Requiring a woman to present with a full bladder prior to a sonographic pelvic evaluation could become a practice of the past, as ultrasound with an empty bladder provides equally valid information, according Harvard University researchers.
A group from Brigham and Women's Hospital and Massachusetts General Hospital in Boston, both of which are affiliated with the university, tested transvaginal and transabdominal ultrasound with an empty bladder for routine pelvic screening. The results of the study were published in the April 2000 issue of the Journal of Ultrasound in Medicine.
"I've been doing ultrasound for a long time now and, for the past 25 years, I've been asking women to fill their bladders," said lead author Dr. Beryl Benacerraf. "I've also been noticing more of the incredible changes that have gone on in the quality of instrumentation that we have. There have been a lot of changes that have taken place in our ability to evaluate the pelvis, yet the full bladder technique has remained a mainstay. Maybe it's time to revisit this."
During a one-month period, 206 consecutive patients were scanned prospectively. All of those presenting with a full bladder were scanned transabdominally by a sonographer. The patient was then scanned transvaginally by a physician. Finally, the patient was scanned with both techniques and an empty bladder. The doctor and sonographer then concurred on the sufficiency of the following scans: transvaginal alone, transvaginal plus transabdominal with an empty bladder, and either technique with a full bladder.
According to the results, a transvaginal scan alone was acceptable in 83.5% of the patients. The transvaginal and transabdominal scans through an empty bladder were needed for 15% of the women. In 1.5% of the cases, a full bladder was necessary for a transvaginal scan to visualize one normal ovary.
"All three of these patients had enlarged uteruses," Benacerraf said. "Perhaps that was why the normal ovary was up high and out of the way. Also, two of these patients were postmenopausal."
While age was not a significant factor in the success rate of the scans, the type of findings did influence whether the bladder needed to be full or empty.
"There is a difference depending on what the anomaly was in terms of which technique worked best," Benacerraf said. "If the uterus was enlarged or there were fibroids, 24% of the patients needed a transabdominal scan with an empty bladder along with the transvaginal scan. For those that had endometrial abnormalities only, or those that had normal scans -- in the 90% range -- the transvaginal approach was sufficient."
Specifically, 96.2% of the patients with normal scans and 96.9% of those with adnexal findings only needed transvaginal sonography. Benacerraf concluded that transvaginal sonography with the adjunct of transabdominal imaging of an empty bladder can replace the full bladder for a routine pelvic exam.
"I wrote this study in order to begin the switch over that I intend to do in our practice," she said. "Already we do a lot of patients without full bladders. The request is that they come in with a full bladder, but I would say that only about 65% of them do. We don't send anybody away because they are not full. We simply do them the way they are. There is only a small number of patients in which (ultrasound with an empty bladder) fails to provide all of the information that is necessary."
By Shalmali Pal
AuntMinnie.com staff writer
May 2000
Related Reading
"Is a full bladder still necessary for pelvic sonography?," Journal of Ultrasound in Medicine, April 2000, Vol.19:4, pp.237-241
"Role of transvaginal sonography in pelvic scan for female reproductive system," Journal of the Indian Medical Association, August 1995, Vol.93:8, pp.301-304, 309
"Transvaginal sonography of cervical width and length during pregnancy," Journal of Ultrasound in Medicine, Sept. 1992, Vol.11:9, pp.465-467
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