Synonyms
Medical: Vesica urinaria ultrasound examination, bladder, urinary cystitis, cystitis
Introduction
An ultrasound probe with 3.5-5 MHz is used for ultrasound examination of the bladder. The thickness of the bladder wall should not exceed 6-8 mm during the ultrasound examination. The length, width and thickness of the bladder are determined in ultrasound. Below is a list of diseases of the urinary bladder.
Procedure of the ultrasound of the urinary bladder
To enable a good assessment of the bladder, it is important that the bladder is silenced when it is full. The os pubis, over which the filled bladder extends, serves as a bony orientation. Sometimes it is necessary to push the transducer backwards (towards the back) or downwards (towards the feet) so that the os pubis with its sound shadow does not cover the bladder.
Like every organ, the bladder is examined and evaluated in two planes. It can happen that intestinal loops overlap the bladder, making an examination more difficult. In such cases, the examiner has to push the transducer slowly but firmly into the lower abdomen to move the intestinal loops.
What can be seen in an ultrasound of the bladder?
The bladder can only be well silenced when it is full. When the bladder is empty, the roof of the bladder sinks in and the organ is covered by intestinal loops, so that no insight is possible. When the bladder is full, however, it presents itself as a round, echo-free structure, which can also serve as a sound window for structures located behind and under the bladder.
Occasionally, repetition and layer thickness artifacts can occur in the bladder. They should never be confused with pathological changes. The same transducer settings can also be used to detect the reproductive organs: In women, the vagina and uterus can be examined, in men the prostate and seminal vesicles.
The ultrasound can be used to calculate the maximum volume of the bladder or prostate. It is also possible to perform a residual urine test by measuring the maximum volume of the filled bladder, asking the patient to urinate and then continuing the examination. The bladder volume is then measured again.
An ultrasound examination can also detect bladder stones or a bladder tumour. It is also possible to see a benign enlargement of the prostate through the bladder by means of ultrasound. A bladder catheter can also be visualized by ultrasound.
In the context of a urinary tract infection (UTI) the bladder can also be involved. A urinary tract infection is usually caused by bacteria that enter the normally sterile bladder from outside, for example. Since the exit of the urethra is closer to the anus in women and the urethra is generally shorter, the urinary tract infection (UTI) (cystitis) occurs 10 times more frequently in women than in men.
Typical symptoms can be burning when urinating. In some cases, bacteria in the urine can be detected as a sign of a urinary tract infection (= urine culture or uricult for short) without the symptoms of an infection being present. In this case one speaks of an asymptomatic urinary tract infection.
If there is an infection in the bladder (urinary cystitis), the germs can also rise into the supplying ureter and spread to the renal pelvis (pelvis renalis) and the kidney. This is called inflammation of the renal pelvis (pyelonephritis). Inflammation of the renal pelvis is usually a dangerous disease, which can be accompanied by symptoms such as pain in the renal bed, i.e. on the flanks and back, and fever.
Untreated, an inflammation of the renal pelvis can develop into sepsis, which can have potentially life-threatening consequences. A urinary tract infection is detected by microscopic examination of the urine, with bacteria and white blood cells (leukocytes) providing an indication. A urine test strip can provide initial indications of the presence of bacteria in the urine.
A urinary tract infection is treated with an antibiotic such as trimethoprim and sulfamethoxazole (e.g. Cotrim ®), amoxillin or a so-called gyrase inhibitor such as ciprofloxacin (Ciprobay ®).The bacteria can be cultivated in a microbiological examination and the effectiveness against the various antibiotics can be tested. This process is called an antibiogram. The mucosa of the bladder can also degenerate, so that bladder cancer can develop.
In men, bladder cancer is the fourth most common tumor disease and occurs 3 times more frequently than in women. In most cases, the tumour is removed by means of so-called electroresection and then examined (histological examination). Sometimes surgical removal is sufficient, but in some cases the entire bladder must be removed.
This makes a bladder replacement necessary. For this purpose, the draining urinary tract can be connected to the small intestine or, similar to the artificial intestinal outlet, can be led to the surface via the skin. Chemotherapy is usually only necessary when metastases have developed.
From the vicinity of the pubic bone (Os pubis), a slight vulnerability of the urinary bladder develops in the case of a pelvic fracture. The bladder wall may tear and urine may leak into the surrounding connective tissue; serious inflammation may result, which can spread to the entire abdominal cavity (peritonitis). An injury can be diagnosed using ultrasound.
If the urinary bladder has to be emptied continuously against resistance, such as when the prostate gland is enlarged (prostate hypertrophy), the muscles increase in mass. A so-called “barred bladder” forms, which is clearly visible on X-rays with contrast medium. If the bladder had to be removed due to one of the above-mentioned diseases or for any other reason, there are various possibilities to restore the urinary diversion.
On the one hand, a connection to the abdominal wall can be created at various points in the system, which continuously drains urine into a bag attached to it. (stoma). On the other hand, a replacement bladder (pouch) can be formed from different sections of the intestine and connected to either the urinary or the digestive system, which causes renewed continence.
Another common problem with regard to the urinary bladder is bladder weakness (incontinence), which manifests itself through uncontrolled leakage of urine. Older women are particularly affected by this. Depending on the situation in which the bladder weakness occurs, a distinction is made between stress incontinence, where the stress can be coughing for example, and urge incontinence with frequent attacks of the urge to urinate. For bladder weakness there are physiotherapeutic approaches such as pelvic floor exercises, as well as medicinal or, as a last alternative, surgical treatment methods.
