Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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The diagnostic capabilities of urological ultrasound have expanded into the realm of “multiparametric” assessment, mirroring the evolution of MRI. This approach combines standard B-mode anatomical imaging with functional data streams including Color Doppler, Elastography, and Contrast-Enhanced Ultrasound (CEUS). In the diagnosis of prostate cancer, mpUS aims to identify suspicious foci based on their hypervascularity (on Doppler/CEUS) and increased stiffness (on Elastography). This data is often synthesized by AI algorithms to create a probability map of malignancy, guiding targeted biopsies.
Digital diagnostics involve the quantification of these signals. Rather than a subjective assessment of “increased flow,” modern systems can quantify vascular indices and perfusion parameters in mL/min/g of tissue. Computer-Aided Diagnosis (CAD) systems analyze the texture and speckle pattern of ultrasound images—a field known as radiomics. These algorithms can detect subtle variances in the grey-level distribution of a kidney lesion that the human eye cannot perceive, offering a probabilistic classification of benign oncocytoma versus malignant renal cell carcinoma.
Diagnosis is rarely an isolated imaging event; it is integrated with systemic biomarkers. In testicular cancer, the ultrasound finding of a microlithiasis or a hypoechoic mass triggers the evaluation of serum tumor markers (AFP, beta-hCG, LDH). The imaging phenotype—whether the mass is homogeneous or cystic—often correlates with the histological subtype (seminoma vs. non-seminoma).
Functional ultrasound plays a critical role in evaluating renal physiology. In the workup of congenital anomalies like ureteropelvic junction (UPJ) obstruction, “diuretic ultrasound” is employed. The patient is administered a diuretic (furosemide) to induce a high-flow state. The response of the renal pelvis—whether it washes out effectively or dilates further—provides a functional diagnosis of obstruction versus simple dilation. This dynamic test directly assesses the compliance of the collecting system and the patency of the urinary tract.
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Fusion biopsy is a state-of-the-art diagnostic technique that combines the superior tissue resolution of MRI with the real-time availability of ultrasound. First, the patient undergoes a Multiparametric MRI, where a radiologist marks suspicious areas. During the subsequent biopsy, this MRI data is digitally overlaid (fused) onto the live ultrasound image used by the urologist. This allows the surgeon to guide the biopsy needle precisely into the suspicious areas identified on MRI, which might be invisible on standard ultrasound alone.
Yes, this is one of the strengths of ultrasound. A simple cyst is a fluid-filled sac. On ultrasound, fluid is “anechoic” (black) and allows sound waves to pass through easily, creating a bright enhancement behind the cyst (posterior acoustic enhancement). A solid tumor, however, contains cells and tissue that reflect sound waves, appearing grey (echogenic) and often showing internal blood flow on Doppler. Complex cysts, which have solid parts or thick walls, may require Contrast-Enhanced Ultrasound or CT for further clarification.
TRUS stands for Transrectal Ultrasound. Because the prostate sits directly in front of the rectum, placing a slim ultrasound probe into the rectum allows for very close, high-resolution imaging of the gland. It is the standard method for measuring prostate size (to plan for BPH treatment) and for guiding prostate biopsies. It causes mild discomfort but is generally well-tolerated.
Testicular torsion occurs when the spermatic cord twists, cutting off blood supply to the testicle. Ultrasound with Color Doppler is the gold standard for diagnosis. The technician compares the blood flow in the painful testicle to the healthy one. If the ultrasound shows a complete absence of blood flow in the painful testicle while the other side is normal, it confirms torsion, necessitating immediate surgery to untwist the cord and save the organ.
No. Unlike CT scans and X-rays, which use ionizing radiation (X-rays/photons), ultrasound uses high-frequency sound waves. This makes it safe for repeated use, for pregnant women, and for children, as it does not damage DNA or increase the risk of cancer.
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