Despite the fact that advanced imaging techniques are assuming increasing importance in the management of urologic patients, ultrasound remains a vital component of both diagnosis and treatment.¹ The “Hands-on Urologic Ultrasound” course (101HO) was presented April 27 in Chicago for the 25th year. If the participant completes the precourse didactic component and successfully demonstrates the skills outlined in the hands-on course objectives, they are awarded a total of 16.5 hours of American Medical Association Physician’s Recognition Award category II continuing medical education credit.

The longevity and popularity of the course is explained by a precourse didactic segment consisting of comprehensive instruction in the physics and technique associated with each of the most common procedures performed by urologists in their clinical practice. The hands-on portion of the course uses human models (which is unique among the hands-on imaging courses offered) to acquire the skills necessary to perform and document a quality examination (Figure 1).² The instructors are all clinical urologists with many years of practical experience.

Figure 1. Course faculty guides participant in the performance of transabdominal ultrasound.

This course is characterized by a physics-based approach and makes optimization of imaging a priority. The course provides training which includes ethical patient selection, image documentation, and appropriate selection of imaging category (eg, limited vs complete). These are skills that are required to produce optimal examinations to answer specific clinical questions which are encountered in office patients. These same skills can be applied directly to any other specific diagnostic or therapeutic procedure in which ultrasound plays a role (eg, platform-based fusion biopsy of the prostate, focal ablation of renal and prostate tumors).

The course is intended to train the health care provider in the effective use of ultrasound (whether a urologist or an advanced practice provider associated with the urologist). The course has proven valuable for residents, academicians, and those in private practice settings. Previous participants have taken this training back to their clinical practice and report the course improved their practice.

Specific technical training in the performance of renal, transabdominal prostate and bladder, and scrotal examinations is offered. Human models are used to teach specific examinations, and gel phantoms are used to demonstrate ultrasound artifacts and to practice ultrasound targeting and biopsy of objects. The phantom includes a renal phantom and other objects (Figure 2, A and B). Multiparametric ultrasound is emphasized with a discussion of techniques using Doppler ultrasound, contrast-enhanced ultrasound, and elastography.

Figure 2. A, Phantom containing olive which is the target for ultrasound-guided biopsy. B, Course participant using ultrasound to guide the needle to biopsy the olive within the phantom.

A major focus of this course is the ethical use of ultrasound to answer specific clinical questions. For example, renal ultrasound may be used with excellent sensitivity to exclude hydronephrosis in the follow-up of ureteroscopic procedures (Figure 3).³ Instruction in the selection of the proper procedure and coding and documentation of each exam were provided.

Figure 3. Renal ultrasound image demonstrating hydronephrosis.

Based on the AUA/SUFU (Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction) Guideline for Microhematuria published in 2020,⁴ a patient who presents to the office with low- or intermediate-risk microscopic hematuria may be completely evaluated by cystoscopy and point-of-service renal ultrasound in a single visit. This provides great value to the patient in terms of time savings and immediacy of results. “In low-risk patients with microscopic hematuria, clinicians should engage patients in shared decision-making to decide between repeating [urinalysis] within 6 months or proceeding with cystoscopy and renal ultrasound. (Moderate Recommendation; Evidence Level: Grade C).”

Obstructive voiding symptoms may be investigated by transabdominal ultrasound of the pelvis. This technique provides excellent anatomical resolution of the bladder and prostate, giving information about the size and morphology of the prostate (Figure 4). This information, in turn, may inform the urologist about the optimum interventions for managing bladder outlet obstruction.

Figure 4. Transabdominal ultrasound image demonstrating measurement of prostate volume.

Most urologists perform some form of ultrasound in practice, with transrectal ultrasound being the most commonly performed procedure. Data from the American Board of Urology (ABU) surgical logs from 2012 to 2014 were reviewed to evaluate the utilization of nonprostate ultrasound. The data from 2,427 urologists submitting case logs for certification or recertification to the ABU for those years revealed 43% submitted codes for at least 1 renal, scrotal, or penile ultrasound.⁵ Similar data from ABU case logs of 6,049 urologists from 2015 to 2022 showed that 53.1% of urologists submitted codes for nonprostatic ultrasound. There is clearly an increasing need for ongoing postgraduate training in urological ultrasound.

As imaging continues to evolve in complexity, high-quality ultrasound examinations remain a vital component of the diagnosis and treatment of urology patients. Providers must stay abreast of innovations in multiparametric ultrasound to support effective and efficient examinations if our patients are to derive the maximum benefit from our interventions.