Ultrasound and the Complete Urologist Part 1: Methodology

Computed tomography (CT) scanning is considered as the imaging study of choice for asymptomatic microhematuria according to the American Urological Association guidelines. For those patients with persistence of microhematuria after a negative initial examination, the guidelines suggest repeating the evaluation including CT scanning within 3 to 5 years. However, the cost and risk involved for utilizing this technology going forward is an issue, especially when the yield of finding significant pathology on subsequent imaging studies is exceedingly low. To minimize those concerns, I have proposed incorporating the utilization of ultrasound rather than the guideline-recommended CT for reasons and considerations to be discussed. In addition, I propose extending the use of ultrasound beyond evaluation of asymptomatic microhematuria to the routine urologic physical examination as it is superior to the current standard of palpation and percussion. The original concept of applying sound to a physical examination led to the technique of percussion. Technological advancement has taken the same sound, converted it to a digital image, and allowed us to see what we hear to achieve a greater diagnostic accuracy. The literature on this subject is reviewed and demonstrates support for just such a change in the delivery of urologic healthcare. I conclude by proposing that the quality of urologic care can be enhanced during a routine urologic physical examination through upgrading the technique of palpation and percussion by routinely utilizing ultrasound, creating the Complete Urologist.