Ultrasonographic assessment of male anterior urethra. Description of the technique of examination and presentation of major pathologies.

During the last years the role of sonourethrography (SUG) in the assessment of anterior male urethra pathologies, has significantly increased. The investigation is easily performed, not time consuming and should be considered the imaging technique of choice for preliminary diagnosis, without exposing the patient to X-rays. In this paper we present the technique of examination and the most common pathologies in which SUG is indicated.

Ultrasound in the assessment of pelvic organ prolapse.

Imaging is increasingly being used in urogynaecology. Because of low cost and universal availability, ultrasound (US) is the most commonly used diagnostic modality, which allows the observation of manoeuvres such as Valsalva and pelvic floor muscle contraction in real time. The ability to see beyond surface anatomy is particularly important in the posterior compartment and in obstructed defecation where this method may replace defecation proctography. Imaging is especially useful in the form of 3D/4D multiplanar and tomographic translabial US, as these modalities give access to the axial plane and the levator ani. This allows assessment of both avulsion, i.e. major maternal birth trauma, and hiatal overdistension, i.e. ballooning. Both are major risk factors for both prolapse and prolapse recurrence. This review will outline current clinical utility, introduce recent research in the respective field and provide an overview of likely future utility of imaging in the investigation of pelvic organ prolapse.

[Ultrasonographic assessment of urethral condyloma acuminatum in men].

OBJECTIVE: To evaluate the value of ultrasonography in diagnosing urethral condyloma acuminatum (CA) in men. METHODS: Twenty-two male patients, aged 36 +/- 19, diagnosed as with urethral CA based on history and clinical symptoms underwent ultrasonography and urethroscopy. The patients were asked to micturate to distend the urethra. The posterior urethra was detected by transrectum approach. Transperineal scans were performed to image the bulbar urethra, scrotal urethra and penile urethra. The sonographically positive results were compared with the pathological results. RESULTS: Eighty-three vegetations were found in the anterior urethra of seventeen patients, and eighty-one vegetations were diagnosed as CA by pathology, of which 1.2% were polyp shape, 38.3% papillary shape, and 60.5% cauliflower mass. Sonourethrography was an accurate predictor of papillary shape and cauliflower mass; however, it was difficult to differentiate between polyp shape vegetation and crystal. CONCLUSION: Sonourethrography is a sensitive and accurate tool not only for primary diagnosis of but also for follow-up of urethral CA in men.

[Contrast-enhanced sonourethrography versus conventional miction cystourethrography in the assessment of the urethra: preliminary study]. / Uretrocistosonografía contrastada versus cistouretrografía miccional convencional para el estudio de la uretra: estudio preliminar.

BACKGROUND AND AIMS: Voiding cystourethrography (VCUG) is the first choice imaging modality for assessing the urethra, but this technique exposes patients to ionizing radiation. Cystosonography with echocontrast (CS) has proved to be a reliable technique to detect and grade vesicoureteral reflux (VUR) without exposing patients to ionizing radiation, but its capacity to adequately study the urethra has yet to be demonstrate in large series of patients. The aim of this study is to demonstrate the reliability of contrast-enhanced CS for assessing the urethra by comparing the results with those of the VCUG. MATERIAL AND METHODS: 108 patients were studied with ultrasound (US) using a galactose-based contrast agent. This exam was always followed by VCUG. Basal and voiding urethral US studies were performed with. Patients were studied in supine decubitus position. Girls were examined by longitudinal translabial approach, with the probe (a 7.5 MHz liner array transducer) positioned longitudinally at the introitus, to evaluate the bladder neck and urethra. In boys the transducer was initially placed longitudinally in the escrotum at ventral root of the penis to assess the bladder neck and proximal bulbar urethra, and then displaced distally toward the penile urethra. On basal study the echogenic urethral mucosa and the collapsed sonolucent urethral lumen were indentified and measured when distended. The patients were asked to void with the probe in place. During voiding attention was focused on elasticity and distention of urethral walls, as well as in the caliber of the entire urethra. Patients unable to void during either CS or VCUG were excluded. RESULTS: The bladder neck and the entire urethra were well demonstrate with CS. All females and 43 males showed a normal urethra both in CS and VCUG. Four patients were dignoses of posterior urethral valves (PUV) with CS and confirmed at VCUG, one patient had anterior urethral valves and 5 showed urethral stenosis at both techniques. Three patients with a vesicosphincteric dysinergia, 14 with resected PUV and one with a resected syringocele were adequately evaluated. Twelve girls showed vaginal reflux. The information provided by CS was equivalent to the VCUG in all patients but two with a syringocele (only seen on VCUG). CONCLUSIONS: CS is a reliable imaging modality sufficiently sensitive and specific to study the urethra, adding dynamic information to VCUG and can be used as a complement to VCUG.

Transvaginal ultrasonography in the assessment of organic diseases of female urethra.

The current investigation aimed to check the effectiveness of transvaginal ultrasonography in the diagnosis of organic urethral diseases, comparing its results with those of conventional examinations (physical examination, voiding cystourethrography, pelvic ultrasonography, cystourethroscopy). Transvaginal ultrasonography was performed in 560 female patients with recurrent cystitis, dysuria, or palpable masses and diagnosed the following urethral diseases: 25 diverticula, seven stenoses, three carcinomas, two leiomyomas of periurethral tissue, and one incomplete duplex urethra. In our study transvaginal ultrasonography proved to be the most reliable diagnostic tool among imaging methods used.

Ultrasonographic assessment of bladder neck mobility in continent bitches and bitches with urinary incontinence attributable to urethral sphincter mechanism incompetence.

OBJECTIVE: To determine bladder neck positional changes between standing and recumbent positions in bitches and whether change is related to continence status or general anesthesia, or both, and to evaluate reproducibility of measurements. ANIMALS: 45 continent animals and 46 incontinent bitches with urethral sphincter mechanism incompetence (SMI). PROCEDURE: Distance between the bladder neck and perineal skin was measured ultrasonographically via the perineum while each dog was conscious in standing and right lateral recumbency and in right lateral recumbency under general anesthesia. Measurements of the bladder neck position obtained in right lateral recumbency under anesthesia were compared with radiographic measurements of the same parameter. Reproducibility of the ultrasonographic measurements of the distance between bladder neck and perineum was assessed on 3 occasions for each position in 50 dogs. RESULTS: In all dogs, differences in bladder neck position between standing and recumbent conscious-associated positions were not significant. However, caudal bladder neck movement between standing conscious- and recumbent anesthesia-associated positions and between recumbent conscious- and anesthesia-associated positions was significant for all dogs. Incontinent bitches had greater degree of caudal bladder movement during anesthesia. Mean difference in bladder neck positions between recumbent conscious- and recumbent anesthesia-associated positions was 0.24 cm in continent, compared with 0.73 cm in incontinent, bitches. Radiographic measurements were significantly greater than ultrasonographic measurements. Differences between repeated measurements for standing position were not significant, but those for recumbent conscious- and recumbent anesthesia-associated positions were significant. CONCLUSIONS: Additional vesicourethral support mechanisms in continent dogs, are deficient in bitches with SMI, allowing the bladder neck to move further caudad.

[An evaluation of the diagnostic efficacy of video cystourethrosonography]. / Valoración de la eficacia diagnóstica de la vídeo cisto-uretro sonografía.

Evaluation of the diagnostic capacity of lineal ultrasound examination of a male's vesical neck and urethra, known as video cysto-urethro-sonography. The tests has been shown to have high diagnostic accuracy (93.6%), with 93.4% overall sensitivity and 94.4% specificity, in a selected group of men with suspicion disease in the cervico-prostate-urethral area (prevalence, 80.9%). The technique, nevertheless, is not exempt from limitations, including anal or ureteral meatus stenosis, as well as highly obstructive prostate adenoma (where maximal vesical repletion necessary to carry out the examination may decompensate the picture, and lead to retention), or the inhibition of the voiding urge referred by certain individuals when they have to urinate in uncomfortable circumstances.