bladder normal
scan plane
ultrasound scan plane longitudinal bladder
longitudinal ultrasound of a normal bladder.
scan plane transverse bladder.
transverse image of a normal, distended bladder.
the right and left ureteric jets are seen using colour doppler imaging indicating there is no obstruction of the ureters.
scan protocol
role of ultrasound
ultrasound is an important tool for assessing 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.
limitations
- extensive pelvic scarring or overlyiying bowel gas will make scanning the bladder difficult.
- if the bladder is not sufficiently distended, pathology may be hidden by the folds.
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 setup
use of a curvilinear probe (3-5mhz) with colour doppler.
common pathology
- trabeculation
- diverticulum
- calculus
- ureterocele
- adenocarcinoma
- transitional cell carcinoma
scanning technique
patient supine with suprapubic area exposed.
examine the bladder sagitally in the midline. now angle laterally & sweep the probe both left and right to check the lateral margins.
rotate 90 degrees into the axial(transverse) plane. sweep through from the superior dome to the bladder base. ensure the ultrasound beam is projected as close to perpendicular to the bladder wall as possible.
look for ureteric jets at the bladder base. this confirms bilateral renal function and ureteric patency. to do this, in transverse angle inferiorly using power doppler (or colour doppler with low prf & wall filter settings). you may need to be patient to wait for the ureteric jet depending on renal function and degree of hydration.
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.
- measure the volume.
note the shape of the prostate, whether it bulges into the bladder.
uterus and ovaries
be aware that gynaecological pathology may contribute to pelvic/urinary symptoms and may also require investigation
basic hardcopy imaging
a bladder series should include the following minimum images:
- longitudinal bladder: midline, right and left
- transverse bladder: dome, mid and base
- prostate long and transverse with volume.
- ureteric jets if possible
- bladder volume pre and post micturition.
document any pathology found in 2 planes, including measurements and any vascularity.