Transrectal ultrasound of the prostate: description, preparation and recommendations

In recent years, the incidence of cancer of the pelvic organs is growing rapidly. This is due not only to the fact that oncological pathologies occur more often than before. First of all, the cause of the increase in morbidity is the improvement of diagnostic methods. Now almost every person over the age of 50 periodically passes tests to determine cancer markers. In addition, when suspected of such diseases, qualitative instrumental diagnostics are performed. One of the methods is transrectal ultrasound. It is administered to both men and women with suspicion of oncological and inflammatory processes in the pelvic organs. In comparison with abdominal ultrasound, this method is considered more reliable, since the sensor is closer to pathological processes. Therefore, it is better to examine the organs.

What is transrectal ultrasound?

This method is based on the action of ultrasound. As is known, this method of imaging refers to non-invasive procedures. Waves of ultrasound can reflect on the tissues of the human body, and also pass through them. Transrectal ultrasound (TRUS) does not differ in the mechanism of action from other varieties of the study. The only difference is that the sensor is inserted into the rectum, and not mounted on the surface of the abdomen.

Due to the fact that all tissues have different echo-density, the doctor can visualize the organs on the screen. In the presence of inflammatory changes or any seals (formations), the ultrasound pattern changes. That is, the density of the organ or its site is different from the norm. Both hypo- and hyperechoogenicity indicate the presence of a pathological process, that is, a change in the structure of the tissue.

TRUS is performed for visualization of the prostate gland, rectum, Douglas space, bladder. All these organs are displayed on the monitor and with other types of ultrasound (abdominal, in women - transvaginal). Nevertheless, when the sensor is installed in the rectum, visualization is better, due to a reduction in the distance between the instrument and the tissues.

Indications for transrectal ultrasound of the prostate

Transrectal ultrasound of the prostate gland is a reliable method of diagnosing prostate diseases. It is the preferred method of investigation, especially if there is a suspicion of an oncological process. Nevertheless, the appointment of TRUS does not mean that there is cancer. Therefore, do not panic and make hasty conclusions in advance. It is worth knowing that with abdominal access, ultrasonic waves pass through a variety of tissues (skin, fatty tissue, muscles). Only after that they fall on the prostate gland. Therefore, the diagnosis of pathologies is difficult, especially if the patient is overweight. Transrectal ultrasound of the prostate allows several times to reduce the distance from the sensor to the organ under investigation. After all, the prostate glands with the rectum. Indications for TRUS are the following conditions:

1. Benign prostatic diseases. This pathology is quite common in older men. According to statistics, prostate adenoma occurs in almost every second member of the stronger sex after 50 years.
2. Prostate cancer. If you suspect a cancer, TRUS is the main method of diagnosis. This is due to the fact that under the control of ultrasound , the organ is punctured. Thus, the doctor evaluates the ultrasound picture and performs a targeted biopsy. That is, it takes the material (tissue) from the pathological foci.
3. Preparation for surgical interventions on the prostate.
4. Male infertility. Often the inability to fertilize develops against the backdrop of a chronic inflammatory process - prostatitis.

Transrectal ultrasound of the prostate gland is performed if the patient complains of pain in the genitals and inguinal area, giving to the anus. Also, this study is performed when urination and ejaculation, impotence are impaired.

Indications for transrectal ultrasound in women

Transrectal ultrasound in women is less frequent than in men. Most often this method of diagnosis is carried out with suspicion of oncological pathology. In addition, TRUZI perform if there is a possibility of inflammation in the Douglas space, abscesses, etc. As is known, the structure of the pelvis in women and men is somewhat different. Given that the examination of the uterus and appendages is more frequent, in most cases, transvaginal ultrasound is recommended . Nevertheless, in some cases, the visualization of organs through the rectum gives more information about the disease.

The indication for transrectal ultrasound in women is the study of the Douglas space. It is a pocket of the peritoneum located between the rectum and the uterus. Thus, TRUS allows you to assess the condition of the pararectal tissue and the posterior fornix of reproductive organs. It is conducted under the following conditions:

1. Suspicion of the abscess of the Douglas space. Often this inflammatory process is a consequence of complications of appendicitis and peritonitis.
2. Oncological pathologies of the uterus, rectum.
3. Suspicion of metastases in the pararectal tissue. It occurs with tumors of the stomach.
4. Inflammatory processes in the rectum.
5. Benign neoplasm on the posterior wall of the uterus.

Both in women and men, TRUS is used to assess the condition of the genito-urinary organs. Nevertheless, in most cases, they are examined using transabdominal access.

Diagnosis of diseases of the urinary bladder by the TRUSY method

In addition to the organs listed above, the bladder is located in the cavity of the small pelvis. It is located in front of the rectum. Women have access to the uterus. Therefore, transrectal ultrasound of the bladder is more often performed for men. It is carried out with suspicion of tumoral, benign formations and inflammatory infiltrates. In women, the urinary bladder is performed if there is an adhesion process in the small pelvis or expressed obesity. Also a similar method is used to not damage the hymen by inserting the sensor into the vagina.

Contraindications to transrectal ultrasound

In some cases, transrectal ultrasound is not recommended. Absolute contraindication to this method of diagnosis is the atresia of the anus. It is a congenital malformation of the development, in which there is no anus. A similar developmental anomaly is diagnosed in the first days of life. Other contraindications are relative. This means that in the case of acute need for research is carried out. Nevertheless, it is better to replace it with other diagnostic methods. Relative contraindications include:

1. Fresh cracks in the rectum. With this disease, any manipulations performed transrectally are prohibited. Nevertheless, after the treatment of a crack (relief of an acute condition), TRUZI is possible.
2. The presence of inflamed hemorrhoids on the outside and inside the rectum. In this case, transrectal administration of an ultrasound sensor is not indicated because of the risk of vascular trauma.
3. Surgical manipulations on the rectum, conducted shortly before the appointment of the study. These include any surgical interventions: opening and draining fatty tissue, fistulous movements, etc.

Transrectal ultrasound: preparation for the study

Like any research performed transrectally, TRUSY requires preparation. To achieve normal visualization of the pelvic organs, the rectum must be cleaned beforehand. For this purpose, a few hours before the procedure, you should take a laxative remedy or make an enema. If the indications for the study are diseases of the rectum, it is necessary to exclude from the diet spicy food, carbonated and alcoholic beverages. Before the implementation of the prostatic TRUS, a preliminary diet is not necessary. If the subject of research is the bladder, it must be filled. For this purpose, before the diagnostic procedure, the patient should drink 1-2 liters of water.

Technique of the research

Transrectal ultrasound is performed in different positions. To view the prostate well, the patient is offered to lie on his left side. His feet should be bent at the knee joints and pressed to the stomach. Transrectal ultrasound of the pelvis in women is most often performed on a proctological chair (or gynecological). In the same way, the bladder is examined. In some cases, the patient is offered to take a knee-elbow position. More often - if you suspect a pathology of the rectum.

Before you insert an ultrasound sensor into the anal canal, it is lubricated with petroleum jelly or a special lubricant. After that, the device is inserted into the lumen of the intestine to a depth of 6 cm. The anal canal, sphincters, and organ walls are inspected. Next, the prostate and seminal vesicles are examined. In women after the examination of the rectum, the posterior arch of the uterus and the Douglas space are visualized, then the bladder. All results are recorded on the monitor screen. After this, the device is carefully removed from the rectum.

Advantages of transrectal ultrasound

The advantages of TRUS are:

1. Absence of radiation load.
2. Painless.
3. Informativeness.
4. Improved visualization of the pelvic organs. High information content of ultrasound, performed through the rectum, is achieved due to the proximity of the prostate and the absence of a thick layer of fatty tissue, which is found in the abdominal wall.

Results of transrectal ultrasound

Thanks to the TRUSI method, it is possible to diagnose neoplasms of the pelvic organs, as well as metastases to the pararectal tissue. In addition, using this method of research assess the size, thickness and location of the prostate, bladder. Inflammatory processes and formations are displayed on the monitor as hypo- or hyperechoic tissue sites. The conclusion on the ultrasound picture is performed by the physician of functional diagnostics, urologist, gynecologist.