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 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 periodically passes tests to determine cancer markers. In addition, if such diseases are suspected, a high-quality instrumental diagnosis is performed. One method is transrectal ultrasound. It is carried out for both men and women with suspected oncological and inflammatory processes in the pelvic organs. Compared with abdominal ultrasound, this method is considered more reliable, since the sensor is closer to pathological processes. Therefore, it is possible to consider the organs better.
What is transrectal ultrasound?
This method is based on the action of ultrasound. As you know, this method of visualization refers to non-invasive procedures. Ultrasound waves are able to reflect on the tissues of the human body, as well as pass through them. Transrectal ultrasound (TRUS) does not differ in mechanism of action from other varieties of research. The only difference is that the sensor is inserted into the rectum, and not installed on the surface of the abdomen.
Due to the fact that all tissues have different echo densities, the doctor manages to 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 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 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). Nevertheless, when installing the sensor in the rectum, visualization is better, due to the reduced distance between the device and the tissues.
Indications for transrectal ultrasound of the prostate
Transrectal ultrasound of the prostate is a reliable method for the diagnosis of prostate diseases. It is the preferred research method, especially if cancer is suspected. Nevertheless, the appointment of TRUS does not mean that there is cancer. Therefore, do not panic and draw hasty conclusions in advance . It is worth knowing that with abdominal access, ultrasonic waves pass through many tissues (skin, fatty tissue, muscles). Only after that they get on a 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 examination. After all, the prostate gland borders on the rectum. Indications for TRUS are the following conditions:
- Benign prostate masses. 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. If cancer is suspected, TRUS is the main diagnostic method. This is due to the fact that under the control of ultrasound , a puncture of the organ is performed. Thus, the doctor evaluates the ultrasound picture and performs a targeted biopsy. That is, it extracts material (tissues) from pathological foci.
- Preparation for surgery on the prostate.
- 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, giving to the anus. Also, this study is performed in violation of urination and ejaculation, impotence.
Indications for transrectal ultrasound in women
Transrectal ultrasound in women is performed less frequently than in men. Most often, this diagnostic method is carried out with suspected cancer pathology. 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 slightly different. Given the fact that examination of the uterus and appendages is carried out more often, in most cases transvaginal ultrasound is recommended. However, in some cases, visualization of organs through the rectum provides more information about the disease.
An indication for transrectal ultrasound in women is the study of Douglas space. It is a peritoneum pocket located between the rectum and the uterus. Thus, TRUS allows to assess the state of pararectal fiber and the posterior fornix of reproductive organs. It is carried out under the following conditions:
- Suspicion of an abscess of Douglas space. Often this inflammatory process is a consequence of complications of appendicitis and peritonitis.
- Oncological pathologies of the uterus, rectum.
- Suspicion of metastases in pararectal fiber. It occurs with tumors of the stomach.
- Inflammatory processes in the rectum.
- Benign neoplasms on the back of the uterus.
In both women and men, TRUS is used to evaluate the condition of the urogenital organs. However, in most cases they are examined using transabdominal access.
Diagnosis of diseases of the bladder by TRUS
In addition to the organs listed above, the bladder is located in the pelvic cavity. It is located in front of the rectum. In women, the uterus blocks access to it. Therefore, transrectal ultrasound of the bladder is more often performed in men. It is carried out with suspicion of tumor, benign masses and inflammatory infiltrates. In women, TRUS of the bladder is performed if there is an adhesion process in the pelvis or severe obesity. Also, a similar method is used so as not to damage the hymen by inserting the sensor into the vagina.
Contraindications to transrectal ultrasound
In some cases, transrectal ultrasound is not recommended. An absolute contraindication to this diagnostic method is atresia of the anus. This is a congenital malformation, in which there is no anal opening. A similar developmental anomaly is diagnosed in the first days of life. Other contraindications are relative. This means that in case of urgent need, research is underway. Nevertheless, it is better to replace it with other diagnostic methods. Relative contraindications include:
- Fresh rectal fissures. With this disease, any manipulations performed transrectally are prohibited. Nevertheless, after treatment of a crack (relief of an acute condition), TRUS is possible.
- The presence of inflamed hemorrhoids outside and inside the rectum. In this case, transrectal administration of an ultrasound probe 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 passages, etc.
Transrectal ultrasound: preparation for the study
Like any transrectal study, 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 several hours before the procedure. If rectal diseases serve as an indication for the study, it is necessary to exclude spicy foods, soda and alcohol from the diet. Before performing prostate transplantation, a preliminary diet is not required. If the object of the study is the bladder, it must be filled. For this purpose, 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 invited 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 pelvic ultrasound in women is most often performed on a proctological chair (or gynecological). In the same way, a bladder examination is performed. In some cases, the patient is offered to take a knee-elbow position. More often - with suspected rectal pathology.
Before you enter the ultrasound probe into the anal canal, it is lubricated with petroleum jelly 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 arch of the uterus and the 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
The benefits of TRUSI include:
- Lack of radiation exposure.
- Painlessness.
- Informational content.
- Improving visualization of the pelvic organs. High informativeness 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 in the abdominal wall.
Results of transrectal ultrasound
Thanks to the TRUS method, it is possible to diagnose pelvic neoplasms, as well as metastases in pararectal fiber. 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 sites. The conclusion on the ultrasound picture is performed by a functional diagnostics doctor, urologist, gynecologist.