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In urological practice, such a technique for examining patients as ultrasound is widely used. At the same time, in this branch of medicine, specialists today use 4 main approaches: transabdominal ultrasound, performed non-invasively through the anterior abdominal wall, external ultrasound by scanning through the perineum, transrectal ultrasound, performed through the rectum, and intracavitary transurethral ultrasound, which is performed by inserting a sensor ultrasound machine in the urethra.
At the same time, a non-invasive external diagnostic method through the anterior abdominal wall – transabdominal ultrasound – is the most easy and affordable examination technique.
The essence of diagnostics
There are no contraindications for transabdominal ultrasound of the prostate and seminal vesicles, but there are some limitations. For example, the procedure is not recommended for low bladder fullness, which can give low-quality ultrasound images, all kinds of postoperative wounds in this area, and with a cystostomy drainage tube inserted.
To carry out diagnostics through the anterior wall of the peritoneum, it is necessary to make a physiological filling of the bladder, which will become a kind of acoustic window for monitoring the prostate. In this aspect, it is important to know that both small and excessive filling with urine can play a negative role in the diagnostic process.
The ultrasound itself is performed by moving a special sensor over the patient’s body, which is in a prone position. It is important to scan both in the transverse and longitudinal planes, as well as in oblique planes or any arbitrary angles that become necessary for the specialist during the examination. With the transabdominal ultrasound technique, the patient’s seminal vesicles are examined simultaneously with the prostate.
Ultrasound images show that the prostate may look like a triangular, round, or oval symmetrical formation located just behind the back wall of the bladder. A transverse scan measures the thickness or anteroposterior dimension of the prostate, as well as its width or transverse dimension. The norm for these indicators are the corresponding values within 1,6-2,5 centimeters and 2,7-4,2 centimeters.
With a longitudinal section, the prostate can be seen as an elongated oval formation, located in the direction from the base of the glands to the top. With this section, the upper-lower size or length of the prostate is measured, the norm of which is an indicator within 2,4-4,1 centimeters. Normally, the contours of the prostate gland should be clear and even, and its volume in the normal state of a person is easily calculated by multiplying the three above indicators by each other. With a healthy prostate, this figure does not exceed 30 cubic centimeters, but more often it is 20-26 cubic centimeters. The mass of this organ is determined by multiplying its volume by the specific density coefficient of the prostate gland, equal in medicine to 1,05.
The main disadvantage of abdominal ultrasound is its low resolution, which allows only the shape, size, and symmetry of this part of the body to be assessed. Also, with an additional study, it is possible to determine the volume of residual urine, which largely determines the course of treatment for adenoma and some cases of prostatitis.
Indications for abdominal examination and diseases detected with it
The indications for abdominal ultrasound are the same signs as for other methods of studying this organ:
- dysuric phenomena;
- various pain sensations;
- blood impurities in the semen;
- inflammatory processes in secretory secretions from the prostate gland;
- spermatorrhea, prostorrhea and other discharge from the urination canal;
- premature cases of ejaculation;
- age of a man after 40 years.
At the same time, doctors refer to dysuric manifestations as frequent and small urination, its difficulty, incontinence or urinary retention. Pain syndromes are important for the urologist if they are localized in the lower abdomen of a man, felt in the scrotum or perineum, give sharp pains in the coccyx or sacrum, occur during periods of urination or during sexual intercourse or ejaculation.
With this method of examination of a man, changes in the size of the prostate gland are easily detected, both upward and downward, irregularities in its contour, as well as blurry boundaries of the capsule, calcifications or other seals are detected, edema, the presence of stones, and deformation of the prostatic canal are visualized. urination, induration and enlargement of the seminal vesicles, and any abnormal condition of the bladder.
When these changes are detected, specialists study the history of the disease in detail and can diagnose chronic prostatitis or prostatitis in the acute stage, vesiculitis, sclerosis, prostate cancer.
Features of prostate diseases
Very often, in chronic prostatitis, ultrasound does not show doctors any changes in this organ. For prostatitis, there are no characteristic distinguishing features of the inflammatory process at all. All changes detected during ultrasound and confirmed by bacteriological studies may indicate a large list of diseases that will need to be accurately diagnosed in order to prescribe qualified therapy, for example, increased arterial blood flow to the organ, impaired outflow of venous blood from the prostate, stagnation of secret fluid in the ducts, swelling of the prostate gland, the formation of stones in the prostate.
When young men develop chronic prostate problems, the prostate tends to increase in size by up to 20% of normal for age. This increase occurs along with the rounding of the shape of the organ and the preservation of its symmetry. In this case, the echogenicity of the gland is reduced.
Further, doctors distinguish those symptoms of chronic prostatitis, which indicate stagnant secretion processes in the gland. By itself, the stagnation does not indicate inflammatory processes, it can even be physiological, which is why it is so important not to waste time in determining the causes of such stagnation. Expansion of the excretory ducts and glands of the prostate with their simultaneous filling with a secret leads to the appearance of a kind of small-cell prostatic pattern on the outside of the organ.
More attention should be paid to the detection of stones in the prostate, as evidenced by the hyperechogenicity of any of its inclusions. Both rather large calcifications and vast areas filled with small inclusions can form in the prostate. Such inclusions are not always calcifications, sometimes they are sclerotic fields, indicating the result of the end of the inflammatory process.
After a very long inflammation, sclerosis of the prostate gland occurs, when it is sharply reduced in size, and the tissue in it begins to be replaced by fibrous (connective) tissue.