EP36.14: Routine gynecological ultrasound: don't forget to look at the bladder and the ureters

To illustrate the technical simplicity and additional diagnostic value of looking at the bladder and the ureters during a standard transvaginal ultrasound examination. We present a case series illustrating ureter and bladder pathology diagnosed by transvaginal ultrasound. Once a bladder is minimally filled, the anechogenic content is visible on ultrasound scan. To differentiate between a unilocular anechogenic adnexal cyst and the bladder, we identify the urethra and the ureters. The evaluation of bladder wall incidentally shows a deep endometriosis nodule or a transitional cell carcinoma, while ureters are scanned for the presence of lithiasis and hydroureteronephrosis. Moreover, site specific tenderness during transvaginal scan over the trigonum, the urethra or a bladder wall nodule is suggestive for cystitis, urethritis or bladder wall endometriosis respectively. In a first case, transvaginal ultrasonography in a woman with lower abdominal pain showed a calculus in the left distal ureter. The small echogenic lesion was easily detectable within the ureter lumen. A second patient, presenting with suprapubic pain, urge incontinence and back pain, was also diagnosed with a ureteral calculus and had additional hydroureter. The presence of a hydroureter is part of the differential diagnosis of any cystic structure in the pelvis. In a third case, an elderly woman, referred with uterine prolapse, transvaginal ultrasound examination showed a hydrouteronephrosis, illustrating the differential diagnosis with a hydrosalpinx. A fourth patient, presenting with hematuria, showed an irregular and highly vascularised mass in the bladder and was diagnosed with a transitional cell carcinoma. The bladder and pelvic part of the ureters are easily identifiable on transvaginal scan. Important pathology of the lower urinary tract and the distal ureters can be readily be diagnosed by transvaginal ultrasound examination. The evaluation of the bladder and the ureters should therefore be part of the standard gynecological ultrasound investigation. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.