USG IN UROLOGY

*first used by Schlegel et al in diagnosing renal calculi .

*High frequency soundwaves generated by a transducer is transmitted

through the body tissues via a probe held against the skin

*Probe also contains a receiver to detect soundwaves reflected from tissues

*Acoustic electric conversion occurs.

*Sound waves encounter tissues of different density and sound waves are
either reflected or absorbed or transmitted through tissues at
different velocities

*The image is white or gray depending on the intensity of reflection

SPECIFICATION

• Mid range: 3.5—5mhz convex transducer

adult
• High frequency:>5mhz - great spatial
resolution, limited penetration,effective in
children & superficial structures
Advantages

1.Easy Availability
2.Cost effective
3.Lack of ionising radiation
4.Accurate anatomic&physiologic
information
5.No need for iv contrast
6.Blood flow can be detected
Disadvantages

1.Inferior resolution than excretory urogram

2.No functional information
3.Certain structures not visualised---non
dilated abdominal ureter,retroperitoneum
4.Operator dependent
Grey scale
*Variations in the amplitude of the echoes –
Various shades from black to white
*Cysts,dilated calyxes,ureter,distended bladder –
anechoic and distal acoustic enhancement.
*Solid tissues—lower intensity echoes
*Fat—highly echogenic

Hypoechoic—lesions of lower intensity than surrounding

Hyperechoic—lesions of higher intensity
Isoechoic--similar
Renal USG-Normal appearence
*Approach –Right kidney - laterally and anteriorly
Left kidney - posteriorly
*Imaged in multiple sagittal and transverse plane
*Entire renal contour is evaluated
*Kidney is isoechoic or slightly hypoechoic
*Medulla is slightly hypoechoic than cortex
*Renal pelvis-highly echogeneic b’cos of
perinephric fat
Indication of usg
1.Presence or absence of kidney
2.Location –ectopic kidney
3.Calculus
4.Hydronephrosis
5.Renal cysts
6.Renal cystic disease
7.Renal solid masses
8.Nonfunctioning kidney on ivp
9.Renal failure 1.chronic
2.acute
10.Renal hypertension
11.Renal transplant
12.Post surgical complication
13.Localising calculus during lithotripsy&post
lithotripsy follow up
14.Post DJ stent follow up
15.Renal trauma
16.Urinoma or perinephric
abscess/haematoma
Renal calculus

* with advent of modern high resolution

machine even small calculus can be
identified
*hyperechoic with acoustic shadowing
*differentiation from pelvic fat and calculus
mostly in calyx or collection system
*follow up of patient with serial usg in
conservative management
Hydronephrosis

*Anechoic or hypoechoic fluid collection

*Often assumes shape of calyces and renal
pelvis(pelvicalictasis)
Renal cystic mass

*Easily diagnosed by usg

*usg guided -aspiration
-FNAC –to r/o malignancy
*multiple cortical cyst --- polycystic renal
disease
*diffuse renal cystic disorder can be
differentiated
Solid renal masses

*sensitive
*hypoechoic
*>2-2.5cm masses can be detected
Medical renal disease
*To differentiate CRF& ARF
CRF : -- kidneys are small, contracted, with
thinned out renal cortex
-- hyperechoic
-- loss of normal cortico medullary
differentiation
ARF : -- kidneys are enlarged thickened with
oedematous cortex
-- prominent and more hypoechoic
pyramids
Renal trauma

*injury of parenchyma with haematoma in

perinephric space &retroperitoneum seen
*management decision
Renal transplant
*for evaluating complications:
1. immediate post-operative complication like
--obstruction
--urinary leak
--perinephric collection of lymph, blood,pus (infection)
usg guided aspiration can be done
2. vascular complication like
--arterial &venous thrombosis can be diagnosed by colour doppler
3.Medical complications:
--acute tubular necrosis
--rejection
--drug toxicity.
Ureters
*upper and lower ureters can be visualised
especially when dilated
*mid ureter difficult to be visualised
*full bladder is necessary to visualise
--lower ureter&UVjunction
--calculus at UVjunction
*UV reflux
*mega ureter
*ureterocele
*extrinsic pelvic masses displacing or obstructing
the ureter
Urinary bladder
*abdominal and endoscopic probes used
*BOO –ivp has been completely replaced by
usg
*indications:
1.residual volume
2.diverticuli
3.bladder calculi
4.chronic interstitial cystitis with diminished
bladder capacity
5.bladder tumor & invasion into bladder wall
6.vesicoureteric reflux
7.ureterocele
8.post operative complications
9.neurogenic bladder
*bladder volume:0.7x length x width x depth
Prostate
*TRUS
*abdominal usg
*ca prostate – most are hypoechoic
--usg guided biopsy
4-6 quadrant biopsy
*Indications:1.prostatic ca
2.prostatitis
3.prostatic abscess
4.prostatic cyst
 TRUS
Transrectal ultrasonography(TRUS)
used to visualise the prostate and
to aid in guided needle biopsy.
Technique:
preparation:1.enema
2.antibiotics
position: left lateral,lithotomy,knee elbow
contraindications:1.acute painful perianaldisorder
2.haemorrhagic diathesis
3.aspirin(should be stopped 10 days
before procedure)
 Procedure
Local anaesthesia: two types of used namely
1.periprostatic:into region of prostatic
Vascular pedicle
2.intraprostatic:into the prostate
probe:
7mhz transducer within an endorectal probe
Images:
taken in both sagittal & axial planes
* Seminal vesicle: visualised first & it will
be anechoic
*base of prostate:
central zone—hyperechoic
peripheral zone—isoechoic
transition zone– hypoechoic
Junction of peripheral and transition zone
--hyperechoic
*verumontanum: “eiffel tower sign”
(anterior shadowing)
*capsule :hyperechoic,seen all around the gland
*prostatic venous plexues:hypoechoic rounded
Volume measurement:
Ellipsoid formula
volume = height x width x length x 0.52
INDICATION FOR TRUS
DIAGNOSTIC:
1.Early diagnosis of ca prostate
2.azoospermia evaluation
3.volume determination to plan for brachytherapy
THERAPEUTIC:
1.Brachytherapy for ca prostate
2.cryotherapy
3.deroofing or aspiration of ejaculatory duct ,
prostatic cyst or prostatic abscess
URETHRA

*small probe on penile shaft during

micturition
*by transrectal probe for evaluation of
stricture
Scrotum
*high resolution probe (7.5mhz-10mhz)
*Indications:
1.hydrocele
2.epididymo orchitis
3.testicular tumor
4.testicular torsion
5.epididymal cysts
6.spermatocele
7.varicocele
USG in infertility

*varicocele –colour doppler

*testis :presence,location,size,morphology
*vas deferens
*seminal vesicle
*ejaculatory duct
USG guided intervention
Biopsy:
renal
renal sol –fnac
prostate
transplant allograft
Aspiration:
renal cyst(only if symptomatic)
perinephric collection
prostatic abscess
post operative collection
scrotal cyst
urinoma
Nephrostomy
Lithotripsy