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This book provides the latest recommendations for ultrasound examination of the entire urogenital system, particularly in the male. The coverage encompasses the role of ultrasound in imaging of disorders of the kidneys, urinary tract, prostate, seminal vesicles, bladder, testes, and penis, including male infertility disorders. In addition, detailed consideration is given to intraoperative and interventional ultrasound and recently developed ultrasound techniques. Each chapter defines the purpose of and indications for ultrasound, identifies its benefits and limitations, specifies the technological standards for devices, outlines performance of the investigation, establishes the expected accuracy for differential diagnosis, and indicates the reporting method. Most of the recommendations are based on review of the literature, on previous recommendations, and on the opinions of the experts of the Imaging Working Group of the Italian Society of Urology (SIU) and the Italian Society of Ultrasound in Urology, Andrology, and Nephrology (SIEUN). The book will be of value for all physicians involved in the first-line evaluation of diseases of the renal/urinary system and male genital disorders. This paper has been prepared on the basis of the Standards of the Polish Ultrasound Society and updated based on the latest reports from the relevant literature. The author presents a renal artery examination technique, patient preparation for the testing, limitations of the method, currently recommended proper blood flow standards and criteria for the diagnosis of significant stenoses. Renal artery ultrasound is performed using a 2–5 MHz probe, usually a convex 3.5 MHz one. The ultrasound machine must be equipped with the Doppler options for the evaluation of color coded blood flow and recording of the blood flow spectrum, including the triplex Doppler mode. ![]() Patients have to fast for at least eight hours before testing. Ultrasound always begins with the assessment of renal structure using the grayscale. Next, color coded blood flow imaging is used, followed by placing a sampling gate in the lumen of the target vessel to record the spectral image. The aim of renal artery ultrasound is to assess the course and position of arteries, evaluate blood flow parameters, as well as visualize possible changes: stenoses, occlusions, aneurysms, or arteriovenous fistulas. Blood flow velocity is always measured in a longitudinal projection/ longitudinal section of the vessel, after placing the sampling gate in the central part of the flowing bloodstream, which normally corresponds to the central part of the vascular cross-section. When diagnosing renal artery stenosis, it is necessary to know the nature of the blood flow and norms for flow parameters in healthy vessels. The spectrum of the blood flow velocity in renal arteries and their branches is a low resistance one. The following parameters are used to evaluate normal renal arteries and to identify the narrowed ones: V max, V min, RAR, AT, AI, RI and PI. Introduction Due to the increasing possibilities of treating stenoses and vascular occlusions through surgical or endovascular procedures, there is a growing number of patients referred for diagnostic vascular tests, including the Doppler ultrasonography. In recent years, hypertension has been more and more frequently diagnosed in increasingly younger age groups. The most common form of secondary hypertension is renal artery stenosis caused by the narrowing of one or both renal arteries. An early diagnosis of this pathology and effective endovascular or surgical treatment offer a real chance for the normalization of blood pressure. Preparation Patients have to fast for at least eight hours prior to the testing. In some ca ses (obese people, patient s whose intestinal loops are filled with gas) special preparation is recommended: for three days preceding the test two capsules of Espumisan should be taken three times a day. The last easily digestible meal should be consumed at about 4 p.m. On the day preceding the test. On the day of the examination the patient needs to be fasted – regardless of whether the test is performed in the morning or in the afternoon. It is recommended that the patient also refrain from chewing gum and smoking on that day (). Technique Renal artery ultrasound always begins with the assessment of renal structure – the location, size and morphological image of the kidneys on the grayscale.
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