Skip to main content
SpringerLink
Log in

Intraoperative Urologic Ultrasound

  • Chapter
  • First Online:
Practical Urological Ultrasound

Part of the book series: Current Clinical Urology ((CCU))

  • 1639 Accesses

Abstract

Interventional ultrasonography (US) in urology includes many different diagnostic and therapeutic minimally invasive procedures. It also represents a noninvasive tool that, if placed in the hands of a trained surgeon, can aid various types of urologic interventions, allowing for on-the-fly, real-time visualization of important structures and operative activity that is both safe and inexpensive. Newer machines and probes allow for ultrasound application intraoperatively in virtually all areas of the urogenital tract and are increasingly used by urologists as an adjunct to standard operating techniques.

Procedures guided by dynamic ultrasound scanners produce real-time two-dimensional (2D) images and a needle-steering device mounted on the transducer can direct a needle into the image plane along a predictable route. Transducers are equipped with puncture-guiding devices, either as an external attachment or as an internal biopsy canal. First the transducer is positioned to identify the target. Then, the transducer is angulated using the rocking technique until the target is transected by the puncture line on the monitor. The needle is subsequently inserted through the guiding device and monitored continuously until the tip reaches the target.

During the US, the needle tip may generate reflections and backscattering. Target visualization can be enhanced with color Doppler signals to detect malignant neovascular formations. Recently, the experimental IV ultrasound contrast agents have demonstrated encouraging initial reports. The advancements of minimally invasive surgery required the adaptation and development of newer probes that could deliver the high-quality images via different handles and smaller dimensions. Nowadays, laparoscopic or robotic-assisted nephron-sparing kidney surgery cannot be performed safely without a laparoscopic ultrasound. These refined transducers have reached the pinnacle of portability and now are incorporated into the arms of robotic systems.

According to the American Urological Association Consensus Statement on Urologic Ultrasound Utilization, the appropriate transducer frequencies are 3.0–5.0 MHz for abdominal scanning, 6.0–9 MHz for transrectal, and 7.0–12.0 MHz for genital ultrasound. Intraoperative and laparoscopic renal ultrasound is performed with a 6–10-MHz linear array transducer. Transducers of higher frequency may be used for specialized exams. The equipment should be safe and display mechanical and thermal indices and provide for adjusting power output. Equipment should have software-controlled options which allow the user to obtain the highest-quality image and documentation (http://www.auanet.org/content/guidelines-and-quality-care/policy-statements/c/consensus-statement-on-urologic-ultrasound-utilization.cfm).

We will describe many of the instruments, practical applications, and techniques and describe important findings the urologist should appreciate on ultrasound during these procedures. We will further discuss hallmark ultrasonography images found in intraoperative urologic procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. http://www.auanet.org/content/guidelines-and-quality-care/policy-statements/c/consensus-statement-on-urologic-ultrasound-utilization.cfm.

  2. Goodwin WE, Casey WC, Woolf W. Trocar (needle) nephrostomy in hydronephrosis. JAMA. 1955;157: 891–4.

    Article  CAS  Google Scholar 

  3. Gu Z, Qi J, Shen H, Liu J, Chen J. Percutaneous nephroscopic with holmium laser and ultrasound lithotripsy for complicated renal calculi. Lasers Med Sci. 2010;25:577–80.

    Article  PubMed  Google Scholar 

  4. Gupta S, Gulati M, Uday Shankar K, et al. Percutaneous nephrostomy with real-time sonographic guidance. Acta Radiol. 1997;38:454–7.

    CAS  PubMed  Google Scholar 

  5. Bird VG, Fallon B, Winfield HN. Practice patterns in the treatment of large renal stones. J Endourol. 2003; 17:355–61.

    Article  PubMed  Google Scholar 

  6. Skolarikos A, Alivizatos G, Papatsoris A, et al. Ultrasound-guided percutaneous nephrostomy performed by urologists: 10-year experience. Urology. 2006;68:495–9.

    Article  PubMed  Google Scholar 

  7. Alken P, Hutschenreiter G, Günther R. Percutaneous kidney stone removal. Eur Urol. 1982;8:304–11.

    CAS  PubMed  Google Scholar 

  8. Miano R, Scoffone C, De Nunzio C, Germani S, Cracco C, Usai P, et al. Position: prone or supine is the issue of percutaneous nephrolithotomy. J Endourol. 2010;24:931–8.

    Article  PubMed  Google Scholar 

  9. Wah T. Percutaneous nephrostomy and antegrade ­ureteric stenting. Controversies and Consensus in Imaging and Intervention. 2005;3:20–2. Retrieved from www.c2i2.digithalamus.com (Feb 2012)

  10. El-Nahas AR, Shokeir AA, El-Assmy AM, Shoma AM, Eraky I, El-Kenawy MR, et al. Colonic perforation during percutaneous nephrolithotomy: study of risk factors. Urology. 2006;67(5):937–41.

    Article  PubMed  Google Scholar 

  11. Basiri A, Ziaee A, Kianian H, et al. Ultrasonographic versus fluoroscopic access for percutaneous nephrolithotomy: a randomized clinical trial. J Endourol. 2008;22:281–4.

    Article  PubMed  Google Scholar 

  12. Radecka E, Magnusson A. Complications associated with percutaneous nephrostomies: a retrospective study. Acta Radiol. 2004;45:184–8.

    Article  CAS  PubMed  Google Scholar 

  13. von der Recke P, Nielsen MB, Pedersen JF. Complications of ultrasound guided nephrostomy: a 5-year experience. Acta Radiol. 1994;35:452–4.

    PubMed  Google Scholar 

  14. Lewis S, Patel U. Major complications after percutaneous nephrostomy—lessons from a departmental audit. Clin Radiol. 2004;59:171–9.

    Article  CAS  PubMed  Google Scholar 

  15. Torres Muñoz A, Valdez-Ortiz R, González-Parra C, Espinoza-Dávila E, Morales-Buenrostro LE, Correa-Rotter R. Percutaneous renal biopsy of native kidneys: efficiency, safety and risk factors associated with major complications. Arch Med Sci. 2011;7:823–31.

    Article  PubMed  Google Scholar 

  16. Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol. 2000;163:442–5.

    Article  CAS  PubMed  Google Scholar 

  17. Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H. Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc. 2000;75:1236–42.

    Article  CAS  PubMed  Google Scholar 

  18. Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, et al. Chronic kidney disease after ­nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006; 7:735–40.

    Article  PubMed  Google Scholar 

  19. Lee CT, Katz J, Shi W, Thaler HT, Reuter VE, Russo P. Surgical management of renal tumors 4cm or less in a contemporary cohort. J Urol. 2000;163:730–6.

    Article  CAS  PubMed  Google Scholar 

  20. Baust JG, Gage AA, Clarke D, et al. Cryosurgery—a putative approach to molecular-based optimization. Cryobiology. 2004;48:190–204.

    Article  CAS  PubMed  Google Scholar 

  21. Baust JG, Gage AA. The molecular basis of cryosurgery. BJU Int. 2005;95:1187–91.

    Article  PubMed  Google Scholar 

  22. Curry NS, Bissada NK. Radiologic evaluation of small and indeterminant renal masses. Urol Clin North Am. 1997;24:493–505.

    Article  CAS  PubMed  Google Scholar 

  23. Onik G, Reyes G, Cohen J, Porterfield B. Ultrasound characteristics of renal cryosurgery. Urology. 1993; 42:212–5.

    Article  CAS  PubMed  Google Scholar 

  24. Lockhart ME, Smith JK, Kenney PJ. Imaging of ­adrenal masses. Eur J Radiol. 2002;41(2):95–112.

    Article  PubMed  Google Scholar 

  25. Hijioka S, Sawaki A, Mizuno N, Hara K, Mekky MA, El-Amin H, et al. Contrast-enhanced endoscopic ultrasonography (CE-EUS) findings in adrenal metastasis from renal cell carcinoma. J Med Ultrason. 2011;38:89–92.

    Article  Google Scholar 

  26. Bang HJ, Littrup PJ, Goodrich DJ, Currier BP, Aoun HD, Heilbrun LK, et al. Percutaneous cryoablation of metastatic renal cell carcinoma for local tumor control: feasibility, outcomes, and estimated cost-effectiveness for palliation. J Vasc Interv Radiol. 2012; 23:770–7.

    Article  PubMed  Google Scholar 

  27. Rosenstein D, McAninch JW. Urologic emergencies. Med Clin North Am. 2004;88:495–518.

    Article  PubMed  Google Scholar 

  28. Borrelli J, Brandes SB. Pelvic fractures: assessment and management for the urologist. AUA Update Series. 2004;23:82–6.

    Google Scholar 

  29. Ozkan B, Kaya O, Akdağ R, Unal O, Kaya D. Suprapubic bladder aspiration with or without ultrasound guidance. Clin Pediatr (Phila). 2000;39(10): 625–6.

    Article  CAS  Google Scholar 

  30. Miano R, Kim FJ, De Nunzio C, Mauriello A, Sansalone S, Vespasiani G, et al. Morphological evaluation of the male external urethral sphincter complex by transrectal ultrasound: feasibility study and potential clinical applications. Urol Int. 2012; 89(3): 275–82.

    Article  PubMed  Google Scholar 

  31. Coppola R. Diagnosis of prostatic carcinoma by means of transperineal needle biopsy. Riforma Med. 1963;77:1282–4.

    CAS  PubMed  Google Scholar 

  32. Igel TC, Knight MK, Young PR, et al. Systematic transperineal ultrasound guided template biopsy of the prostate in patients at high risk. J Urol. 2001; 165:1575–9.

    Article  CAS  PubMed  Google Scholar 

  33. Crawford ED, Wilson SS, Torkko KC, et al. Clinical staging of prostate cancer: a computer-simulated study of transperineal prostate biopsy. BJU Int. 2005; 96:999–1004.

    Article  PubMed  Google Scholar 

  34. Gonder MJ, Soanes WA, Smith V. Experimental ­prostate cryosurgery. Invest Urol. 1964;14:610–9.

    Google Scholar 

  35. Onik G, Cobb C, Cohen J, et al. US characteristics of frozen prostate. Radiology. 1988;168:629–31.

    CAS  PubMed  Google Scholar 

  36. Littrup P, Monti J, Mody A, et al. Prostatic cryotherapy: ultrasonic and pathologic correlation in the canine model. Urology. 1994;44:175–84.

    Article  CAS  PubMed  Google Scholar 

  37. Scardino P, Carlton C. Combined interstitial and external irradiation for prostatic cancer. In: Javadpour N, editor. Principles and management of urologic cancer. Baltimore: Williams & Wilkins; 1983. p. 392–408.

    Google Scholar 

  38. Whitmore Jr WF, Hilaris B, Grabstald H. Retropubic implantation to iodine 125 in the treatment of prostatic cancer. J Urol. 1972;108:918–20.

    PubMed  Google Scholar 

  39. DeLaney TF, Shipley WU, O’Leary MP, Biggs PJ, Prout Jr GR. Preoperative irradiation, lymphadenectomy, and 125iodine implantation for patients with localized carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1986;12:1779–85.

    Article  CAS  PubMed  Google Scholar 

  40. Aronowitz JN. Dawn of prostate brachytherapy: 1915–1930. Int J Radiat Oncol Biol Phys. 2002;54: 712–8.

    Article  PubMed  Google Scholar 

  41. Holm HH, Juul N, Pedersen JF, Hansen H, Stroyer I. Transperineal Iodine-125 seed implantation in prostatic cancer guided by transrectal ultrasonography. J Urol. 1983;130:283–6.

    CAS  PubMed  Google Scholar 

  42. Ho A, Burri R, Cesaretti J, et al. Radiation dose predicts for biochemical control in intermediate-risk prostate cancer patients treated with low-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys. 2009; 75:16–22.

    Article  CAS  PubMed  Google Scholar 

  43. Potters L, Roach III M, Davis B, et al. Postoperative nomogram predicting the 9-year probability of prostate cancer recurrence after permanent prostate brachytherapy using radiation dose as a prognostic variable. Int J Radiat Oncol Biol Phys. 2010; 76:1061–5.

    Article  PubMed  Google Scholar 

  44. Hinnen KA, Jan JB, van Roermund JG, et al. Long-term biochemical and survival outcome of 921 patients treated with I-125 permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2009;76:1433–8.

    Article  PubMed  Google Scholar 

  45. Nag S, Ciezki JP, Cormack R, et al. Intraoperative planning and evaluation of permanent prostate brachytherapy: report of the American Brachytherapy Society. Int J Radiat Oncol Biol Phys. 2001;51: 1422–30.

    Article  CAS  PubMed  Google Scholar 

  46. Han BH, Wallner K, Merrick G, Butler W, Sutlief S, Sylvester J. Prostate brachytherapy seed identification on post-implant TRUS images. Med Phys. 2003;30: 898–900.

    Article  PubMed  Google Scholar 

  47. Rove KO, Sullivan K, Crawford ED. High-intensity focused ultrasound: ready for primetime. Urol Clin North Am. 2010;37:27–35.

    Article  PubMed  Google Scholar 

  48. Gelet A, Chapelon JY, Bouvier R, et al. Local control of prostate cancer by transrectal HIFU therapy: ­preliminary results. J Urol. 1999;161:156–62.

    Article  CAS  PubMed  Google Scholar 

  49. Warwick R, Pond J. Trackless lesions in nervous ­tissues produced by high intensity focused ultrasound (high-frequency mechanical waves). J Anat. 1968; 102:387–405.

    CAS  PubMed  Google Scholar 

  50. Chaussy C, Thuroff S. The status of high-intensity focused ultrasound in the treatment of localized ­prostate cancer and the impact of a combined resection. Curr Urol Rep. 2003;4:248–52.

    Article  PubMed  Google Scholar 

  51. Dewhirst MW, Viglianti BL, Lora-Michiels M, et al. Basic principles of thermal dosimetry and thermal thresholds for tissue damage from hyperthermia. Int J Hyperthermia. 2003;19:267–94.

    Article  CAS  PubMed  Google Scholar 

  52. Ukimura O, Gill IS, Desai MM, et al. Real-time transrectal ultrasonography during laparoscopic radical prostatectomy. J Urol. 2004;172:112–8.

    Article  PubMed  Google Scholar 

  53. Zuniga A, Lawrentschuk N, Jewett MA. Organ-sparing approaches for testicular masses. Nat Rev Urol. 2010;7:454–64.

    Article  PubMed  Google Scholar 

  54. Cormier CM, Canzoneri BJ, Lewis DF, et al. Urolithiasis in pregnancy: current diagnosis, treatment, and pregnancy complications. Obstet Gynecol Surv. 2006;61:733–41.

    Article  PubMed  Google Scholar 

  55. Andreoiu M, Macmahon R. Renal colic in pregnancy: lithiasis or physiological hydronephrosis? Urology. 2009;74:757–61.

    Article  PubMed  Google Scholar 

  56. Loughlin KR, Kerr LA. The current management of urolithiasis during pregnancy. Urol Clin North Am. 2002;29:701–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery/Urology, University of Colorado Health Science Center, Denver Health Medical Center, Tony Grampsas Cancer Center, 777 Bannock Street MC 0206, Denver, CO, 80204, USA

    Fernando J. Kim MD, FACS & David E. Sehrt BS

  2. Department of Urology, University of Colorado Health Science Center, Aurora, CO, USA

    Kyle Rove MD

Authors
  1. Fernando J. Kim MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyle Rove MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David E. Sehrt BS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fernando J. Kim MD, FACS .

Editor information

Editors and Affiliations

  1. , Department of Urology, Texas Health Presbyterian Dallas, 8210 Walnut Hill Lane Suite 014, Dallas, 75231, Texas, USA

    Pat F. Fulgham

  2. , The Arthur Smith Institute For Urology, Hofstra North Shore LIJ, 450 Lakeville Road Suite M41, New Hyde Park, 11042, New York, USA

    Bruce R. Gilbert

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kim, F.J., Rove, K., Sehrt, D.E. (2013). Intraoperative Urologic Ultrasound. In: Fulgham, P., Gilbert, B. (eds) Practical Urological Ultrasound. Current Clinical Urology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-59745-351-6_14

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-351-6_14

  • Published:

  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-58829-602-3

  • Online ISBN: 978-1-59745-351-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation