In recent years, the incidence of pelvic cancer has been growing rapidly. This is due not only to the fact that oncological pathologies are more common than before. First of all, the reason for the increase in the incidence is the improvement of diagnostic methods. Now almost every person over 50 years old periodically takes tests to determine cancer markers. In addition, if such diseases are suspected, high-quality instrumental diagnostics is performed. One of the methods is transrectal ultrasound. It is carried out for both men and women with suspicion of oncological and inflammatory processes in the pelvic organs. Compared with abdominal ultrasound, this method is considered more reliable, since the sensor is closer to the pathological processes. Therefore, it is possible to examine the organs better.
What is transrectal ultrasound?
This method is based on the action of ultrasound. As you know, this imaging method refers to non-invasive procedures. Ultrasound waves can be reflected ontissues of the human body, as well as pass through them. Transrectal ultrasound (TRUS) does not differ in mechanism of action from other types of research. The only difference is that the transducer is inserted into the rectum rather than placed 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 picture changes. That is, the density of the organ or its section differs from the norm. Both hypo- and hyperechogenicity indicate the presence of a pathological process, that is, a change in the structure of the tissue.
TRUS is performed to visualize the prostate, rectum, Douglas space, bladder. All these organs are displayed on the monitor and with other types of ultrasound (abdominal, in women - transvaginal). However, when the transducer is placed in the rectum, visualization is better due to the reduced distance between the transducer and tissues.
Indications for transrectal ultrasound of the prostate
Transrectal ultrasound of the prostate is a reliable method for diagnosing prostate diseases. It is the preferred research method, especially when a cancerous process is suspected. However, a TRUS appointment does not mean that there is cancer. Therefore, do not panic in advance and draw hasty conclusions. It is worth knowing that with abdominal access, ultrasound wavespass through many tissues (skin, fatty tissue, muscles). Only after that they get to 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 study. After all, the prostate gland borders on the rectum. Indications for TRUS are the following conditions:
- Benign growths of the prostate. This pathology is quite common in older men. According to statistics, prostate adenoma occurs in almost every second representative of the stronger sex after 50 years.
- Prostate cancer. When cancer is suspected, TRUS is the main method of diagnosis. This is due to the fact that under the control of ultrasound, an organ puncture is performed. Thus, the doctor evaluates the ultrasound picture and performs a targeted biopsy. That is, it takes material (tissues) from pathological foci.
- Preparation for prostate surgery.
- Male infertility. Often the inability to fertilize develops against the background of a chronic inflammatory process - prostatitis.
Transrectal ultrasound of the prostate gland is performed if the patient complains of pain in the pubic and inguinal region, radiating to the anus. Also, this study is performed in violation of urination and ejaculation, impotence.
Indications for transrectal ultrasound in women
Transrectal ultrasound is less common in women than in men. Most often, this diagnostic method is carried out with suspicion of oncological pathologies. In addition, TRUS is performed if there is a possibility of inflammatory processes in the Douglas space, abscesses, etc. As you know, the structure of the pelvis in women and men is somewhat different. Given that the examination of the uterus and appendages is carried out more often, transvaginal ultrasound is recommended in most cases. However, in some cases, imaging of organs through the rectum provides more information about the disease.
Indication for transrectal ultrasound in women is the study of Douglas space. It is a pocket of the peritoneum located between the rectum and the uterus. Thus, TRUS allows assessing the state of pararectal tissue and the posterior fornix of the reproductive organs. It is carried out under the following conditions:
- Suspicion of Douglas pouch abscess. Often this inflammatory process is the result of complications of appendicitis and peritonitis.
- Oncological pathologies of the uterus, rectum.
- Suspicion of metastases in pararectal tissue. Occurs with tumors of the stomach.
- Inflammatory processes in the rectum.
- Benign neoplasms on the posterior wall of the uterus.
In both women and men, TRUS is used to assess the condition of the urinary organs. However, in most cases they are examined using transabdominal access.
Diagnosis of bladder diseases by TRUS
In addition to the organs listed above, the bladder is also located in the pelvic cavity. It is located in front of the rectum. In women, access to it is blocked by the uterus. Therefore, transrectal ultrasound of the bladder is more often performed in men. It is carried out with suspicion of tumor, benign formations and inflammatory infiltrates. In women, TRUS of the bladder is performed if there is an adhesive process in the pelvis or severe obesity. Also, a similar method is used in order not to damage the hymen by inserting the probe into the vagina.
Contraindications for transrectal ultrasound
In some cases, transrectal ultrasound is not recommended. An absolute contraindication to this diagnostic method is anus atresia. This is a congenital malformation 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 case of urgent need, the study is carried out. Nevertheless, it is better to replace it with other diagnostic methods. Relative contraindications include:
- Fresh cracked rectum. In this disease, any manipulations performed transrectally are prohibited. However, after the fissure has been treated (acute relief), TRUS is possible.
- The presence of inflamed hemorrhoids outside and inside the rectum. In thattransrectal insertion of an ultrasound transducer is not indicated due to the risk of vascular injury.
- Surgical manipulations on the rectum, carried out shortly before the appointment of the study. These include any surgical interventions: opening and drainage of adipose tissue, fistulous tracts, etc.
Transrectal ultrasound: preparation for the study
Like any transrectal examination, TRUS requires preparation. To achieve normal visualization of the pelvic organs, the rectum must first be cleaned. For this purpose, a laxative or an enema should be taken a few hours before the procedure. If the indication for the study are diseases of the rectum, it is necessary to exclude spicy foods, carbonated and alcoholic beverages from the diet. Before performing TRUS of the prostate, a preliminary diet is not required. If the object of study is the bladder, it must be filled. To this end, the patient should drink 1-2 liters of water before the diagnostic procedure.
Research technique
Transrectal ultrasound is performed in various positions. To have a good view of the prostate gland, the patient is asked to lie on his left side. At the same time, his legs should be bent at the knee joints and pressed to the stomach. Transrectal ultrasound of the small pelvis in women is most often performed on a proctological chair (or gynecological). In the same way, the study of the bladder is carried out. In somecases, the patient is offered to take the knee-elbow position. More often - with suspicion of pathology of the rectum.
Before inserting the ultrasonic probe into the anal canal, it is lubricated with Vaseline or a special lubricant. After that, the device is inserted into the intestinal lumen to a depth of 6 cm. The anal canal, sphincters, and organ walls are examined. Next, the prostate and seminal vesicles are examined. In women, after examining the rectum, the posterior fornix of the uterus and Douglas space are visualized, then the bladder. All results are recorded on the monitor screen. After that, the apparatus is carefully removed from the rectum.
Benefits of transrectal ultrasound
TRUS benefits include:
- No radiation exposure.
- Painless.
- Informative.
- Improved visualization of the pelvic organs. The 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 adipose tissue, which is present in the abdominal wall.
Results of transrectal ultrasound
Thanks to the TRUS method, it is possible to diagnose neoplasms of the pelvic organs, as well as metastases to the pararectal tissue. In addition, using this research method, the size, thickness and location of the prostate and bladder are evaluated. Inflammatory processes and formations are displayed on the monitor as hypo- or hyperechoic tissue areas. The conclusion on the ultrasound picture is performed by the doctorfunctional diagnostics, urologist, gynecologist.
