Prostate and bladder as a single system
With prostate adenoma, not only the prostate itself suffers - the patient’s main problems are related to the bladder. The enlarged gland creates an obstacle to the outflow of urine, the bladder is forced to work with overload, its wall hypertrophies, trabecularity and diverticula appear, and then decompensation occurs with the accumulation of residual urine. Therefore, it makes little sense to evaluate these organs separately.
Transrectal access provides a quality image of the prostate that is unattainable when viewed through the abdomen: the sensor is located a few millimeters from the gland. The volume of the gland and separately the volume of the middle lobe protruding into the lumen of the bladder are accurately measured, the structure of the zones is assessed, nodes, calcifications and signs of chronic prostatitis are identified. The accuracy of volume measurement is practically important: the choice between drug treatment and surgery, as well as the choice of surgical technique, depends on it.
Then the bladder is assessed: wall thickness, presence of trabecularity, diverticula and stones, condition of the ureteric orifices. The patient is asked to urinate, after which the volume of residual urine is measured - a key indicator reflecting the degree of outflow disturbance. It is the combination of prostate volume, bladder wall thickness and residual urine, and not one of these numbers, that determines treatment tactics.
Ultrasound capabilities
Ultrasound remains the first choice for imaging in almost every situation: it is accessible, safe, does not require radiation, and provides images in real time. It perfectly shows parenchymal organs, fluid formations, walls of hollow organs and soft tissues, and in Doppler mode, blood flow in the vessels.
A separate advantage is the possibility of dynamic tests: the doctor can ask you to strain, change your body position, fill or empty an organ and see how the picture changes. Neither computed tomography nor magnetic resonance imaging provide such an opportunity.
What influences the quality of research
The main enemy of ultrasound is gas: it completely reflects the wave. Therefore, distended intestines can make the pancreas, aorta, and retroperitoneal structures invisible. For the same reason, preparation for examining the abdominal cavity is not a formality, but a condition for a reliable result.
Severe obesity, postoperative scars, bandages and open wounds in the area of interest also have an effect. If the picture turns out to be uninformative, the doctor indicates this in the protocol and recommends an alternative method - computed tomography or magnetic resonance imaging.
Doppler mode
Dopplerography shows the movement of blood: color mapping reflects the direction of flow, spectral analysis measures velocities and resistance indices. This allows you to assess the patency of the vessel, identify stenosis, thrombus, aneurysm, pathological reflux and the nature of the blood supply to the formation.
Increased blood flow in Doppler mode is an important sign of active inflammation or tumor growth, which is why many organ studies are supplemented with Doppler as a mandatory part of the protocol.