostate examinations are simultaneously performed. Women may be prescribed additional examinations of the uterus and appendages to fully assess the condition of the genitourinary system.

How to properly prepare for an ultrasound of the bladder

Preparation for a bladder ultrasound plays a very important role. By the time of the procedure, the organ should be filled - this will help determine the thickness of the walls, the shape of the organ and its contour. To do this, approximately 1.5 - 2 hours before the ultrasound, you need to drink about 2 liters of liquid in the form of teas, compotes, still water. There is another way - do not empty the bladder for 5 - 6 hours before the procedure.

If the ultrasound will be performed transrectally, it is necessary to do a cleansing enema on the eve of the procedure and several hours before it. After such preparation, patients have no questions about whether they can eat before ultrasound of the bladder. After all, it is already clear that it is better to conduct an examination after an enema on an empty stomach or on a diet (for other types of examination: external and transvaginal or transurethral).

Many patients find it difficult to refrain from urinating before the procedure and the question arises of how to prepare then. In this case, it is recommended to partially evacuate, but you will need to drink 1.5 - 2 liters of liquid so that the organ is filled again by the time of the ultrasound. The accuracy of the results after the examination depends on the correct preparation of the patient, because only a full bladder can determine the condition of the organ.

How is the procedure performed?

Ultrasound of the bladder is performed in 3 ways:

Abdominal - with this examination, the examination is carried out from the anterior abdominal cavity. This is an external type of research.
Transurethral - diagnosis occurs through the urination channel.
Transrectally - the organ is examined through the rectum.

The most used is the first method of examination. The other two are necessary to confirm or refute problems that were identified during an external examination. Ultimately, the method of performing an ultrasound is determined by the attending physician, who prescribes this procedure. The patient’s position is determined during the diagnosis; you will be asked to lie on your back or side, in some cases you will be asked to stand up so that the organ can be examined for the presence of formations inside it.

How to do an ultrasound of the bladder in women

Diagnosis sometimes differs depending on the gender of the patient. Women also have their uterus and ovaries examined. The procedure makes it possible to measure these organs, determine their structure, location, and shape. In some cases, women undergo transvaginal ultrasound. This helps to clearly see the picture of the state of the organs inside and accurately diagnose the existence of certain diseases. Pregnancy and menstruation are not an obstacle to diagnosis; it is only important to warn the doctor so that he can choose the right examination method.

Ultrasound of the genitourinary system in men

The examination of male patients has some of its own characteristics, for example, during an ultrasound of the bladder, sometimes there is a need to diagnose the prostate gland. If you suspect diseases associated with the prostate, ultrasound of the bladder with determination of residual urine. To do this, the man is asked to go to the toilet, and then the amount of fluid that is retained in the organ is measured. Otherwise, the diagnosis of a bladder in men and women is no different.

What an ultrasound can show

Organ diagnostics helps to see:

Patency of the ureteral canals.
The presence of foreign formations, tumors, stones.
Sediment in the bladder on ultrasound is visible in the form of salts, crystalline formations, epithelium, erythrocytes and leukocytes.
Inflammation (acute or chronic).
Increased tone.
Atony.
Wall diverticulosis.
Organ prolapse.
Existence of prostate problems (in men).
Diseases of the ovaries, appendages, uterus (in women).

Interpretation of ultrasound of the bladder

Deciphering the ultrasound results helps the doctor to adequately assess the condition of the bladder, and in combination with the patient’s complaints, make an accurate diagnosis and prescribe treatment if necessary. After all, a normal echo picture does not always indicate the absence of problems with the bladder. At the same time, it is very important for the doctor to know the acceptable indicators for the correct examination. A round or oval shape of the organ, smooth edges and a volume ranging from 350 to 750 ml in men and 250-550 ml in women are considered normal.

Approximate cost of ultrasound examination

In Moscow and St. Petersburg, the price for such a service depends on the clinic where it is performed and the qualifications of the specialist. At the time of writing, the cost varies between:

Minimum – 600 rub. in the multidisciplinary medical center "Prima Medica", located on the street. Academician Chalomeya, house 10B (near Kaluzhskaya metro station).
Maximum – 2500 rub. at the Center for Endosurgery and Lithotripsy, which is located on Shosse Entuziastov, 62 (next to the Shosse Entuziastov station).

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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Quite often, women who are prescribed an ultrasound of the bladder have a question: how to prepare for this study correctly. Let's try to answer it, taking into account the specifics of the procedure.

Why is this type of examination prescribed?

Before talking about how an ultrasound of the bladder is performed in women, let’s consider the main indications for its performance. To begin with, it is worth noting that this type of examination, along with examination of other pelvic organs, is not the last place in the process of diagnosing gynecological disorders.

Most often, an ultrasound examination is prescribed when symptoms appear that indicate the presence of genitourinary diseases in a woman’s body. In particular, when:

pain just above the pubis (suprapubic area);
increased urge to urinate;
suspicion of
emergence
development of difficulty urinating, etc.

Ultrasound is also performed to determine the functioning of the kidneys, to identify diseases such as chronic cystitis and pyelonephritis.

How should one prepare for an ultrasound of the bladder in women?

This type of procedure should be performed on a full bladder. This allows you to determine the shape and structure of the organ itself, assess its condition, wall thickness and other parameters.

Approximately 2 hours before the start of the study, the woman needs to drink 1-1.5 liters of liquid. You can use ordinary water, tea, juice, compote. A full bladder allows better visualization of the anatomical structures located behind it.

Also, along with the method of preparing for research described above, there is also the so-called physiological one. It consists of abstaining from urination for 5-6 hours. This is usually possible when conducting research in the morning. If the ultrasound is scheduled for daytime, then the first method is used.

Very rarely, ultrasound of the bladder can be performed transrectally, i.e. the sensor is inserted into the rectum. In this case, on the eve of the study, the woman is given a cleansing enema.

How is the research conducted?

Having figured out when an ultrasound of the bladder in women is prescribed and what it shows, as well as what is needed to carry it out, let’s consider the sequence of the procedure.

During this study, as a rule, the so-called transabdominal access is used, i.e. the sensor is placed on the anterior abdominal wall. In cases where there is severe obesity or a tumor is present, for example, an ultrasound is performed through the rectum. Access can also be made transvaginally.

The patient is located on the couch and lies on her back. The specialist applies a special contact gel to the suprapubic area, and then places a sensor on it. The duration of the procedure, as a rule, is no more than 15-20 minutes.

During the examination, the external parameters of the organ, its size, shape, and wall thickness are assessed. The final conclusion is given after completion of the procedure.

Thus, as can be seen from the article, ultrasound of the bladder is a fairly simple study, but requires a certain kind of preparation on the part of the patient. If the above instructions are not followed, some structures may not be visible on the ultrasound machine screen, which will require the procedure to be performed again after some time. The woman is advised to drink even more fluid so that the bladder is completely filled and the ultrasound sensor can scan the organs located directly behind it.

To make a correct diagnosis, prescribe drug therapy and simply assess the condition of the bladder, the urologist needs data from an ultrasound examination of the patient. But for the patient himself, the examination is no less important, because a bladder with normal echogenicity may also have hidden problems. In addition, only an ultrasound of the bladder allows one to identify and promptly eliminate pathologies that cannot be detected without the help of ultrasound.

When interpreting the results of ultrasound diagnostics, several parameters that influence the diagnosis are of particular importance. Let's consider their normal and pathological characteristics.

Video 1. The bladder is normal on ultrasound.

Form

The shape of the bladder is significantly influenced by the level of its filling, as well as the condition of the adjacent organs. Transverse photographs show us a rounded shape, and longitudinal photographs show an oval-shaped organ. The boundaries of a healthy bladder are visually determined as smooth and clear.

Features of the organ in women

In the fairer sex, the shape of the bladder depends on whether the woman is pregnant at the time of examination.

A woman’s bladder differs from a man’s in that it has a shorter but wider shape, which the diagnostician must take into account when deciphering research data.

Structure

The normal structure of the bladder is echo-negative (anechoic) character, but echogenicity increases with age. This occurs due to chronic inflammation, which leaves its mark on the condition of the organ in elderly patients.

Volume

On average, the capacity of the bladder in women is 100-200 ml less than in men, and ranges from 250 to 550 ml (while the volume of the male bladder is 350-750 ml). In addition, the walls of the organ can stretch, so in tall and large men the volume of the bladder can reach 1 liter. (when filled).

Reference! The average urination rate is 50 ml/hour.

The children's bladder has its own characteristics: its volume increases as the child grows. Age norms for bladder volume in healthy children:

infants (up to 1 year) – 35-50 ml;
from 1 to 3 years – 50-70 ml;
from 3 to 5 years – 70-90 ml;
from 5 to 8 years – 100-150 ml;
from 9 to 10 years – 200-270 ml;
from 11 to 13 years – 300-350 ml.

If ultrasound diagnostics reveals an increase or decrease in the organ, then a more detailed examination of the small patient is necessary to determine the causes of this phenomenon.

Bubble walls

Over the entire surface of the organ, its walls should be uniform, with a thickness of 2 to 4 mm (the thickness is directly dependent on the degree of filling of the organ). If the doctor notices local thinning of the wall or its thickening on an ultrasound, this may be evidence of the onset of pathology.

Residual urine

An important factor that must be studied during an ultrasound is the amount of urine remaining in the bladder cavity after visiting the toilet.

Normally, the urine residual value should not exceed 10% of the total volume of the organ: on average up to 50 ml.

How to calculate volume?

Typically, bladder volume is measured during an ultrasound examination using a mobile ultrasound machine. The capacity of the organ can be calculated automatically: for this, the doctor needs to find out such parameters as volume (V), width (B), length (L) and height (H) of the bladder.

Used for calculation formula V=0.75хВхLхН

What are they watching?

During an ultrasound examination of the bladder, among other things, pay attention to:

hematuria (presence of blood particles in the urine, especially in children);
sperm in the urine of male patients (this may mean reflux of the contents of the reproductive glands into the bladder).

Pathologies

When interpreting ultrasound data, serious abnormalities may be detected that need to be treated immediately to avoid complications.

Sediment in urine (flakes and suspension)

In a urine test or during an ultrasound of the bladder, the patient may find flakes and suspensions, which are a mixture of different cells (erythrocytes, leukocytes or epithelial cells). Cells from the walls of the urethra can get into the bladder, and this does not indicate pathology. However, sediment in the urine may also indicate the development of certain diseases, such as:

pyelonephritis (inflammation, often of a bacterial nature);
nephrosis (a whole group of kidney diseases);
cystitis (inflammatory disease of the bladder);
glomerulonephritis (damage to the glomeruli);
tuberculosis (the cause of this severe infectious disease is Koch’s bacillus);
urethritis (inflammatory process in the urethra);
renal dystrophy (pathology with the formation of fat inside the kidney structures);
urolithiasis (sand and stones, i.e. stones, form in the urinary system);
Diabetes mellitus is characterized by a lack of insulin and affects many body systems, including the urinary system.

The inflammatory process in the bladder is called “cystitis”.

Important! The acute form of the disease is characterized by a sharp deterioration in the quality of life: the patient experiences a frequent urge to urinate, which becomes painful, and relief occurs only for a very short time.

In the chronic form of the disease, ultrasound makes it possible to see thickening of the walls of the bladder, as well as sediment at the bottom of the organ. In details .

Cancer

Is cancer visible on ultrasound? If the attending physician suspects the development of an oncological process, he will recommend undergoing a transabdominal ultrasound examination, as it is the most comfortable and meaningful. It is this that will make it possible not only to determine the presence of a tumor, but also to assess the extent of its spread, as well as its size and structural features.

Ultrasound allows you to assess:

bladder capacity;
clarity of its contours;
wall infiltration;
the growth of a neoplasm outside the organ;
type of tumor growth and shape;
regional metastasis;
the condition of nearby lymph nodes.

Enlarged lymph nodes do not always mean they have metastasized– it can be the result of a variety of processes: from a banal scratch to inflammation in the adjacent areas.

An ultrasound can see and evaluate the condition of the upper urinary tract, specifying the presence of enlargement of the ureter and kidneys. The fact is that the cavity system of the ureter and kidneys can expand due to oncological damage to the mouth of the ureter, or damage to the urinary tract. However, the main indicator here will be determining the stage of the disease, and the listed characteristics will be determined a second time.

Reference! For tumor sizes greater than 5 mm, the ultrasound diagnostic method is highly accurate. However, with very small tumor sizes or a flat formation, there is a possibility of false negative results.

If doubts remain after the study, it is better to supplement the diagnosis with intracavitary ultrasound techniques (for example, transvaginal or transrectal).

Polyp

The term “polyp” in medicine refers to a benign formation that protrudes into the cavity of an organ. It can be located either on a wide base or on a small and thin leg.

If the polyp is located in the bladder cavity, then it is important to evaluate its shape, size and exact location.

Neurogenic dysfunction

In case of neurogenic disorders of the bladder, the doctor will not see any specific picture on the screen of the ultrasound machine. The changes will be similar to the signs observed with bladder outlet obstruction, that is, the following will be found:

change in the shape of the organ, its asymmetry;
trabecularity and wall thickening;
diverticula;
stones and sediment in the bladder cavity.

A sac-like protrusion in the wall of the bladder is medically called a “diverticulum” (see image on the right).

It communicates with the main cavity using a neck - a special channel.

For this pathology, an echographic scan of the organ is mandatory.

It will help assess the location, size and shape of the diverticulum, the length of its neck and relationship to adjacent tissues and organs.

If a diverticulum is identified, urodynamic studies (cystometry or uroflowmetry) are required to assess bladder outlet obstruction.

Blood clots

Echographically, blood clots can be identified as formations with increased echogenicity of an irregular shape. Rarely have a round or semicircular shape. They are also characterized by heterogeneous echogenicity and uneven edges; they may have hypoechoic inclusions, shaped like foci or layered stripes (this is caused by the layering of the clot).

Only in the presence of a persistent sediment formed from particles of blood and epithelium can relative echogenic homogeneity of the clot be observed.

Important! If the patient changes his body position during the examination, and the formation in the bladder moves with him, then this indicates the presence of a clot. But if the clot remains near the wall of the organ, then it is very difficult to differentiate it from a tumor.

Stones in the cavity

Concretions (the second name for stones) in the bladder are no different from similar formations in the kidneys or gallstones. All of them are high-density structures that do not conduct echo rays. That is why on the device’s screen they are visualized as white formations with dark acoustic shadow tracks behind them.

A distinctive feature of stones is mobility. Unlike tumors, they are not attached to the walls of the organ, so they easily change their position when the patient moves. This sign is the basis for reliable separation of the stone from the tumor during diagnosis.(the latter will not change its position, since it is fixed in the tissue of the organ).

What else can you see?

Ultrasound examination of the bladder can detect the following phenomena.