Trans-rectal prostatic ultrasound
When is this exam indicated?
The examination is performed upon recommendation of the general practitioner or urological specialist. The software of all ultrasound equipment allows to calculate the volume (and therefore the weight) of the whole gland and of the central zone of nodular hypertrophy (the so-called transition zone or prostate adenoma). This data, rather than providing the degree of obstruction, is useful in the diagnostic procedure for patients with obstructive urinary symptoms, or in cases where a surgical procedure is planned, in order to guide the choice of the most appropriate type of treatment. In addition, for patients with elevated PSA or with a positive rectal examination at the urological examination, during the execution of the examination we always look for possible nodular hypoechogenic areas, especially in the context of the peripheral gland, which may be suggestive of a malignant prostate neoplasm. This condition, however, requires an in-depth diagnostic investigation with second level methods such as multiparametric magnetic resonance imaging of the prostate or, if necessary, ultrasound-guided prostate biopsies. Transrectal ultrasound can provide us with a wide range of information: through transverse and longitudinal scans it is possible to highlight the presence of a detrusor hypertrophy of the bladder, which is often an indication of an obstruction in the compensation phase, or a reduction in the thickness of the bladder wall with diverticula or bladder pseudodiverticula (the so-called "stress bladder"). The visualization of a middle prostatic lobe protruding into the bladder or of a bladder stone could explain the obstructive disorders and justify the finding of an extensive residue after urination or the picture of stress bladder, almost unequivocal indications of an obstructive picture.
How is it performed?
It is performed by introducing an endorectal ultrasound probe to visualize the prostate. The examination should be performed with a full bladder, so it is advisable, in the hour before the inspection, to drink at least one liter of water and to hold your urine.
The presence of bleeding hemorrhoids or anal fissures is a contraindication to transrectal prostate ultrasound.