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Ultrasound is an invaluable tool in the diagnosis and management of many urological disorders. It has the advantages of not involving ionizing radiation, allowing rapid real time imaging and being relatively inexpensive. It can also be performed at the patient’s bedside if necessary. There are limitations, however, and it is best used as an adjunct to clinical assessment, often alongside other complementary imaging modalities. While many ultrasound studies are undertaken by urological surgeons, it is often performed by imaging specialists; close liaison between these two groups is essential. A brief, clinically relevant, introduction to ultrasound physics is included and the use of Doppler techniques and ultrasound contrast agents will be discussed. It is not possible to cover all the urological conditions for which ultrasound is used in one chapter, so some recommended texts are included in the reading list for further study.

Ultrasound assists nephrologists in many situations. It is essential in excluding obstruction as the cause of acute kidney injury, but it also helps to reach other diagnoses and guides interventions such as renal biopsy and placement of lines for dialysis and evaluating dialysis fistulae. It is the imaging technique of choice in assessing renal transplants. It has advantages: it does not involve ionizing radiation, allows rapid real-time imaging, is relatively inexpensive, and can be performed at the patient’s bedside. Ultrasound is the primary imaging modality in paediatric radiology for most conditions, largely because it does not involve ionizing radiation. The strengths and limitations of ultrasound need to be understood to ensure that the technique is applied appropriately.

Renal artery stenosis (RAS) is an important and potentially reversible cause of both hypertension and renal failure. Ultrasound offers an attractive, non-invasive, method to examine the renal arteries and confirm or exclude the presence of RAS. This article will describe the techniques and diagnostic criteria employed in the ultrasound diagnosis of this condition and will also evaluate the usefulness of ultrasound in comparison with other non-invasive imaging techniques.