The standards of an ultrasound examination of the prostate gland. Part 2.

The paper discusses the rules of the proper performing of the ultrasound examination of the prostate gland. It has been divided into two parts: the general part and the detailed part. The first part presents the necessary requirements related to the ultrasound equipment needed for performing transabdominal and transrectal examinations of the prostate gland. The second part presents the application of the ultrasound examination in benign prostatic hyperplasia, in cases of prostate inflammation and in prostate cancer. Ultrasound examinations applied in the diagnostics of benign prostatic hyperplasia accelerated the diagnosis, facilitated the qualification to surgery and the selection of the treatment method. The assessment of the size of the prostate gland performed using the endorectal ultrasound examination is helpful in making the choice between transurethral electroresection and adenomectomy. In prostate inflammation this examination should be performed with particular gentleness due to pain ailments. The indication for performing the examination in acute inflammation is the suspicion of prostate abscess. In chronic, exacerbating prostatitis it is possible to perform an intraprostatic antibiotic injection. In the recent years increased morbidity and detectability of prostate gland cancer is observed among men. In Poland it ranks second (13%) among diseases occurring in men. The indication for an endorectal examination is the necessity to assess the size of the prostate gland, its configuration, the echostructure in classical ultrasonography, the vascularization in an ultrasound examination performed with power doppler and, if possible, the differences in the gland tissue firmness (consistency) in elastography. The ultrasound examination is used for performing the mapping biopsy of the prostate gland - from routine, strictly defined locations, the targeted biopsy - from locations suspected of neoplastic proliferation and the staging biopsy - from the neurovascular bundles, the seminal vesicles, from the apex of the prostate and from the periprostatic tissue - this type of biopsy is supposed to help in determining local staging of the neoplastic disease. The ultrasound examination is also helpful during the treatment of the neoplasm performed using brachytherapy or using the method of ultrasonic ablation which is still in the phase of clinical trials.

The standards of an ultrasound examination of the prostate gland. Part 1.

The article discusses the principles of the proper performance of the ultrasound examination of the prostate gland. The paper has been divided into two parts: the general one and the detailed one. The first part presents the necessary requirements referring to the ultrasound apparatus for performing transabdominal examinations of the urinary bladder and the prostate gland as well as for transrectal examinations of the prostate gland. The paper also describes the techniques of performing both examinations together with the methods of measuring the capacity of the urinary bladder and the volume of the prostate gland. It also mentions the most frequent indications for performing the examinations as well as diagnostic algorithms applied in case of finding irregularities. The transabdominal ultrasonography is a part of the examination of the abdominal organs and it should be performed in patients complaining of dysuric symptoms. An addition to the examination, especially when the prostate gland is enlarged, should be the measurement of the capacity of the urinary bladder and the assessment of the amount of residual urine after voiding. The indications for the endosonographic examination of the prostate gland are patological changes found in the per rectum examination, elevated concentration of the prostate-specific antigen in the blood serum, cancer and inflammations of the prostate gland if an abscess is suspected, qualification for surgery in the course of benign prostatic hyperplasia and the diagnostics of disorders of ejaculation. A standard procedure performed in case of prostate cancer for the purpose of obtaining specimens for the histopathology examination is biopsy carried out with transrectal ultrasound imaging. The paper presents the indications and techniques of performing prostate biopsy, as well as the types of biopsies together with the necessary preparation and the protection against its side effects for the patient. The paper also lists the necessary elements of the description of the presented procedures. The second part of the paper presents the application of the ultrasound examination in benign prostatic hyperplasia, in cases of inflammation and in prostate cancer.

Standards for scrotal ultrasonography.

The paper presents a description of essential equipment requirements for scrotal ultrasonography, including current ultrasound techniques, as well as a review of the most common scrotal pathologies. Patient preparation for the examination as well as ultrasound methodology for the assessment of scrotal and inguinal canal structures are discussed. The standard for scrotal ultrasound examination includes a precise B-mode evaluation, including testicular volumetric assessment performed using automatic measurement options based on the formula of a rotating ellipsoid or three measurements perpendicular to one another. Also, criteria for morphological assessment of abnormalities within testicular or epididymal parenchyma, including a precise evaluation of lesion size, delineation, shape and vascular pattern obtained with Doppler US, have been proposed. Standard assessment further includes epididymal evaluation, including epididymal size in the case of enlargement. The paper additionally discusses the method of ultrasonographic examination and describes the most common pathologies occurring within scrotal structures, including a quantitative analysis of hydrocele and other abnormal fluid reservoirs. We have also presented criteria for the assessment of varicocele as well as color and spectral Doppler flows in scrotal pathologies. Furthermore, we have proposed key components of scrotal ultrasound documentation, so that the contained data could be used to establish appropriate diagnosis, allowing for both adequate clinical management and the reproducibility of subsequent US evaluations performed by either the same or a different examiner. The most common causes of diagnostic errors have also been discussed.

Standards of the Polish Ultrasound Society - update. Ultrasound examination of the kidneys, ureters and urinary bladder.

The paper presents the principles of performing proper ultrasound examinations of the urinary tract. The following are discussed: preparation of patients, type of optimal apparatus, technique of examination and conditions which its description should fulfill. Urinary track examination in adults and in children constitutes an integral part of each abdominal examination. Such examinations should be performed with fasting patients or several hours after the last meal, with filled urinary bladder. APPARATUS: Ultrasound examinations in children and infants are performed using transducers with the frequency of 5.0-9.0 MHz and in adults - with the frequency of 2.0-6.0 MHz. Doppler options are desirable since they improve diagnostic capacity of sonography in terms of differentiation between renal focal lesions. SCANNING TECHNIQUE: Renal examinations are performed with the patients in the supine position. The right kidney is examined in the right hypochondriac region using the liver as the ultrasound "window." The left kidney is examined in the left hypochondriac region, preferably in the posterior axillary line. Ultrasound examinations of the upper segment of the ureters are performed after renal examination when the pelvicalyceal system is dilated. A condition necessary for a proper examination of the perivesical portion of the ureter is full urinary bladder. The scans of the urinary bladder are performed in transverse, longitudinal and oblique planes when the bladder is filled. DESCRIPTION OF THE EXAMINATION: The description should include patient's personal details, details of the referring unit, of the unit in which the examination is performed, examining physician's details, type of ultrasound apparatus and transducers as well as the description proper.

Errors in the ultrasound diagnosis of the kidneys, ureters and urinary bladder.

The article presents the most frequent errors made in the ultrasound diagnosis of the urinary system. They usually result from improper technique of ultrasound examination or its erroneous interpretation. Such errors are frequent effects of insufficient experience of the ultrasonographer, inadequate class of the scanner, insufficient knowledge of its operation as well as of wrong preparation of patients, their constitution, severe condition and the lack of cooperation during the examination. The reasons for misinterpretations of ultrasound images of the urinary system may lie in a large polymorphism of the kidney (defects and developmental variants) and may result from improper access to the organ as well as from the presence of artefacts. Errors may also result from the lack of knowledge concerning clinical and laboratory data. Moreover, mistakes in ultrasound diagnosis of the urinary system are frequently related to the lack of knowledge of the management algorithms and diagnostic possibilities of other imaging modalities. The paper lists errors in ultrasound diagnosis of the urinary system divided into: errors resulting from improper technique of examination, artefacts caused by incorrect preparation of patients for the examination or their constitution and errors resulting from misinterpretation of ultrasound images of the kidneys (such as their number, size, fluid spaces, pathological lesions and others), ureters and urinary bladder. Each physician performing kidney or bladder ultrasound examination should possess the knowledge of the most frequent errors and their causes which might help to avoid them.