What does a homogeneous uterus mean

Sonographic examination of the urinary bladder and genital organs

Abstract

The urinary bladder lies immediately behind the pelvic symphysis when it is unfilled. It should be sufficiently filled for the examination so that wall thickenings or tumors can be clearly distinguished from the urinary bladder wall. In women, the vagina and uterus, in men the prostate and the vesicle gland should also be assessed. Here, too, a well-filled urinary bladder is an advantage, as it can be used as a sound window for the organs behind and below.

An ultrasound examination of the urinary bladder is indicated for incontinence, dysuria, hematuria and to determine residual urine. In women, ultrasound of the pelvis can also be used for an initial assessment of unclear pelvic problems, masses in the pelvis or vaginal bleeding. In men, it is carried out, among other things, when the PSA levels are elevated.

Physiologically, the urinary bladder presents itself as an anechoic, homogeneous organ, the wall of which is sharply defined and rich in echoes. The appearance of the uterus, vagina and ovaries can vary depending on the time of the cycle. The male reproductive organs that can be assessed with the aid of abdominal ultrasound include the vesicle gland and the prostate, which are homogeneous, parenchymal organs.

Examination video

Anatomical basics

bladder

  • Location: In the small pelvis immediately behind the pelvic symphysis
  • shape
    • Rectangular in cross-section
    • Triangular in longitudinal section
  • Volume: Depending on the filling level, 500–1,000 mL

For a detailed explanation of the organs see: urinary bladder.

Female reproductive organs

The female reproductive organs that can be assessed using abdominal ultrasound include

For a detailed explanation of the organs see: uterus, tuba uterina, ovary, vagina and vulva.

Male reproductive organs

The male reproductive organs that should be assessed in an abdominal ultrasound include:

For a detailed explanation of the organs see: prostate, vesicle gland and Cowper's gland.

Indications

bladder

Female reproductive organs

A sufficient transabdominal assessment of the uterus and ovaries is usually only possible in very slim patients. In general, if possible, transvaginal sonography is always preferable for gynecological questions, as it is superior to transabdominal sonography in terms of spatial resolution and local processes can be better assessed. A transabdominal sonography of the female internal genitalia is a good alternative to vaginal ultrasound, e.g. for vaginal stenosis or virgo intacta.

  • Usually co-assessment in the context of abdominal ultrasound
  • Others

Male reproductive organs

For specific questions (e.g. extent of prostate cancer), a transrectal ultrasound examination should be carried out, as the spatial resolution in this examination is significantly higher and parenchymal changes can be assessed much better.

Levels

  • Suprapubic longitudinal section
  • Suprapubic cross-section

execution

Both the urinary bladder and the genital organs are fully examined in the suprapubic longitudinal section and cross-section (i.e. beyond the organ boundaries) in the sagittal and transverse planes. The urinary bladder should always be filled so that its wall can be adequately assessed and to act as a sound window for the organs below and behind it.

bladder

Sagittal survey

  1. Place the transducer suprapubically in the longitudinal section of the lower abdomen and emit sound waves in a caudal direction
    • Adjust the triangular urinary bladder in the sagittal section
    • Measure the cranio-caudal diameter
  2. First move the transducer to the right and then to the left in the sagittal plane

Transverse survey

  1. Rotate the transducer 90 ° counterclockwise
    • Adjust the urinary bladder in cross section
    • Measure the ventrodorsal diameter and transverse diameter
  2. First move the transducer cranially and then caudally
    • Make a complete cross-section of the urinary bladder

Female reproductive organs

Sagittal survey

  1. Position the transducer in a suprapubic longitudinal incision
    • Use a filled urinary bladder as a sound window
    • Adjust uterine median-sagittal
    • Measure the uterus
      • Length (= cranio-caudal diameter): From the fundus to the caudal end of the cervix
      • Thickness (= ventrodorsal diameter): At right angles to the longitudinal axis at the point of maximum expansion
    • Measure the endometrium at its thickest point at right angles to the longitudinal axis of the uterus
  2. Swivel the transducer to either side of the body

Transverse survey

  1. Rotate the transducer 90 ° counterclockwise
    • Adjust the cross-section of the uterus (and, if visible, ovaries)
    • Measure the width of the uterus (= transverse diameter) at the point of maximum expansion
  2. Continuously move the transducer cranially and caudally
    • Scan the uterus completely beyond the organ borders in the transverse plane
  3. If necessary, adjust the position of the transducer to the longitudinal axis of the ovary

Male reproductive organs

Sagittal survey

  1. Place the transducer in a suprapubic longitudinal section and emit sound waves caudally
  2. Swivel the transducer to either side of the body
    • Scan the entire prostate in the sagittal section

Transverse survey

  1. Rotate the transducer 90 ° counterclockwise
  2. Tilt the transducer caudally
  3. Rotate the transducer continuously cranially and caudally

Normal findings

In normal findings, the urinary bladder presents itself as an echo-free, homogeneous organ, the wall of which is sharply defined and rich in echoes. Uterus, vagina, and ovaries can vary in appearance depending on the time of the cycle. The vesicle gland and the prostate appear as homogeneous, parenchymal organs.

Normal findings in the urinary bladder

  • Position: Immediately dorsal to the symphysis
  • Surroundings: