Ultrasound, Bladder

Ultrasound, Bladder

Synonym/acronym: Bladder sonography.

Common use

To visualize and assess the bladder toward diagnosing disorders such as retention, obstruction, distention, cancer, infection, bleeding, and inflammation.

Area of application

Bladder.

Contrast

Done without contrast.

Description

Ultrasound (US) procedures are diagnostic, noninvasive, and relatively inexpensive. They take a short time to complete, do not use radiation, and cause no harm to the patient. High-frequency sound waves of various intensities are delivered by a transducer, a flashlight-shaped device, pressed against the skin. The waves are bounced back off internal anatomical structures and fluids, converted to electrical energy, amplified by the transducer, and displayed as images on a monitor. US is often used as a diagnostic and therapeutic tool for guiding minimally invasive procedures such as needle biopsies and fluid aspiration. The contraindications and complications for biopsy and fluid aspiration are discussed in detail in the individual monographs.

Bladder US evaluates the structure and position of the contents of the bladder and identifies disorders of the bladder, such as masses or lesions. The methods for imaging may include the transrectal, transurethral, and transvaginal approaches. The examination is helpful for monitoring a patient’s response to therapy for bladder disease. Bladder images can be included in other US studies such as the kidneys, ureters, bladder, urethra, and gonads in diagnosing renal/neurological disorders.

The bladder scan is another noninvasive US study commonly used to assess post-void residual. Advantages of the bladder scan over other studies, such as cystometry, is that the study can be performed at the bedside and does not require the patient to be catheterized, thereby eliminating the possibility of the patient developing a catheter-related UTI. The patient’s gynecological history should be obtained prior to using the scanner in order to select the proper setting. The scanners have settings for male, female, and child, but scanning a female patient who has had a hysterectomy and is without a uterus should be performed using the settings for a male patient. This test is not usually performed on pregnant women. Normal findings are less than 50 mL. Report a residual urine that is greater than 100 mL or as directed by the requesting HCP.

This procedure is contraindicated for

    N/A

Indications

  • Assess residual urine after voiding to diagnose urinary tract obstruction causing overdistention
  • Detect tumor of the bladder wall or pelvis, as evidenced by distorted position or changes in bladder contour
  • Determine end-stage malignancy of the bladder caused by extension of a primary tumor of the ovary or other pelvic organ
  • Evaluate the cause of urinary tract infection, urine retention, and flank pain
  • Evaluate hematuria, urinary frequency, dysuria, and suprapubic pain
  • Measure urinary bladder volume by transurethral or transvaginal approach

Potential diagnosis

Normal findings

  • Normal size, position, and contour of the bladder

Abnormal findings related to

  • Bladder diverticulum
  • Cyst
  • Cystitis
  • Malignancy of the bladder
  • Tumor
  • Ureterocele
  • Urinary tract obstruction

Critical findings

    N/A

Interfering factors

  • Patients with latex allergy; use of the vaginal probe requires the probe to be covered with a condom-like sac, usually made from latex. Latex-free covers are available.

  • Factors that may impair clear imaging

    • Incorrect placement of the transducer over the desired test site; quality of the US study is very dependent upon the skill of the ultrasonographer
    • Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images
    • Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status
    • Retained gas or barium from a previous radiological procedure
    • Dehydration, which can cause failure to demonstrate the boundaries between organs and tissue structures
    • Insufficiently full bladder, which fails to push the bowel from the pelvis and the uterus from the symphysis pubis, thereby prohibiting clear imaging of the pelvic organs in transabdominal imaging

  • Other considerations

    • Failure to follow pretesting preparations may cause the procedure to be canceled or repeated.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in assessing the bladder and pelvic organs.
  • Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s genitourinary system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent procedures that can interfere with test results (i.e., barium procedures, surgery, or biopsy). There should be 24 hr between administration of barium and this test.
  • Endoscopic retrograde cholangiopancreatography, colonoscopy, and computed tomography (CT) of the abdomen, if ordered, should be scheduled after this procedure.
  • Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Address concerns about pain related to the procedure. Explain to the patient that some pain may be experienced during the test, and there may be moments of discomfort. Inform the patient that the procedure is performed in a US department by a health-care provider (HCP), with support staff, and takes approximately 30 to 60 min.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Inform the patient for the transvaginal approach, that a sterile latex- or sheath-covered probe will be inserted into the vagina.
  • Instruct the patient receiving transabdominal US to drink three to four glasses of fluid 90 min before the procedure, and not to void, because the procedure requires a full bladder. Patients receiving transvaginal US only do not need to have a full bladder.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
  • Ensure that the patient has removed all external metallic objects from the area to be examined prior to the procedure.
  • Ensure that the patient receiving transabdominal US drank three to four glasses of fluid and has not voided.
  • Instruct the patient to remove jewelry and other metallic objects from the area to be examined.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to change into the gown, robe, and foot coverings provided.
  • Instruct the patient to cooperate fully and to follow directions. Instruct the patient to remain still throughout the procedure because movement produces unreliable results.
  • Place the patient in the supine position on an examination table. The right- or left-side-up positions may be used to allow gravity to reposition the liver, gas, and fluid to facilitate better organ visualization.
  • Expose the abdominal area and drape the patient.
  • Transabdominal approach: Conductive gel is applied to the skin, and a transducer is moved over the skin while the bladder is distended to obtain images of the area of interest.
  • Transvaginal approach: A covered and lubricated probe is inserted into the vagina and moved to different levels during scanning.
  • Ask the patient to breathe normally during the examination. If necessary for better organ visualization, ask the patient to inhale deeply and hold his or her breath.
  • Instruct the patient who is to be examined for residual urine volume to empty the bladder; repeat the procedure and calculate the volume.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Allow the patient to void, as needed.
  • When the study is completed, remove the gel from the skin.
  • Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include bladder cancer markers urine, CT pelvis, cystoscopy, IVP, KUB study, and MRI pelvis.
  • Refer to the Genitourinary System table in the end of the book for related tests by body system.