The urinary system includes the following structuring its organs - the kidneys, ureters, urethra, bladder. Most often the kidney and ureters are involved in the pathological process. These organs are most often subject to serious pathological processes. In order to study in detail the emerging problems of the kidneys or ureters, experts have long begun to apply the ultrasonic method of research.
General indications and preparatory procedures for ultrasound
Ultrasound examination of the urinary organs is carried out in cases where there is a suspicion of inflammatory diseases, nephrosclerosis, in various diseases of the body, pathologies leading to urodynamic disorders, urolithiasis, congenital anomalies of development, formation of cysts and cancer, and also for preventive purposes for evaluation health conditions.
Under the preparatory stage for ultrasound of the kidneys and ureters, experts understand the creation of such conditions under which the diagnosis will bring the most accurate results of the state of the internal organs. Despite the high quality of modern ultrasound machines, many tissues and organs have poor echogenicity, and in order to enhance it, the patient must be prepared for the procedure in a certain way. In this case, experts take into account the principles of ultrasound diagnostics, indicating that the beam is able to scatter in an environment with air and be reflected in an environment with a large amount of liquid.
That is why a few days before the study it is recommended to reconsider your diet and eliminate food products that contribute to gas formation. A few days before the procedure, it is undesirable to eat raw fruits and vegetables, soda, alcohol, rye bread, legumes. In some cases, in the presence of associated diseases of the gastrointestinal tract, it is recommended to carry out a cleansing enema 2-3 days before the diagnosis.
Ultrasound examination of the kidneys and ureters is carried out regardless of the state of fullness of the stomach, so there is no need to monitor the patient's food intakes. An hour before the planned procedure, it is recommended to drink 4 cups of pure non-carbonated water, which will increase the echo signal and improve the accuracy of the procedure. If there is a very strong urge to toilet, empty the bladder and drink water again on the eve of the diagnosis.
During an ultrasound examination of the kidneys and ureters, you can perform various puncture procedures that will require a different preparation.
Preparation for ultrasound in nephrostomy
In some clinical conditions, there is a need for an invasive procedure, which is called nephrostomy. At the same time through the abdominal wall, under the control of ultrasound, a catheter is inserted into the cavity of the kidney, through which the urine is removed.
Nephrostomy is necessary for patients with impaired natural outflow of urine from the kidneys through the ureters, in the presence of oncological processes, stones or strictures. If you do not ensure the timely flow of urine, then hydronephrosis is formed (filling the cavity of the kidney with urine, followed by the formation of atrophy of its tissues). In addition, the violation of the processes of urine outflow leads to the development of pyelonephritis. Sometimes nephrostomy is performed with the purpose of access to the ureters for crushing the formed stones, as well as for carrying out chemotherapy for oncological diseases.
In order to perform nephrostomy, a certain patient preparation is required. It includes the mandatory delivery of a set of tests, which are usually necessary before any surgical intervention:
- blood tests;
- urine tests;
Sometimes, with this method of diagnosis, they also carry out computed tomography for a more complete picture of the disease.
Preparing for ultrasound during laparoscopy
Ignipuncture is a decompression surgical procedure aimed at dissecting the formed cysts and introducing the sclerosing substance into them. This procedure allows to reduce the pressure inside the kidneys, which minimizes pain in the patient. Sometimes, if there is no particular difficulty in treating cysts, surgical ignipuncture is replaced by puncture with laparoscopic techniques with ultrasound control. This method is an invasive percutaneous puncture of a cyst without open surgical access to it, under the control of an ultrasound.
Special preparation for such a small operation is not required, except that it is carried out on an empty stomach.
Preparation for ultrasound in kidney biopsy
A biopsy is a collection of tissue from a specific organ for subsequent diagnosis. An open and closed biopsy is distinguished, when the tissue for morphological analysis is obtained by puncture or during surgical access to the test organ. Biopsy tissues are checked for:
- clarification of the diagnosis;
- clarification of the dynamics of therapy;
- tracking changes in the kidney condition after transplantation.
In preparation for an ultrasound of the kidneys for a closed percutaneous biopsy, the patient is recommended to undergo blood tests, urine tests, X-rays and renal urography, a coagulogram. In severe hypertension, the patient is carefully reduced and the normal pressure level is established before and after the biopsy. Before the biopsy, an additional ultrasound is performed. Doctors recommend to stop taking medicines, in particular coagulants and anti-inflammatory drugs. You also need to start to follow a diet that helps reduce flatulence, 3 days before the procedure. Before starting the study, you need to fill the bladder by drinking about half a liter of clean water.
Thus, it will not be difficult to prepare for an ultrasound examination of the kidneys and ureters, but in each case individual recommendations of specialists are possible, which must be complied with.
Ultrasound examination of the kidneys
If you experience pain in the lumbar region, discoloration of urine, pain when urinating and deviations in urinalysis and blood biochemistry, an ultrasound scan of the kidneys is shown for diagnostic purposes. In particular, the indications for this diagnosis are various edemas, diagnosed pyelonephritis, trauma to the urinary organs, cystitis, indications for examinations of the kidney arteries in cases of hypertension, urolithiasis, gout, diabetes, cysts and focal renal diseases.
An ultrasound of the kidneys is performed in the prone position on the side, back or abdomen, and in nephroptosis - standing. In the normal state, the kidney has a length of about 12 centimeters, its width and thickness is 5 centimeters, its parenchyma is homogeneous, and the echo is normal. Normally, it is also unacceptable to expand the cup-pelvis-plating system, the anteroposterior size of which is usually 1.5-2 centimeters. During an ultrasound examination, both the kidney and the fiber are examined around it. However, for many categories of citizens, these parameters may differ from those mentioned above. These categories include pregnant women, the elderly, children. If during the ultrasound of the kidneys new growths are detected, then the blood flow is measured by the Doppler method.
Ultrasound examination of the ureters
Under normal human physiological condition, the ureters cannot be determined. Their visualization is available only with strong dilatations arising due to pathologies of various kinds, such as the formation of stones, cicatricial narrowing of the ureters, or other obstructive causes. Therefore, for the purpose of detailed diagnostics of the state of the ureters, ureteroscopy is most often used. The essence of the method is to introduce a microscopic sensor through the lower urinary tract upwards. This study is the only effective method for examining the ureters from the inside.
The ureters are anechoic tube echostructures, the length of which normally should be about 30 centimeters and a diameter of about 5 millimeters. Stretch the ureters from the renal pelvis to the bladder. With their diseases, symptoms such as the appearance of blood marks in the urine, painful urination, pain in the iliac and lumbar areas are detected.
When urolithiasis occurs, the ureters expand due to the accumulation of urine due to obstruction of their lumen by the formed stones. With the help of ultrasound of the ureters, it is easy to determine the localization and size of the stones, because they have different echogenicity from the normal cavity of the ureter. At occurrence of tumors the contour of ureters changes.
Ultrasound examination of the ureters is often carried out in parallel with ultrasound of the kidneys, and, if necessary, it can be performed individually for certain indications. Ureters are examined by external ultrasound, transrectal or transvaginal access.
Specialty: therapist, nephrologist.
Total experience: 18 years.
Place of work: Novorossiysk, medical center "Nefros".
Education: 1994-2000 Stavropol State Medical Academy.
- 2014 - "Therapy" full-time advanced training courses on the basis of the State Budgetary Medical Educational Institution of Higher Professional Training "Kuban State Medical University".
- 2014 - "Nephrology" full-time refresher courses on the basis of the Stavropol State Medical University.