Is a full bladder still necessary for pelvic sonography?

The objective was to determine whether a full bladder is routinely necessary for a complete sonographic evaluation of the female pelvis. Over the course of 1 month, all women having a gynecologic sonogram were scanned initially transabdominally through a full bladder by the sonographer (standard images taken). A physician then joined the sonographer and scanned the patient transvaginally without prior knowledge of the findings seen transvesically. The physician finished the examination transabdominally, with the bladder empty. The physician and sonographer then determined (1) whether the scan was sufficient transvaginally only, (2) whether the scan was sufficient transvaginally and transabdominally with an empty bladder, or (3) or whether a full bladder was necessary. Two hundred and six consecutive patients were scanned prospectively. The transvaginal scan alone was sufficient to demonstrate all findings for 172 (83.5%) patients. The transvaginal and transabdominal scans through an empty bladder were needed for 31 (15.1%) patients. Three patients (1.5%) required a full bladder in addition to the other two techniques to visualize one normal ovary each. In conclusion, transvaginal scanning with an adjunctive transabdominal empty bladder approach can replace the full bladder technique for routine pelvic sonography. The transabdominal scan with an empty bladder is necessary, particularly for patients with enlarged uteri. It is no longer reasonable, however, to subject all patients undergoing pelvic sonography to bladder distention.