The use of ultrasound for urological imaging has steadily grown over the past decade. Where CT and MRI scans were once the mainstay for evaluating conditions of the kidneys, bladder, prostate and other pelvic structures, ultrasound is now increasingly recognized for its utility in visualizing the urinary tract with no ionizing radiation. As an expert sonographer with over 20 years of experience, I have witnessed the expanding role of ultrasound in urology firsthand at my private clinic Sonoworld in London. In this article, I will outline the key applications of ultrasound for urological imaging and discuss the benefits it offers patients in a private practice setting.
One of the most common reasons patients are referred for a renal ultrasound is to look for kidney stones. Ultrasound is an excellent imaging modality for detecting stones in the kidney or ureters as it can readily identify the hyperechoic and shadowing signature of calculi. It can characterize the number, size and location of stones, all important factors in planning treatment. Ultrasound is also useful for follow up to ensure stone passage or resolution after treatment.
In addition to stones, ultrasound provides excellent structural detail of the kidneys. It can detect cysts, masses or abscesses that may require further characterization with CT or MRI. Subtle abnormalities like renal scarring or pyelonephritis may also be apparent sonographically. Duplex ultrasound allows assessment of kidney blood flow to screen for renal artery stenosis. Overall kidney size, cortical thickness and echogenicity give an indication of kidney health and function. So ultrasound acts as an accessible, radiation-free method to evaluate the kidneys.
Many patients visit my ultrasound clinic to assess bladder health and look for causes of urinary symptoms. Ultrasound accurately measures bladder wall thickness, with thickening potentially indicative of bladder outlet obstruction or interstitial cystitis. Filling defects along the bladder wall may represent masses or blood clots needing further diagnosis. Bladder ultrasound also enables measurement of post-void residual urine volume, which can identify incomplete emptying related to neurogenic bladder, prostatic enlargement or urethral strictures. Dynamic imaging during urination can assess causes of incontinence like urethral sphincter deficiency or cystocele formation.
Transrectal ultrasound (TRUS) has become the standard technique for guiding prostate biopsy to diagnose prostate cancer. The ultrasound probe inserted in the rectum provides excellent resolution for visualizing the prostate and any suspicious lesions requiring biopsy. TRUS allows sampling of tissue in a systematic manner to maximize cancer detection. Once a diagnosis is made, ultrasound is also central in staging by assessing for extraprostatic extension or seminal vesicle invasion. Prostate ultrasound also measures prostate volume, which has implications for symptoms and surgery. Enlarged prostate volume may lead to referral for TURP or other prostate reduction procedures.
Scrotal ultrasound is routinely performed at my clinic to evaluate testicular symptoms like pain or swelling. It reliably differentiates testicular masses as either solid, cystic or complex, giving key information to determine whether surgical exploration is warranted. Ultrasound identifies testicular cancers as areas of mixed echogenicity with increased blood flow. It can also detect benign conditions like epididymitis, varicoceles or hydroceles. For men with male factor infertility, scrotal ultrasound analyzes testicular size, echogenicity and blood flow to assess for causes.
While less routinely performed than other urological exams, ultrasound can also assess the penis when patients have symptoms like penile pain, curvature or erectile dysfunction. It identifies fibrotic plaques in Peyronie’s disease and deformities like chordee. Penile ultrasound with Doppler evaluates vascular flow to the corpora cavernosa, which may be diminished in ED. It can also diagnose venous leak impeding erections. When a palpable penile mass is present, ultrasound determines if it is cystic or solid-appearing.
The retroperitoneum and adrenal glands are readily assessed during kidney ultrasound exams. Incidental findings like adenopathy or adrenal masses can have implications for underlying malignancy. For patients with known abdominal aortic aneurysms, ultrasound provides surveillance of aneurysm size and growth. Ultrasound also guides procedures like prostate biopsy, kidney biopsy or cyst aspiration to enhance precision and safety.
There are significant advantages of having ultrasound performed in a private clinic setting compared to large hospital radiology departments. Wait times for appointments are minimized so issues can be evaluated in a timely manner. The intimate environment allows me to take time to explain each exam to patients in simple terms and answer all their questions. Having an expert sonographer dedicated to urological issues often provides more personalized care than a general radiologist. Our state-of-the-art equipment produces exceptional high-resolution images. Many patients appreciate the convenience of having a scan right in their neighborhood versus traveling to a distant hospital facility. Out-of-pocket costs may be lower than paying hospital facility fees and radiologist interpretation fees.
In summary, ultrasound serves as a versatile, non-invasive imaging technique to evaluate the spectrum of urological conditions. From diagnosing prostate or testicular cancer to assessing post-void urine retention, it provides real-time structural and functional detail to identify issues and guide interventional procedures. The personalized service delivered in a private practice setting optimizes the patient experience and streamlines access to testing. As ultrasound technology continues to advance, its role diagnosing urological diseases will keep expanding. I feel privileged as a sonographer to offer this service and positively impact patients’ lives.