The bladder is an organ made of smooth muscle. It stores urine until it’s released when you go to the bathroom. The most common reason for bladder ultrasound is to check bladder draining. The urine that remains in the bladder after urinating (“post void residual”) is measured. If urine remains, there can be a problem like:
Bladder ultrasound can also give information about:
From the outside, the top of the bladder is the top of the bladder and the bottom is the bottom of the bladder. Between them is the bladder body, and the bottom is the bladder neck. The bladder is composed of the wall and cavity. There is a triangular area at the bottom, with the tip facing forward and down, followed by the inner urethral opening, and the ureteral outlet at both sides of the corner, called the bladder triangular area, where there is a lack of submucosa, which is good tumor site.
Using the SIFULTRAS-5.43 Bladder can be scanned either by the Transabdominal method of wall detection. Or by the Transrectal detection. The bladder can also be scanned by the Transurethral method. The advantage is that a high frequency probe can be used, which is beneficial to the detection and staging of bladder cancer.
When checking for bladder tumors, a normal bladder sonoogram will show, When the bladder is filled, the urine in the bladder a non-echoic zone, the bladder wall a bright echo zone, the echo strong at the interface between the inner wall of the mucosa and the urine, and a flat and smooth thin light zone. The muscle layer under the mucosa is uniformly low when the echo filling is insufficient, the echo of the serosa is bright.
Pathologically and clinically speaking, the most common tumors in the urinary system are more common in males than females. The pathology of bladder tumors is divided into: epithelial cell tumors (about 98%) and non-epithelial cell tumors. Bladder cancer mostly occurs in people over 40 to 50 years old. Common clinical manifestations are painless gross hematuria and intermittent attacks.
In the late stage, it is often due to tumor necrosis and infection. If the tumor is located in the triangle of the bladder, it can cause hydronephrosis of the kidneys and ureters, and the patient may have back pain and discomfort.
Nonetheless, there are two kinds of bladder tumors, which are convex to the bladder cavity and infiltrating the bladder wall. Well-differentiated tumors are mainly manifested by uneven mass lumps echoing into the bladder cavity, connected to the wall, with continuous bladder wall echoes and clear muscle layer echoes. The masses have varying echo strengths, varying sizes, irregular shapes, irregular papillary or cauliflower-like edges.
When the pedicled tumor changes position or taps the bladder, the tumor will sway in the urine. The poorly differentiated tumor has a broad base, with a portion of the tumor protruding toward the bladder cavity wall irregularly thickened, the echoes are disordered, the normal structure is lost, and even protrudes out of the bladder.
What makes the diagnosis Differential is the blood clot in the bladder that can be moved when changing its position and is not connected to the bladder wall. there is no color blood flow display in the clot. In addition, the Glandular cystitis the nodular type is similar to the bladder tumor sonogram, but the former is limited to the mucosal layer, the base is wider, the surface is smooth and completer, and the internal echo in uniform. Color Doppler examination does not show blood flow. The diagnosis depends on histological biopsy.
On the other hand when checking the bladder for stones, it is imperative to not that Primary bladder stones are mostly related to malnutrition, lack of animal protein diet, and form in the bladder. Secondary bladder stones are mostly caused by lower urinary tact obstruction and kidney stones falling to the bladder. The most common causes are benign prostatic hyperplasia, bladder foreign body, bladder diverticulum, and neurogenic bladder, so that the kidney stones that can be smoothly discharged are retained and enlarged in the bladder.
The clinical manifestations are mainly the stimulation of stones to the bladder and the obstruction of the urethra caused by stones. The main symptoms are dysuria, interruption of urinary flow, hematuria, frequent urination, urgency, and difficulty in postural urination. The disease is more common in the elderly and children.
On ultrasound, bladder stones are seen as massive strong echo in the bladder cavity, which can indicate single or multiple stones, and is more common in the shape of an ellipse. Acoustic shadows are accompanied by massive echoes also, such as small stones and loose sound shadows. Further, the strong echo group moves with the body position and is located in the low position. Furthermore, suture stones do not move with body position and have a history of bladder surgery.
It is mainly distinguished from calcified foci of bladder tumors. In addition to strong echoes, tumors still have soft tissue echoes, and do not separate from the bladder wall with body position, and blood supply within the tumor can be seen. Differentiated from the foreign body in the bladder, the foreign body usually has its own unique shape. For example, the urinary catheter can show an elongated
Moreover, sonography of the bladder provides qualitative and quantitative information regarding cystits. The latter is a common disease of the urinary system, which is divided into acute and chronic. Prostate hyperplasia, bladder stones, foreign bodies, tumors, damaged bladder wall and prolonged retention of urine can cause bladder infection. Due to the short, thick and straight anatomy of women’s urethra, women are more prone to cyctitis than men. In acute cycstitis, the mucosa and submucosa are congested and edema, and the cells infiltrate and ooze out.
Chronic cystitis can be caused by the prolongation of acute cystits, but also has its specificity. For example, the pahtogenic bacteria are mainly Escherichia coli. The main clinical manifestations of the disease are bladder irritation symtoms, such as frequent, urination, urgency, dysuria, hematuria, and pyuria. In addition, there may be corresponding manifestations of the primary disease.
On ultrasound acute cystitis and chronic cystitis are projected differently. First acute cystitis diffuse thickening of the bladder wall, mainly manifested in the mucosal layer, the surface is rough, so that the interface reflection should be clear and unclear. In the bladder cavity, the urine is poor in sound transmission, and can have fine dot-like low-level echoes, sometimes seen in thebladder. See low-level echo deposits at low levels. Rotating position can be moved or spread out, gas cyctitis is rare. In acute cyctitis, the patient’s tolerable bladder capacity is significantly reduced.
Secondly, chronis cystitis where there is no obvious change in the early sonogram, and the lesion takes a long time. Due to the extensive fiber hyperplasia, the thickening of the bladder wall is obvious, and the bladder mucosa layer is rougher. Urine can be turbid, with poor sound transmission and spotted flocculent hyperechoic floating objects, which can be deposited when at rest, and can be dispersed when rotated.
When combined with lower urinary tract obstruction, trabecular trabecula can be formed, and it can be seen that the regularly arranged multiple columnar protrusions extend into the bladder and are regarded as bladder trabeculae. In the thickened bladder wall, the small chamber appears as an echoless area embedded in the bladder wall. The shape is irregular and frequent. It merges with the trabecula. Sometimes the small chamber is embedded in the bladder wall with a small opening. Which is a diverticulum.
Last but not least, ultrasound is also used for glandular cystitis examination. Glandular cystitis, also known as custic cystitis, is a non-specific proliferative inflammation. Occurs in middle age, women are more common than men, the cayuse of the disease is related to bladder infection, lower urinary tract obstruction and bladder stones.
Although the lesion is mainly in the bladder triangle, but it may affect other parts. The lesion mainly occurs in the bladder mucosa and has no effect on the muscular layer and serous layer of the bladder wall. However, large lesions with broad base, flat surface and rough surface, uneven internal echo, scattered in multiple low or no echo focus. On the other hand smaller lesions, nodular or paillary, protrude into the bladder cavity, with clear boundaries, smooth surface, uniform internal echo, and complete bladder wall. Combining stones, diverticulum and lower urinary tract obstruction is helpful for diagnosis.
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