All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Bladder ultrasound
Medical expert of the article
Last reviewed: 05.07.2025
Indications for ultrasound of the bladder
- Dysuria or frequent urination.
- Hematuria (wait until bleeding stops).
- Recurrent inflammation (cystitis) in adults; acute infection in children.
Indications for ultrasound of the bladder
The patient's preparation for the ultrasound examination of the bladder is as follows: The bladder should be full. Give the patient 4 or 5 glasses of fluid and perform the examination an hour later (do not allow the patient to urinate). If necessary, the bladder can be filled with sterile saline through a catheter: filling should be stopped when the patient feels discomfort. Avoid catheterization if possible due to the risk of infection.
Preparation for ultrasound of the bladder
Start with transverse cuts from the symphysis to the navel area. Then move on to longitudinal cuts from one side of the abdomen to the other.
This is usually sufficient, however, with this scanning technique it is difficult to visualize the lateral and anterior walls of the bladder, so it may be necessary to rotate the patient by 30-45° to obtain an optimal image of these areas.
Methodology for performing ultrasound examination of the bladder
The filled bladder is visualized as a large anechoic structure emerging from the pelvis. At the beginning of the examination, determine the condition (evenness) of the internal contour and symmetry on the cross-sections. The thickness of the bladder wall varies depending on the degree of filling of the bladder, but it is the same in all sections.
Non-invasive ultrasound of the urinary bladder is performed through the anterior abdominal wall with a full urinary bladder (at least 150 ml of urine). Normally, on transverse scanograms it is visualized as an echo-negative (liquid) formation of a round shape (on longitudinal scanograms - ovoid), symmetrical, with clear even contours and homogeneous contents, free of internal echo structures. The distal (relative to the sensor) wall of the urinary bladder is somewhat easier to determine, which is associated with the amplification of reflected ultrasound waves at its distal border, associated with the fluid content in the organ.
The wall thickness of an unchanged bladder is the same in all its sections and is about 0.3-0.5 cm. Invasive ultrasound methods - transrectal and intravesical (transurethral) - allow a more detailed assessment of changes in the bladder wall. Transrectal ultrasound (TRUS) only clearly shows the neck of the bladder and the adjacent pelvic organs. Intravesical echoscanning with special intracavitary sensors passed through the urethra allows a more detailed study of pathological formations and the structure of the bladder wall. In addition, layers can be differentiated in the latter.
Ultrasound signs of a normal bladder
Poor bladder emptying indicates the presence of an acute inflammatory process, as well as a long-standing or recurrent infection. The prevalence of calcification does not correlate with the activity of schistosomiasis infection, and calcification may decrease in the late stages of the disease. However, the bladder wall remains thickened and poorly stretchable. Hydronephrosis may be detected.
On echograms, bladder tumors are represented by formations of various sizes, usually protruding into the cavity of the organ, with an uneven outline, often of a bizarre or rounded shape and a heterogeneous echostructure.
Differential diagnosis of the tumor should be carried out with blood clots in the bladder. As a rule, the tumor is characterized by hypervascularization, which can be detected by Dopplerography.
In acute inflammation of the bladder, echography usually does not provide the necessary information. However, in individual observations, as well as in chronic cystitis, it is possible to detect wall thickening, contour unevenness, and sometimes bladder asymmetry.
Ultrasound is of great help in diagnosing diverticula and bladder stones, as well as ureterocele.
Using echo-Dopplerography, it is possible to visualize the urine discharge from the ureteral orifices and perform its quantitative assessment. Thus, as a result of complete occlusion of the UUT, there is no urine discharge from the corresponding orifice using color Doppler mapping. With impaired but partially preserved urine outflow from the kidney, during the discharge of the urine bolus from the corresponding ureteral orifice, a decrease in its flow velocity and a change in the spectrum of the latter are determined. Normally, the spectrum of ureteral discharge flow velocities is presented in the form of peaks, and the maximum urine flow velocity is on average 14.7 cm/s.
In cases of bladder damage, ultrasound helps to detect paravesical urine leakage in case of extraperitoneal rupture or fluid in the abdominal cavity in case of intraperitoneal lesions. However, the final diagnosis can only be established using X-ray examination methods.