Is a full bladder still necessary for pelvic sonography?

Abstract

The objective was to determine whether a full bladder is routinely necessary for a complete sonographic evaluation of the female pelvis. Over the course of 1 month, all women having a gynecologic sonogram were scanned initially transabdominally through a full bladder by the sonographer (standard images taken). A physician then joined the sonographer and scanned the patient transvaginally without prior knowledge of the findings seen transvesically. The physician finished the examination transabdominally, with the bladder empty. The physician and sonographer then determined (1) whether the scan was sufficient transvaginally only, (2) whether the scan was sufficient transvaginally and transabdominally with an empty bladder, or (3) or whether a full bladder was necessary. Two hundred and six consecutive patients were scanned prospectively. The transvaginal scan alone was sufficient to demonstrate all findings for 172 (83.5%) patients. The transvaginal and transabdominal scans through an empty bladder were needed for 31 (15.1%) patients. Three patients (1.5%) required a full bladder in addition to the other two techniques to visualize one normal ovary each. In conclusion, transvaginal scanning with an adjunctive transabdominal empty bladder approach can replace the full bladder technique for routine pelvic sonography. The transabdominal scan with an empty bladder is necessary, particularly for patients with enlarged uteri. It is no longer reasonable, however, to subject all patients undergoing pelvic sonography to bladder distention.

Consider ultrasound first for imaging the female pelvis

“…This advance allows the operator to place a high-frequency endocavitary ultrasound transducer in close proximity to target pelvic organs, thus improving image resolution and obviating the need for patients to have a full bladder before ultrasound examinations. 16 Ultrasound imaging has the added advantage of real-time imaging, which allows for the probing of pelvic organs to elicit patient's symptoms and thus correlate symptoms with specific pelvic anatomic locations. The practitioner therefore can gain crucial information about the degree and area of pain and mobility of organs in the pelvis and correlate the ultrasound findings with the physical examination.…”

Prenatal Diagnosis of Placenta Accreta

“…It has been suggested that transvaginal sonography may improve accuracy for antenatal diagnosis of placenta accreta by improving the near-field resolution of the interface between the placenta and the lower uterine segment, especially in cases of placenta previa or a posterior placenta 16. It has also been suggested that the accuracy of sonography could also be affected by the frequency of the abdominal transducer used (a higher frequency will improve spatial resolution for superficial structures) or by the degree of bladder filling, especially when transvaginal sonography is not used 17,18. The difference in the specificity of MRI could be due to the use of gadolinium.…”

Translabial ultrasound: “three tracks” technique

“…Немало усилий приложено в области совершенства технологии и методологии проведения ТПУС. Вопросам использования метрических таблиц, цветного и пульсирующего доплера посвящены работы ряда авторов [43][44][45]. УЗ техника «трех треков» (ТТТ) разработана с целью простой, быстрой и точной идентификации топографии субъектов, расположенных в клетчатке промежности и области дна малого таза.…”