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RADIOLOGY CORNER A Case in Point for Relevance of Point-of-Care Ultrasound Imaging in Urology Practice

By: Parth Joshi, MD, NYU Langone Hospital–Long Island, New York; Leili Mirsadraei, MD, NYU Langone Hospital–Long Island, New York; Victoria Popolizio, BS, RVT, NYU Langone Hospital–Long Island, New York; Katharine Hodgen, MD, NYU Langone Hospital–Long Island, New York; Richard Schoor, MD, NYU Langone Hospital–Long Island, New York | Posted on: 20 May 2024

Clinical Case

A 50-year-old male former smoker presented to our institution with dysuria. He reported a brief episode of gross hematuria that resolved several weeks prior to his visit. Initially anxious about undergoing an office cystoscopy, the patient consented to in-office point-of-care ultrasound. This study showed a 2-cm pedunculated bladder mass (Figure 1). After identifying the mass on ultrasound, the patient underwent cystoscopic evaluation (Figure 2), as well as CT urogram to complete the workup (Figure 3).

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Figure 1. Two-cm pedunculated bladder mass seen on ultrasound.

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Figure 2. Papillary-appearing bladder mass on the right lateral wall.

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Figure 3. CT urogram showing bladder mass.

The patient underwent transurethral resection a few weeks later and received 1 dose of intravesical gemcitabine post resection. Pathology results revealed noninvasive low-grade papillary urothelial carcinoma with no involvement of the muscularis propria (Figure 4). The patient underwent surveillance cystoscopy 6 months later, which was negative for recurrent bladder cancer.

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Figure 4. Low-grade noninvasive papillary urothelial carcinoma (hematoxylin-eosin, original magnification ×20).

Discussion

Ultrasound imaging remains integral to urology practice. High-quality units have substantially decreased in price, making it more affordable and accessible to all urologists, even solo practice providers. Point-of-care ultrasound benefits both the urologist and the patient.1

Though not a perfect imaging modality, ultrasound is quite useful to evaluate all organs of the genitourinary tract. Ultrasound is particularly ideal for assessing scrotal pathology, especially when used in conjunction with a thorough physical exam.2 Also, ultrasound is the diagnostic imaging modality of choice in the care of pediatric patients for a variety of reasons and readily detects myriad conditions that afflict children from womb to college age.3,4 Ultrasound is noninvasive, and there have been no confirmed adverse effects caused by diagnostic ultrasound.2,5

Indications for urologic ultrasound are well known and accepted, including bladder-limited scanning for hematuria and voiding dysfunction. Bladder-limited ultrasound can accurately depict prostate volume and anatomy, such as absence or presence of a middle lobe. In the setting of benign prostatic hyperplasia, it can be used to obtain postvoid residual volumes.5 In addition, bladder wall thickness, trabeculae, diverticula, stones, evaluation of clot retention, and dilated ureters can all be readily identified using basic ultrasound technology. When using bladder-limited ultrasound, evaluation ideally includes both transverse and longitudinal images of the distended bladder and its wall.6

While cystoscopy remains the gold standard for bladder cancer detection, bladder-limited ultrasound, when properly utilized, performs surprisingly well in this capacity. Gharibvand et al evaluated 75 patients who underwent sonography for the diagnosis of bladder tumors and reported that the sensitivity, specificity, positive predictive value, and negative predictive value of this imaging modality were 93.24%, 100%, 100%, and 16.66%, respectively.7

  1. Moslemi MK, Mahfoozi B. Urologist-operated ultrasound and its use in urological outpatient clinics. Patient Prefer Adherence. 2011;5:85-88. doi:10.2147/PPA.S17132
  2. Goldenberg E, Gilbert BR. Office ultrasound for the urologist. Curr Urol Rep. 2012;13(6):460-466. doi:10.1007/s11934-012-0280-y
  3. Arbel LT, Phillips TM, Brink DS, Joshi P. Capillary hemangioma of the bladder in a pediatric patient. Urol Case Rep. 2022;42:102002. doi:10.1016/j.eucr.2022.102002
  4. Schiller E, Joshi P, El-Ali A, et al. In-utero diagnosis of prostatic embryonal rhabdomyosarcoma. Urology. 2023;182:e253-e256. doi:10.1016/j.urology.2023.08.030
  5. Terris MK, Klaassen Z. Office-based ultrasound for the urologist. Urol Clin North Am. 2013;40(4):637-647. doi:10.1016/j.ucl.2013.07.006
  6. American Institute of Ultrasound in Medicine; American Urological Association. AIUM practice guideline for the performance of an ultrasound examination in the practice of urology. J Ultrasound Med. 2012;31:133. doi:10.7863/jum.2012.31.1.133
  7. Gharibvand MM, Kazemi M, Motamedfar A, Sametzadeh M, Sahraeizadeh A. The role of ultrasound in diagnosis and evaluation of bladder tumors. J Family Med Prim Care. 2017;6:840. doi:10.4103/jfmpc.jfmpc_186_17

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