Ultrasound in Urology

Introduction

Point-of-care ultrasound (POCUS) has become an essential tool in modern urologic practice. It offers rapid bedside assessment without radiation and fits easily into daily workflow. The technology also helps young doctors improve anatomical understanding and decision-making. As devices become smaller and cheaper, proper training is becoming more important for safe and effective use.

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Important Concepts

• POCUS (Point-of-Care Ultrasound): Bedside ultrasound performed by the clinician to support real-time diagnosis, procedures, or follow-up. It is low-cost, and highly accessible.

• Acoustic windows: Natural body structures like the liver that help transmit ultrasound waves and improve image quality. Urologic organs benefit from these windows.

• Transducer frequency: Higher MHz gives higher resolution but less depth. Different probes (linear, curved, transrectal) are chosen based on the organ.

• TRUS (Transrectal Ultrasound): The standard method for prostate imaging and biopsy, using high-frequency biplanar probes.

• POCUS utilization: How frequently urologists use ultrasound for specific organs such as the prostate, kidney, bladder, scrotum, and penis.

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What We Know

• POCUS is widely applicable across urologic organs because most structures are superficial, fluid-filled, and accessible through good acoustic windows. 
• Ultrasound provides clear visualization of the kidney, prostate, bladder, scrotum, penis, and urethra without ionizing radiation. 
• These features make POCUS attractive for diagnostic assessment, procedural guidance, and postoperative follow-up.
• In clinical practice, prostate imaging through TRUS remains the most commonly performed POCUS application among urologists. 
• Kidney and bladder ultrasound play a major role in evaluating flank pain, obstruction, urinary retention, and hematuria. 
• Scrotal and penile ultrasound offer high-resolution views and Doppler evaluation, essential for conditions like torsion, epididymo-orchitis, erectile dysfunction, trauma, and Peyronie’s disease.
• Surveys show that urologists strongly favor structured training for POCUS, which improves anatomy understanding and enhances physical examination skills. 
• There is evidence that POCUS done by urologists can be more time-efficient and cost-effective than radiology-based imaging in selected scenarios.

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Important Numbers

• 77% — Proportion of practicing urologists who use POCUS in their practice.
  Meaning: Most urologists already depend on ultrasound in day-to-day work.

• 37% — Respondents who had prior formal ultrasound training.

• 39% vs. 16% — Optimal vs. current emergency room POCUS use.
  Meaning: Urologists see an opportunity to expand emergency POCUS.

• 38% — Barrier: equipment procurement.
  Meaning: Cost and access limit expansion of POCUS.

• 27% — Barriers: training time, image interpretation, medicolegal concerns.
  Meaning: Multiple educational and systemic factors hinder adoption.

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The Urologist’s Summary 

1. Identify the target organ and choose the correct transducer.

   • Use a linear probe (6–14 MHz) for scrotum, penis, and urethra.

   • Use a curved probe (3.5–6 MHz) for kidney and bladder.

   • Use a transrectal probe (4–14 MHz) for the prostate.
     This ensures proper resolution and adequate penetration for the specific organ.

2. Position the patient according to the organ being assessed.

   • Supine for scrotum, penis, bladder, and right kidney.

   • Right lateral decubitus for the left kidney.

   • Lithotomy or left lateral decubitus for the prostate.
     Correct positioning provides the best acoustic windows and image clarity.

3. Perform a systematic scan and label all images clearly.

   • Assess all components of the organ:

     • Kidney: cortex, medulla, pelvis, perinephric space.

     • Scrotum: testis, epididymis, cord.

     • Prostate: axial and sagittal views.

   • Use Doppler when evaluating blood flow (e.g., scrotal torsion, ED assessment).
     Proper labeling and complete imaging prevent misinterpretation and confusion.

4. Interpret findings within clinical context.

   • Look for obstruction, masses, fluid collections, changes in echogenicity, and blood flow patterns.

   • Use bladder volume assessment or stone mobility tests when indicated.
     POCUS complements, not replaces, clinical judgment.

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The Point

POCUS is practical, and underused in many areas of urology. Proper training will help young doctors integrate ultrasound into daily patient care with confidence.

For further data about urologic diseases diagnosis and therapeutic options, follow our blog 

The Urologist

By:

Dr. Ahmed M. Bakr, MD, FEBU

Reference: Paneque T, Tracy CR, Steinberg RL. Point-of-Care Ultrasound in Urologic Practice and Training. Current Urology Reports. 2025;26:30.