Prostate ultrasound (basic)

Prostate ultrasound (basic technique) - easy to learn

1. Prostate Ultrasound By: Syed Yousaf Farooq

2. PROSTATE The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body . The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperm as semen. © 2014 WebMD, LLC. All rights reserved.

3. Sonographic Features of Prostate Ultrasound Best assessed with  transrectal ultrasound . Some zonal anatomy distinguishable. Outer gland (central and peripheral zones) - uniform low echogenicity but usually more echogenic than the inner gland. 30 mL is a commonly used upper limit for normal volume.

4. Scanning Technique T ransrectal Ultrasound: It is ideal to have a small amount of urine in the bladder. Ask the patient to try and relax and "bear down" to open the sphincter  as the transducer is inserted slowly . Ensure the transducer has a latex free dedicated probe cover with plenty of gel. The highest frequency sector  probe 7-12MHz should be used. The scanning begins in the axial plane. The seminal vesicles are examined initially. As the probe is angled caudally the base of the prostate is seen. Once the prostate is examined in its entirety in this plane the probe is turned 90degrees in a sagittal plane. The probe is angled from one side across to the other. A volume is taken by measuring height x length  in the sagittal plane and x width in the axial plane and multiply by 0.52. Look for changes in the contours and echogenicity in each zone.

5. TRANSABDOMINAL TECHNIQUE: The patient lies supine. The patient should have a half full bladder .500 mls of water 1 hr before the scan if possible is recommended. The probe is angled approximately 30 degrees caudal using the bladder as a window. Slight compression to ensure the inferior portion of the prostate is not obscured by the shadow artifact from the base of the bladder.

6. Common Pathology Cysts Benign Prostatic Hyperplasia (BPH) Prostate Carcinoma Prostatitis Enlarged seminal vesicles Stones in the seminal vesicles , Prostate or ejaculatory ducts.

7. Prostate cystic disease Prostatic cysts are common, and ~5-8% men will develop one. However they are much more common in patients being investigated for infertility, with one study showing a 20% prevalence  .

8. Benign prostatic hyperplasia: Benign prostatic hyperplasia (BPH)  or  benign prostatic enlargement (BPE)  is an extremely common condition in elderly men and is a major cause of bladder outflow obstruction . Epidemiology: By the age of 60, 50% of men have BPH, and by 90 years of age the prevalence has increased to 90%. As such it is often thought of essentially as a 'normal' part of aging. DISEASE OCCURRENCE IN PAKISTANI POPULATION : Pakistan with as many as 50% of the 2 million men older than 65 year are at risk of bladder outlet obstruction from BPH.

9. Sonographic Features There is an increase in volume of the prostate with a calculated volume exceeding 30 mL (width x height x length x 0.52 ). The central gland is enlarged, and is hypoechoic or of mixed echogenicity. Calcification may be seen both within the enlarged gland as well as in the pseudocapsule (representing compressed peripheral zone ). Post-micturition residual volume is typically elevated Associated bladder wall hypertrophy and trabeculation due to chronically elevated filling pressures.

10. Prostatic carcinoma Prostatic carcinoma  ranks as the most common malignant tumor in men and the second most common cause of cancer-related deaths In men . Epidemiology: It is primarily a disease of the elderly male. In the United States, approximately 200,000 new cases are diagnosed each year . Prevalence in Pakistan: The  prevalence  of  prostate cancer  in males ranged from 2 to 8% with overall pooled  prevalence  of 5 %.

11. Sonographic Features On ultrasound, prostate cancer is usually seen as a hypoechoic lesion (60-70%) in the peripheral zone of the gland, but can be hyperechoic or isoechoic (30-40% of lesions).

12. Prostatitis Prostatitis  refers to an infection or inflammation of the  prostate gland  that presents as several syndromes. Ultrasound: Focal hypoechoic region in the peripheral zone of the gland. Discrete fluid collection suggests abscess formation. Color Doppler ultrasound demonstrates increased flow in the periphery of the abscess.