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Ultrasonography has demonstrated to be a precise test with high sensitivity and specificity. The urologist is the most capable professional to obtain the maximum effectiveness of this technique, so that theavailability of ultrasound machines in urology departments rationalizes and limits the demand of ultrasound tests, diminishes significantly the indication of radiological tests and the number of cystoscopies, being an indispensable element in high-resolution office consultations.We report the statistics of the use of ultrasound in our department, with the disappearance of the demand of ultrasound tests from the urology outpatient clinic to the radiology department. The use rate is high, reflecting the functional criteria for use of the ultrasound equipment. In the economic analysis we found there is an almostcomplete absence of controlled clinical trials comparing the cost effectiveness of imaging tests in urology. There are not cost studies comparing ultrasounds performed by the urologist with those performed by radiologists.
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OBJECTIVES: To perform an update on the usefulness of ultrasound in the study of small size renal tumors and its current possibilities.METHODS: We review the results of ultrasound in this pathology with the addition of the most recent technologicaladvances such as a harmonic digital converters and power color Doppler. We analyze its contribution to the differential diagnosis of the cystic pathology, to the definition of solid masses, to the detection and characterizationof small size masses, and to the definition of the vascular patterns of various tumors.RESULTS: Ultrasonography offers a diagnostic safety of 98% in cystic masses, being able to detect them from 0.5 cm diameter in favourable conditions. The differentialdiagnosis of multiloculated masses, multivesicular hydatidcyst, multiloculated cystic nephroma, and multiloculated cystic carcinoma still poses great difficulty, the same way it happens with other radiological tests. For solid masses,the greater image resolution has lead to a progressive increase in the incidental detection of tumors and the percentage of patients candidates to conservative surgerydue to the decrease in size. It is easy to differentiate between adenocarcinoma and angiomyolipoma, up to 85% of the cases, but the rest of the tumors do not have specific characteristics. For small size masses, smaller than 3 cm, ultrasound sensitivity is clearly inferior to CT scan. Power color Doppler helps to confirm the existence of solid masses and helps a better differential diagnosis with pseudo tumors.CONCLUSIONS: The modern ultrasound techniques provide a high cost-effectiveness both in detection and definition of the nature of small size renal masses.
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OBJECTIVES: The aim of the study is to analyze the usefulness of ultrasound and Doppler ultrasoundfor the evaluation of transplant donors and recipients, for renal transplant follow-up and for the resolution of surgical complications after renal transplant. METHODS: Abdominal ultrasound was performed in donors and recipients of renal grafts. In the recipients with vascular risk factors a doppler ultrasound of the iliac and lower limb arteries was systematically done. Doppler ultrasound was performed in the first and seventh day after renal transplant, as well as for graft dysfunction at any moment.RESULTS: Recipient ultrasound informs about the existenceof acquired renal cystic disease and Doppler ultrasound allows evaluating the vascular state of high risk recipients. In the immediate post-transplant period ultrasound studies are useful for detection of vascular complications, graft obstruction and to control the evolution of acute rejection and acute tubular necrosis. Finally, ultrasound is the technique of choice in the endourological management of surgical complications after renal transplant.CONCLUSION: Ultrasound under urologic control isessential in the evaluation of the kidney transplant recipient,post-transplant follow-up and in the resolution of surgical complications.
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OBJECTIVES: the aim of the study is to analyze the utility of ultrasound in the evaluation and treatment selection of patients with benign prostatichyperplasia (BPH).METHODS: a total of 5000 patients older than 50 years and with prostatic symptoms were evaluated with abdominal ultrasound and in selected cases with transrectalultrasound.RESULTS: the first ultrasonographic sign of BPH is the increase of anteroposterior and longitudinal diameters. Prostatic volume is measured with a safety of 80%, postvoid volume and indirect signs of bladder obstruction are also determined by ultrasound. Upper urinary tract pathological conditions can be also detected.CONCLUSIONS: ultrasound associated with PSA and urinary flow are adequate to evaluate and select treatmentin patients with BPH.
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- We describe the ultrasonographic changes prostate cancer can produce, and analyze the usefulness of ultrasonography in the study of this disease. Transrectal ultrasound does not have enough sensitivity and specificity for the diagnosis, metastasic study, and diagnosis of recurrences after radical prostatectomy.Nevertheless the ultrasound study of the morphology of the prostatic apex may be useful for the planning and performance of the apex dissection during radicalprostatectomy.
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OBJECTIVES: To present the examination technique of grayscale tridimensional transrectalprostatic ultrasound and its clinical viability. To define the ultrasonographic patterns and to report the clinical experience of our group.METHODS: We analyze selected exams from a databaseof more than 600 digitally stored tridimensional transrectalprostatic ultrasounds performed with a robotic probe. We collect the opinion and observations of the examiners,all of them experts on prostatic ultrasound. Each case has been completed with pathologic and clinical data.RESULTS: The time spent for each test was less than three minutes, achieving good quality, reproducible exams. The analysis of the front view offers the greatestcontribution in comparison to the conventional technique,allowing a more clear detection of structures such as the junction with the seminal vesicles, the capsular contour, and urethra.CONCLUSIONS: Tridimensional transrectal prostatic ultrasound is an imaging test applicable in the clinical practice which offers quality images and may provide great benefits for the diagnosis and local staging of prostatecancer, by means of the analysis of the front view.
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To analyze the various techniques of transrectal ultrasound guided biopsy of the prostate described in the literature, as well as the anesthesia modalities for its performance.The diagnostic yield of the classic sextant biopsy, described 16 years ago and considered the standard technique ever since, has been overcome by the extended biopsy techniques (greater number of cores from more prostatic areas in each biopsy). Although their intra-study yield is better than sextant biopsy, the scarce randomized studies have not demonstrated a statistically significant improvement. These new techniques of extended biopsy significantly increase the rate of minor complications, not the major. It has not been demonstrated an increase in either the perception of pain or the diagnosis of non-significant tumors.Any anesthetic technique employed diminishes significantly the perception of pain by the patient. The periprostatic nerve blockage with infiltration of lidocaine is better than the rest of the techniques. The best technique of infiltration and the most effective lidocaine dose are to be defined yet. These techniques do not increase complications and only prolong the procedure briefly.
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OBJECTIVES: Although transrectal ultrasound-guided(TRUS) prostatic biopsy is the procedure ofchoice for the diagnosis of prostate cancer (PC), neitherthe ideal number of cores nor the number of repeatedbiopsies, nor the required diagnostic yield have beenestablished. After our experience of ten years with TRUSbiopsy we perform a review of the technique and itsindications.METHODS: PSA, ultrasound features, and pathologicdata of 6000 patients undergoing modified sextantTRUS biopsy between 1994 to December 2002 werecollected. 222 patients undergoing ten-core TRUSbiopsy were included in an experimental group to studythe role of the extended biopsy. The contribution of theextra cores to the diagnostic yield in the experimentalgroup was studied to determine the effectiveness of theextended biopsy, using as a control group 552 patientsundergoing sextant TRUS biopsy during 2002. Bothgroups were comparable for the study variables at thestart of the study.RESULTS: The incidence of PC in the first biopsy in thegroup of 6000 patients was 39.1% (2345/6000).Patients with PSA between 4 and 10 ng/ml have anincidence of PC greater than 50% among prostatessmaller than 20 cc, diminishing down to 8.9% in thosegreater than 50 cc. The percentage of PC amongpatients with negative digital rectal examination (DRE),normal TRUS, and PSA below 4 ng/ml was 16.7%.The diagnostic yield for PSA density lower than 0.11ng/ml/cc was lower than 8%. The free/total PSA ratioshows a 13.7% incidence of PC with values higher than0.24. Multivariate logistic regression analysis showedthat the only non-significant parameter was free/totalPSA. Sixty (27.15%) patients of the extended TRUSbiopsy group had PC. Only 2.25% of the 221 patientsbenefited from the augmented number of biopsies. Therewere no significant differences in the figures of prostatecancer between groups. Only PSA and volume wheresignificant in the multivariate logistic regression analysis;number of samples, PSA density and age lacked ofinfluence in the detection of PC.CONCLUSIONS: The sextant biopsy model obtainingcores from the lateral horns of the prostate continuesto be the reference for TRUS biopsy, and the extendedbiopsy is not applicable to all patients from the beginningdo to the small increase in the diagnostic yield. IsolatedPSA may not be the unique reference to indicate TRUSbiopsy, being volume, in our experience, a definitivefactor for the adjustment of high risk levels.
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Transrectal biopsy is one of the mostfrequent procedures in urological practice. Generally, transrectal biopsies have been practiced without anesthesia, because of a supposed good tolerance. Nevertheless, it is not infrequent to find patients with a high level of pain and adverse effects attributable to such procedure.OBJECTIVES: In the present article the effect of transrectal local anesthesia in order to significantly diminish theperception of pain by the patient is evaluated. METHODS: A total of 131 consecutive patients undergoing transrectal prostate biopsy are included in the study. After randomization, 76 patients were biopsiated with anesthesia and 55 represent the control group. Cases and control groups do not differ in age or prostate volume. Anesthesia consisted on a periprostatic nerve blockage with injection of 5 cc of 1% mepivacaine solution in the angle between prostate and seminal vesicles bilaterally. A visual analogical scale for pain was used; it was given to the patient at the end of the procedure.RESULTS: Mean pain value was 2.41 with a median of 2.0 in the group with anesthesia, and 4.02 with a median of 4 in the control group. A Student´s t testcomparing the means showed a statistically significant difference of 1.61 (p<0.0001). Pain in the scale was 66% greater in the control group.CONCLUSION: The use of anesthesia in the performance of transrectal biopsies significantly diminishes theperception of pain by patients. This effect, along with the tendency to increase the number of biopsies, will result in short time in a more generalized use of local anesthesia.
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OBJECTIVES: Transrectal ultrasound is the method that gives a direct image of the prostate, its limits, structural and morphologic anomalies, and anatomical relations. Therefore, prostate volume is easily determined, being the first step for the application of certain therapeutic procedures.Prostatic cryotherapy and brachytherapy have been developed over the last years as minimally invasive options for the treatment of prostate cancer. Transrectal ultrasound of the prostate has allowed the application of these technologies in the daily practice, guaranteeing high efficacy and safety indexes. Cryosurgery is the controlled freezing of tissues. Prostatic transrectal ultrasound is the only method able to show the real-time evolution of prostatic cryoablation, allowing the urologist to control the evolution of the ice ball and to reach the targeted anatomical structures guaranteeing the oncological objectives, and diminishing complications and sequels.Brachytherapy, as a local intraprostatic radiotherapy, needs exact volume and dose calculations before the implant of the radioactive source within the gland. With transrectal ultrasound of the prostate, ultrasound-tomographic cuts are made for prostatic volume calculation and planimetry. Once dosimetry is completed, real-time transrectal ultrasound control is necessary to perform the implant of the needles loaded with the seeds.Today, prostate cryotherapy and brachytherapy would be inconceivable without transrectal ultrasound.
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OBJECTIVES: The value of ultrasonography for the study of female urinary incontinence has been redefined over the last years. METHODS: We review the literature about the value of ultrasound in the workup of females with urinary incontinence, mainly transperineal ultrasound for the female stress urinary incontinence (SUI). RESULTS: Many papers have been published over the last few years. Upper urinary tract ultrasound has not a place in the workup of genuine female SUI. Transperineal ultrasound allows to evaluate the mobility of the bladder neck and urethra, the thickness of the bladder wall, the funnel shape of the bladder neck, the presence of SUI or pelvic organ prolapse (POP), to visualize mesh implants, to help with biofeedback, and to evaluate changes after surgical treatment. CONCLUSIONS: Ultrasounds in general, and transperineal or translabial ultrasound in particular, are in the process of becoming the standard diagnostic method in urogynecology. Their wide availability, the standardization of parameters, the possibility of evaluating not only the bladder but also the levator ani muscle or pelvic organ prolapses (POP) contribute to this fact. It allows to obtain data in a non invasive way before and after therapy.
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OBJECTIVES: To review the contribution of ultrasound to the differential diagnosis of scrotal pathology, both testicular and adnexal.METHODS: We performed a bibliographic review on the topic, adding the experience of our Unit over the years; we classified the pathology in testicular and extratesticular, separating liquid and solid lesions, and a miscellaneous group of unclassifiable cases.RESULTS: Currently, ultrasonography with high frequency equipment allows not only to differentiate between intra and extratesticular lesions, but also to identify specific lesions, the manage of which may include follow-up without need of unavoidable surgery.CONCLUSIONS: Ultrasonography is a painless simple test that may be repeated without inconvenience so that it is the first test to be indicated for any problem of the scrotal content.
