Bladder Ultrasound

A Non-Invasive Alternative to Assess Bladder Volume

Bladder ultrasound is used in a variety of settings to include acute care, home health, rehabilitation, and long term care facilities. Mihom Healthcare Inc. has invested in a bladder ultrasound, in an effort to better serve our home health patients, as well as our area physicians requesting this service. A bladder ultrasound is a non-invasive alternative to bladder palpation and intermittent catheterization, which is used to assess for the causes of urinary retention. The test is used to assess bladder volume, urinary retention, and post- void residual volume in postoperative patients, who may have decreased urine output, as well as in patients with urinary tract infections, urinary incontinence, enlarged prostate, urethral stricture, neurogenic bladder, and other lower urinary tract dysfunctions, or in patients with reduced sensation of bladder fullness. Patients who may experience reduced sensation of bladder fullness include patients with diabetes, stroke, spinal cord injuries, and mental handicaps.

Ultrasound imaging uses sound waves within a frequency above the upper limit of human hearing. They are pulsed into the body and the echoes can be recorded, measured, and used to create a picture of the soft tissues in the body. The bladder ultrasound has a probe attached to it, which is placed on the patient’s abdomen over the bladder. It holds a motorized scanning head with an ultrasonic transducer that transmits sound waves that are actually reflected back from the patient’s bladder to the transducer. Data from multiple cross- sectional views of the bladder are then transmitted to a computer within the portable ultrasound device, which automatically calculates bladder volume. The bladder volume measurements are then displayed on a digital screen and results can be printed and sent to the ordering physician. The entire scan only takes a couple of minutes at the most. One clear advantage of its use is that it is non- invasive and painless, and more importantly can eliminate the discomfort and unnecessary risk associated with catheterization to check for urinary retention. Prior to the ultrasound device, urinary retention was checked for strictly by catheterization.

The only preparation that is needed for the scan is for the nurse to apply ultrasound transmission gel to the end of the scanning head. The nurse will also set the ultrasound device to read either male or female patient. The male setting should be used for a female patient who has had a hysterectomy. In women, the bladder lies in front of and below the uterus. In men, the bladder can be partly obstructed by the pubic bone and it should be viewed at a slightly oblique angle. To begin scanning, the tip of the scanning head should be positioned approximately one inch superior to the symphysis pubis and pointing toward the bladder. During scanning, the scanner head should be stationary when obtaining measurements. Depending on the bladder volume measured, urethral catheterization is performed to relieve urine retention if the patient cannot void on his or her own. If the patient has an indwelling catheter, the bladder volume measurement may indicate a need for catheter irrigation or checking for catheter blockage. The bladder ultrasound may need to be repeated, depending on the catheterized or voided urine volume obtained. In general , if the bladder volume measured is greater than 300 mls, urethral catheterization or patient voiding is needed to relieve urinary retention. We consulted Dr. J. Robin Atwell for his knowledge on the use of a bladder ultrasound in assessing for urinary retention.

Dr. Atwell is a urologist who attended and graduated from the University of South Carolina School of Medicine in 1979. Dr. Atwell states that the most common reasons for urinary retention in men is obstructive benign prostatic hypertrophy (BPH), and neurogenic bladder. In women, the most common cause of retention is neurogenic bladder. Basically neurogenic bladder is a problem where a person lacks bladder control due to a brain or nerve condition. It can occur as a result of internal or external trauma of the bladder or as a result of disease. Once urinary retention has been confirmed through use of the bladder ultrasound, female patients may be treated by intermittent self catheterization. Men may be treated with medications to decrease urinary retention. ie: Alpha Blockers, such as Prazosin or 5 Alpha Reductase Inhibitors, such as Proscar. Additional interventions available to men with moderate to severe BPH include a Transurethral Resection of the prostate (TURP) or a Transurethral Vaporization of the prostate (TUVP).

If you have any additional questions for Dr. Atwell, he may be reached at: