Norm of Urinary Bladder Ultrasonography (Urinary Bladder Echogram, Urinary Bladder Ultrasonogram)
Negative for tumor, cyst, overdistention, or residual urine. Proper size, shape, and position of the urinary bladder.
Usage of Urinary Bladder Ultrasonography (Urinary Bladder Echogram, Urinary Bladder Ultrasonogram)
Assessment for residual urine in bladder or for volume or overdistention of bladder; search for radiolucent stones; evaluation of large diverticulae; confirmation of suspicious filling defects seen on other imaging studies; guidance for suprapubic placement of needles and catheter in the bladder; detection of inguinal bladder hernia; evaluation of the size, shape, and position of the urinary bladder; helps diagnose, localize, monitor, and stage bladder tumors and evaluate hemorrhagic cystitis after bone marrow transplantation as well as detect urinary bladder involvement in Crohn's disease; differentiation of superficial from deep infiltrative bladder tumors (transurethral ultrasonography); and measurement of urinary bladder volumes (transrectal ultrasonography or transvaginal ultrasonography).
Description of Urinary Bladder Ultrasonography (Urinary Bladder Echogram, Urinary Bladder Ultrasonogram)
Evaluation of the urinary bladder size, shape, and position by the creation of an oscilloscopic picture from the echoes of high-frequency sound waves passing over the bladder area (acoustic imaging) by the transabdominal or transurethral route. The time required for the ultrasonic beam to be reflected back to the transducer from differing densities of tissue is converted by a computer to an electrical impulse displayed on an oscilloscopic screen to create a three-dimensional picture of the urinary bladder. Additionally, transvaginal or transrectal endosonography can provide an advantage in evaluating the neck of the bladder, the bladder base, and the urethra in females. Because ultrasonography cannot confirm diagnosis of lesions found, when these lesions are found they should be followed by urinary bladder biopsy via cystoscopy.
Professional Considerations of Urinary Bladder Ultrasonography (Urinary Bladder Echogram, Urinary Bladder Ultrasonogram)
Consent form NOT required for transabdominal method. Consent form IS required for transrectal, transurethral, and transvaginal methods.
Transabdominal procedure: none.
Transvaginal procedure: vaginal infection.
Transabdominal procedure: none.
Transvaginal procedure: third-trimester pregnancy.
- The client should disrobe below the waist or wear a gown.
- Obtain ultrasonic gel or paste.
- For transrectal ultrasonography, an enema may be prescribed.
- See Client and Family Teaching . Note: Verify with the physician whether pre-procedure water should be ingested. Some research shows that middle urethral stones are more reliably identified when the ultrasound is done before the client ingests water.
- Transabdominal ultrasonography:
- a. The client is positioned supine.
- b. Ultrasonic gel or paste is applied to the skin overlying the bladder.
- c. A lubricated transducer is placed firmly against the skin over the bladder area and moved slowly back and forth at intervals 1–2 cm apart. The oscilloscope displays a three-dimensional image of the full bladder.
- d. The client is instructed to void, and the procedure is repeated to check for the presence of residual urine.
- e. Photographs are taken of the oscilloscopic display.
- f. The procedure takes less than 30 minutes.
- Transvaginal ultrasonography:
- a. After uroflowmetry studies are completed, 0.9% saline solution is instilled through a urethral catheter to fill the bladder.
- b. A transducer probe is inserted into an ultrasonic gel–filled condom. The condom is covered with a sterile lubricant.
- c. The probe is inserted into the vagina by the client or the examiner and moved to touch the vesicourethral area.
- d. The bladder and urethra are identified by sonography. Pictures are taken of the oscilloscopic display, with the client at rest, or during micturition.
- Transrectal ultrasonography:
- a. The client is positioned supine, and short transabdominal ultrasonography is performed to evaluate for kidney distention.
- b. The rectum is examined digitally for obstruction.
- c. The client is assisted to a knee-elbow, lateral decubitus, or sitting position.
- d. The probe is covered with an air-free, sterile, transparent cover or condom. The condom is then coated with a sterile lubricant, and the probe is slowly inserted into the rectum.
- e. After the probe is inserted into the rectum, the condom is inflated with 20–60 mL of deaerated water.
- f. The probe is angled anteriorly, and ultrasonography of the bladder is performed.
- g. Photographs of the oscilloscopic display are taken.
- Transurethral ultrasonography:
- a. The bladder is filled with sterile 0.9% saline solution.
- b. The probe is covered with an air-free, sterile, transparent cover and inserted into the bladder through a cystoscope.
- c. The probe is rotated within the bladder as transverse sectional scans are taken.
- d. Oscilloscopic images may be recorded on videotape or photographs.
- Remove the gel from the skin.
- Sterilize the endosonography probes by soaking in glutaraldehyde solution for 10 minutes.
Client and Family Teaching
- This test should be performed before intestinal barium tests or else after the barium is cleared from the system.
- Drink three to four 8-ounce glasses of fluid within 2 hours before the test (where not contraindicated because the purpose of the test is to evaluate the bladder when full), and refrain from voiding.
- The transabdominal procedure is painless and carries no risks.
Factors That Affect Results
- Dehydration interferes with adequate contrast between organs and body fluids.
- Lower intestinal barium contrast medium obscures results by preventing proper transmission and deflection of the high-frequency sound waves.
- The more lower abdominal fat present, the greater is the attenuation (reduction in sound-wave amplitude and intensity), which interferes with the clarity of the transabdominal picture.
- Computed tomography is preferred to ultrasonography for staging and measuring urinary bladder tumors.