From the Guidelines
A combined transabdominal and transvaginal (TA/TV) ultrasound approach is typically recommended for evaluating dysuria when pelvic pathology is suspected, as it allows for a comprehensive assessment of the pelvis and surrounding structures 1. When considering the evaluation of dysuria, it's essential to prioritize the imaging modality that provides the most detailed and accurate visualization of the pelvic structures.
- Transvaginal ultrasound offers superior resolution and detailed visualization of pelvic structures, including the bladder, urethra, and surrounding tissues that may be involved in conditions causing painful urination.
- However, transabdominal ultrasound may be preferred in certain situations, such as in virginal patients, those who decline vaginal examination, or when a broader view of the pelvis and upper urinary tract is needed 1. The choice between these modalities should consider patient factors, suspected pathology, and clinical context.
- In many cases, a combination of both approaches provides the most comprehensive evaluation, with TA ultrasound offering an overview of the entire pelvis and upper urinary tract, while TV ultrasound provides detailed assessment of specific pelvic structures potentially causing dysuria. It's also important to note that a combined transabdominal and transvaginal approach allows for assessment of adnexa situated in a high position that may not be visible by the TVUS approach due to a position distant from the US probe, and visualization with TAUS may also be better than TVUS in select other circumstances 1.
From the Research
Evaluation of Dysuria
- Dysuria is a common symptom that can be caused by various factors, including infection, inflammation, and trauma 2, 3.
- The evaluation of dysuria typically involves a comprehensive history and physical examination, urinalysis, and urine culture 2, 3.
Ultrasound Evaluation of the Pelvis
- Transvaginal (TV) and transabdominal (TA) ultrasound are two common techniques used to evaluate the female pelvis 4, 5.
- TV ultrasound is considered superior to TA ultrasound in most cases of pelvic pathology, particularly in evaluating ovarian follicle monitoring, polycystic ovaries, endometrial carcinoma, and suspected ectopic pregnancy 5.
- TA ultrasound may still be necessary in cases with large pelvic masses or when TV ultrasound is not feasible 5.
- A study found that TV ultrasound can replace TA ultrasound with a full bladder for routine pelvic sonography, and that an empty bladder approach can be used as an adjunct to TV ultrasound 4.
Comparison of TA and TV Ultrasound for Evaluating Dysuria
- There is limited direct evidence comparing TA and TV ultrasound specifically for evaluating dysuria.
- However, TV ultrasound has been shown to be effective in evaluating the urinary tract in gynecological oncology patients, with high specificity and negative predictive value for detecting ureteral and bladder involvement 6.
- Based on the available evidence, TV ultrasound may be a better option for evaluating dysuria, particularly in women with suspected pelvic pathology or urinary tract involvement 5, 6.