ROLE OF ULTRASOUND IN

URINARY SYSTEM
&
IN COMMON DISEASES
RELATED TO
IT
 Role of Ultrasound in the Urinary System
Ultrasound of the Urinary Tract is a rapid and safe imaging modality that is highly
specific for the detection of moderates and severe Hydronephrosis and indicative of
nephrolithiasis. Diagnostic Ultrasound offers information about internal areas and parts of the
organ system Liver, Spleen, Pancreas, Small & Large Intestine and many more. It can provide
liver and Gall bladders health, abnormalities in Kidney and Urinary Tract. With the help of
Ultrasound, doctors can assess the size, location, and shape of the tissues, blood flow to Kidney
and related structures, such as Ureters and Urinary Bladder. It can detect Cysts, Tumors,
Abscesses, Obstructions, Fluid collection, and Infection within the body. Ultrasonography is
currently less sensitive and specific than CT imaging for detecting and sizing of any kind of
stones in kidney and Urinary tract, but has good diagnostic ability, and can reliably enable
detection of hydronephrosis.

The Most Common Diseases in Urinary system: Kidney Stone (Nephrolithiasis)

The condition of having Kidney Stone is termed Nephrolithiasis. Kidney Stone is hard,
crystalline mineral material formed within the Kidney or Urinary Tract. Symptoms may not be
noticed until the stones move down the tubes (ureters) through which urine empties into your
bladder. When this happens, the stones can block the flow of urine out of kidney. The main
symptoms are severe pain that starts and stops suddenly. Pain may be felt in the belly area or side
of the back. Pain may move to groin area (groin pain), testicles (testicle pain) in men, and labia
(vaginal pain) in women. Other symptoms may include abnormal urine color, blood in urine,
chills, fever, nausea and vomiting.

There are many ways to Diagnose Kidney Stones

There are several ways to examine and diagnose the kidney stones such as blood tests to
check calcium, phosphorus, uric acid, and electrolyte levels, kidney function tests, abdominal CT
scans, abdominal X-rays and kidney ultrasound.

Ultrasound of Kidney stones

 A noninvasive test that is quick and easy to perform, is another imaging option to
diagnose Kidney Stone. Images obtained using ultrasonography are produced when a transducer
delivers short bursts of acoustic energy to the patient. This energy propagates through tissues as
waves, partially reflection back to the source when passing between tissues of different densities
and/or acoustic impedances. During an ultrasound, you'll lie on an exam table while a
technologist moves a transducer over the part of the body being scanned. A transducer is a
handheld device that sends and receives sound waves. The sound waves will then be processed
by a computer to produce images. When searching for renal stones, the sonographer should scan
along the lines of renal fat; usually, stones smaller than 3mm (about 0.12 in) may not shadow
with the use of traditional B-mode. With the help of B-Mode or brightness Mode
Ultrasonography, Kidney Stones can appear bright sometimes with dark distal shadow. B-Mode
ultrasonography makes use of physical differences between stones and surrounding tissues to
detect the stones.

Relatively to soft tissues, stones strongly reflect ultrasonic waves and appear as bright
echogenic structures in the ultrasonographic images. Ultrasonic waves are unable to penetrate
through stones, leaving a Non echogenic shadow beyond the stone in the image. Sonography can
also define perirenal fluid collection, such as hematoma, lymphocele, urinoma, or an abscess,
and detect dilated ureters and hydronephrosis. When scanning for suspected pathology, it is
helpful to view the asymptomatic side first to establish the appearance of the patient’s kidneys at
baseline.

For the right kidney, the transducer is placed at the mid-axillary line with the indicator
pointed cephalad at the inferior intercostal margin. To view the left kidney, the transducer should
be placed at the left posterior axillary line because it lacks the large acoustic window of the liver
and can be obscured by air in the stomach or bowels. In this plane, the left kidney is medial to
the spleen. The operator may ask the patient to take and hold a deep breath to widen the
intercostal space. Positioning the patient in the right decubitus position can occasionally be
helpful in visualizing the left kidney. On both sides, the operator should fan through the entire
kidney in an anterior to posterior sweep to visualize all structures.

Treatment of Nephrolithiasis with help of ultrasonic waves:

 Lithotripsy treats kidney stones by sending focused ultrasonic energy or shock waves
directly to the stone first located with ultrasound (high frequency sound waves). The shock
waves break a large stone into smaller stones that will pass through the urinary system.
Ultrasound may be performed to assist in placement of needles used to biopsy (obtain a tissue
sample) the kidney, to drain fluid from a cyst or abscess, or to place a drainage tube. This
procedure may also be used to determine blood flow to the kidney through the renal arteries and
veins. It can be used after a kidney transplant to evaluate the transplanted kidney.

Urinary Bladder Stones

Bladder stones are hard masses of mineral in your bladder. They develop when the
minerals in concentrated urine crystallize and form stones. This often happens when you have
trouble completely emptying your bladder. Sometimes bladder stones—even large ones—cause
no problems. But if a stone irritates the bladder wall or blocks the flow of urine, sign and
symptoms may include lower abdominal pain, pain during urination, frequent urination, blood in
the urine, cloudy or unusually dark-colored urine and difficulty urinating or interrupted urine in
flow.

Ultrasound for urinary bladder stones

The urinary bladder must be examined when it's comfortably full. The sonographer will
use curvilinear ultrasound probe or phased array probe. Curvilinear is preferred because its wider
footprint allows full visualization of the bladder. On ultrasound, these stones appear hyperechoic
and mobile with acoustic shadowing. The transabdominal approach is used most commonly. For
most adults a 3.5-MHz probe provides appropriate images. A 2.0-MHz probe is necessary for use
on the very obese patient, however; this longer wavelength scarifies resolution to provide better
depth of penetration. Conversely, for the very thin patient a 5.0-MHz probe may penetrate deep
enough to image the bladder. Bladder stones appear as highly reflective masses within the
bladder, move with altered posture and cast shadows. Small stones may pass through and can be
lodged anywhere in the urethra.

Summary
Ultrasound is an excellent modality for examining renal anatomy and pathology. It is the
very first diagnostic tool and will guide further diagnostics workup with additional imagining
studies or genetic testing. use of point-of-care ultrasonography is rapidly increasing, which will
probably increase operator experience and confidence with this modality. Because Ultrasound is
convenient to use through the entire pediatric age range, as it does not need sedation or
preconditioning and does not expose the child to radiation. It is important to understand the
limitations of renal ultrasound. Interpretation is best performed in conjunction with knowledge of
the clinical status of the patient and the result of the other laboratory investigation. The
practitioner should be aware of other imaging modalities and how these fit in with overall patient
management.

References

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