Transrectal Ultrasound and Prostate Pathology

Transrectal ultrasound is a form of ultrasonic examination that is introduced recently. Like intravaginal, transurethral and transesophageal ultrasound, it utilises a special transducer that can be introduced into the rectum for examination of the adnexal organs, the most important of which is the prostate.

Our hospital started to use this investigation since 1985, and was the first in Hong Kong to use the linear type of transducers. In view of the relative absence of local data1, a study has been done together with the Hong Kong University Pathology Department and the Mathematics Department of Citypolytechnics to assess its accuracy in the measurement of prostate size.

Types of Transducers

There are basically three types of transducers, the radial tomographic type, the linear type and the modifiable axis type. The tomographic type is the most popular3-5; the modifiable axis type is the newest type. The tomographic type gives transverse sections of tissues at right angles to its long axis.Thus complete examination is by advancing and retreating the transducer probe. The linear type gives longitudinal sections of the structures at one side of its long axis, examination requires also probe rotation. The modifiable axis type can switch the axis, so that both types of pictures can be seen.

Examination Procedure

Transrectal ultrasound is not completely noninvasive – it involves inserting the probe into the rectum. From our experience, all patients feel mild discomfort. Adequate lubrication and gentle insertion usually alleviate the problem. However, in tense or uncooperative patients, the examiner must be experienced in order to complete the examination.

The patient is instructed to lie in the lateral position, usually left. A plastic condom is used to cover the end of the probe and fixed in position with special rubber bands. Water is filled into the condom-transducer space via an inlet in the transducer, and all the air is expelled out.

After lubrication with KY jelly, the probe can be introduced into the rectum just like doing digital examination. Sedation is not routinely given to our patients. We usually examine first the 12 o’clock positions of the urethra, prostate, and bladder sequentially, then prostate measurements are made.
The probe is then rotated to examine the other structures. Because bladder distension is required for
proper bladder and upper prostate examination, the patient is required to hold urine for 3 to 4 hours
before the examination. This may be difficult for some patients, but is important for good pictures. In tense patients and those who cannot flex their legs properly, examination may be difficult especially for the bladder region.

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