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Ultrasound of the prostate does not require a catheter and gives an accurate picture of the size and shape of the prostate gland. Ultrasound is very beneficial when planning surgery as well as determining treatment options and gauging their effectiveness (UPMC, 2013). According to University of Maryland Medical Center, ultrasound is a painless procedure that can give an accurate picture of the size and shape of the prostate gland. Ultrasound may also be used for detecting kidney damage, tumors, and bladder stones. Ultrasound tests of the prostate generally use one of two methods:
First is the rectal ultrasound, which is also known as transrectal ultrasonography (TRUS). It is used when there is a suspicion of prostate cancer. Here a probe inserted in the rectum, directs sound waves at the prostate. The echo patterns of the sound waves form an accurate image of the size and shape of the prostate gland on a display screen. uses a rectal probe for assessing the prostate. TRUS is significantly the most accurate method for determining prostate volume. TRUS has many advantages, including its port ability, ease of use, lack of ionizing radiation, low cost, and its capability to perform real-time imaging. Ultimately, however, TRUS is not a high-resolution imaging modality (Medscape, 2009).
Next is the transabdominal ultrasonography, which takes an abdominal approach and gives an accurate measure of post voiding residual urine. It is less invasive and expensive than TRUS. It is useful in determining the treatment options, their effectiveness, and surgery. It also detects kidney damage, bladders stones and tumours. Transabdominal ultrasonography uses a device placed over the abdomen. It can give an accurate measure of postvoid residual urine and is less invasive and expensive than TRUS.
3.2 Intravenous Pyelogram (IVP) or Urogram
An x-ray called an intravenous excretory urography (IVU) is an invasive test that is used only when complications in the upper urinary tract, particularly in the kidney, are suspected (UPMC, 2013). Intravenous pyelogram is a series of x-rays of the kidney, ureters, and bladder with the injection of a contrast dye into the vein to detect tumors, abnormalities, kidney stones, or any obstructions and to assess renal blood flow.
Dye is injected into your system which reveals your entire urinary system on an X-ray or computed tomography (CT) scan (University of Miami Health System, 2013). Traditionally this was always done by means of an intravenous pyelogram (IVP). An ultrasound scan combined with an ordinary abdominal X-ray is a viable alternative to IVP. Abdominal ultrasound plus a normal x-ray may be as useful as IVU for most patients with suspected upper tract problems. If there is any danger of kidney failure, the test should not be performed since it can exacerbate the condition. Severe side effects of the test occur in 0.1 percent of patients. The advantages of ultrasound are that it does not involve any radiation or contrast medium and that it is non-invasive. Ultrasound is also more sensitive than IVP in the detection of small tumours or in other related pathology. Ultrasound is less sensitive than IVP in the detection of small tumours of the drainage system of the kidney, however, and the accuracy of ultrasound is dependent on the skill of the person performing the procedure (e-radiography, n.d). Intravenous pyelography still has a role in certain cases, as other modalities do not outline the anatomy of the collecting system with such definition (Mark Frydenberg, Nathan Lawrentschuk, 2012).
3.3 Magnetic Resonance Imaging (MRI)
Typically demonstrates the enlarged central zone to be heterogenous in signal with an intact low signal pseudocapsule around its periphery. (Radiopaedia, 2013). MRI of Prostate for BPH is recommended to be performed on a 1.5 Tesla MRI or greater field strength (i.e. 3.0T). While an endorectal coil is beneficial, it is not required to achieve excellent diagnostic results.
MRI provides superior soft-tissue contrast, images the entire gland, providing multiple views of the anatomy and all prostate structures, including all prostate zones, urethra, seminal vesicles, bladder, etc (Resonant Directive, 2011). The images can then be examined on a computer monitor, transmitted electronically, printed or copied to a CD. MRI does not use ionizing radiation (x-rays) (Radiological Society of North America,2012).
MRI is a non invasive imaging technique that does not involve exposure to ionizing radiation. MRI images of the soft-tissue structures of the body including the prostate and other pelvic structures are clearer and more detailed than with other imaging methods. This detail makes MRI a valuable tool in early diagnosis and evaluation of tumors. MRI has proven valuable in diagnosing a broad range of conditions, including cancer, and benign conditions such as benign prostatic hyperplasia and infection. MRI spectroscopy can examine the chemical makeup of the prostate which can be helpful in identifying prostate cancer. MRI enables the discovery of abnormalities that might be obscured by bone with other imaging methods. The contrast material used in MRI exams is less likely to produce an allergic reaction than the iodine-based materials used for conventional x-rays and CT scanning (ArchRad, 2010).
However, while the scanner is taking images, the patient will hear rapidly repeating, loud thumping noises coming from the walls of the scanner, so earplugs are usually provided to the patient to reduce the noise. The entire test usually takes quite a long time, which is between 30 and 60 minutes to complete. For generally healthy individuals, MRI poses no risk. But patients with pacemakers, aneurysm clips, ear implants and metallic pieces in vital body locations cannot be imaged safely (UrologyCareFoundation, 2011).
3.4 Computed Tomography (CT) Scan
Not typically used to assess the prostate, BPH is more frequently an incidental finding. Extension above the symphasis pubis was used as a marker on axial imaging, however now that volume acquisition and coronal reformats are standard, the same criteria as on ultrasound can be used (>30 cc) (Radiopaedia, 2013).
CT is a widely used modality in both the diagnosis and follow-up of nearly all malignancies, but it has only a limited role in the imaging of prostate cancer owing to its poor soft-tissue contrast resolution, which does not allow precise distinction of the internal or external anatomy of the prostate (Medscape, 2009).
Table 4 Advantages and disadvantages of ultrasound imaging modality and CT scan.