Our physicians may order or perform a variety of tests or procedures to evaluate, diagnose and treat urologic conditions.
The tests conducted at Urology Associates fall into categories of diagnostic procedures for specific conditions, scans and imaging, and laboratory analysis.
A cystoscopy is a procedure that uses a cystoscope, or lighted telescopic catheter, which allows a urologist to directly view the inside of the bladder and urethra.
Cystoscopies are used to test for the following conditions:
- Frequent urinary tract infections
- Blood in the urine
- Painful urination
- Chronic bladder catheterization
- Chronic pelvic pain or interstitial cystitis
- Prostate enlargement, stricture causing urinary blockage.
Cystoscopic evaluations are typically performed under local anesthesia in an outpatient setting.
Rigid cytoscopy uses a solid, straight telescope and high intensity light. A separate channel allows the urologist to use a variety of instruments for biopsy or other procedures.
Flexible cytoscope is more commonly used, particularly for diagnosis and bladder tumor follow-up. It uses a fiber optic instrument that bends easily to pass along the curves of the urethra, allowing the urologist to view the lining of the bladder.
Digital rectal examination
A digital rectal examination (DRE) is performed to check for growths on, or enlargement of, the prostate in men or rectal lesions in men and women. During a digital rectum exam, a urologist inserts a gloved finger into the rectum to feel the condition of the prostate, which is in front of the rectal wall. Age related enlargement is not a particular concern, but if the gland feels unusually firm or hard, it may indicate an abnormal growth in the prostate gland and further testing can be performed.
Urodynamic testing, also known as cystometrogram (CMG), assists in the diagnosis of urinary incontinence and other voiding conditions by evaluating the sensation and motor control, capacity and coordination of function of the bladder. While monitoring the storage and emptying functions of the bladder, a CMG allows for correlation of urinary flow rates, muscular and neural control of the bladder.
In urodynamic testing, small size catheters are inserted into the bladder and rectum. Fluid fills up the bladder and creates pressures that are monitored by computer to assess lower urinary function. This takes approximately 45 minutes, does not require the use of drugs and typically involves minimal discomfort.
Scans and imaging
CT scan (CAT scan)
Computerized axial tomography (CT scan) is an x-ray tube that rotates in a circle around the patient taking a series of pictures. The multiple x-ray pictures are reconstructed by a computer at different levels. Each level can be examined separately.
A CT scan may be ordered for a variety of reasons including pain and suspicion of tumors or stones. The scan takes 10-30 minutes. During the procedure a patient is typically given a drink or injection of a dye, which allows doctors to see particular body areas more clearly. It is important to let the doctor know if the patient has asthma or an allergy to iodine, which can result in more serious reactions to the dye injections.
Magnetic resonance imaging (MRI or NMR scan)
Magnetic resonance imaging (MRI) is a noninvasive imaging technique similar to a CT scan, but using magnets instead of x-rays to build up cross-sectional pictures of the body. It is used to view organs, soft-tissue and other internal body structures. In an abdominal MRI, the person’s body is exposed to radio waves while in a magnetic field. Cross-sectional pictures of the abdomen are produced by energy emitted from hydrogen atoms in the body’s cells. An individual is not exposed to radiation during this test.
Bone scans may reveal if a cancer has metastasized into the bones. In a bone scan, a small amount of radioactive material is injected into the arm. Abnormal bone absorbs more of the radioactive substance than normal bone and shows up on the scan as highlighted areas (known as “hot spots”).
Transrectal ultrasound guided prostate biopsies
If the blood test PSA (prostate-specific antigen) is abnormally high or the findings on examining the prostate through the back passage are abnormal, a transrectal ultrasound (TRUS) may be recommended. This is the most common way to image and biopsy the prostate.
An ultrasound scan is a test that uses sound waves to create an image of the inside of the body. To scan the prostate gland a small probe is passed into the rectum. This scan measures the prostate’s density and size. While scanning the prostate samples of cells (biopsy) can be taken for further examination under the microscope.
How is a TRUS biopsy performed?
A patient will be given a prescription for a course of antibiotics. The first tablet should be taken the morning of the test and the patient should take the remaining pills as directed by their physician. An enema is recommended prior to the procedure. There is no need to fast for the test (that is, the patient can eat and drink as desired right up until the time of the test).
Patients typically lie on their side with the ultrasound probe inserted into the rectum. Anesthetic is typically placed around the prostate and a special biopsy needle is advanced to collect samples of the prostate.
During the biopsy a patient may hear a clicking noise or feel a slight sting as the needle passes. Typically, 12 biopsy specimens are collected and then sent to a lab for testing. The procedure takes about 10 minutes. Unless a sedative is used, most patients are able to drive to and from the procedure.
What are the risks or side effects associated with a TRUS and biopsy?
After a prostate biopsy a patient can expect to see some blood in the urine, semen or stool. Blood in the urine or bowel movements usually resolves after a week, although brownish discoloration of the semen can last for up to a month. In rare instances a patient may develop an infection, but this risk is minimized by antibiotics. If a patient develops fevers, shaking chills or feels unwell, he or she should seek medical attention immediately.
Results of a biopsy can take up to a week to process.
Chest x-rays and KUB (kidney, ureter, bladder) x-rays are taken to monitor cancers, chest conditions or abdominal conditions.
An intravenous pyelogram (IVP) is a diagnostic x-ray of the kidneys, ureters and bladder before and after the intravenous injection of a contrast agent or a dye, causing the urinary tract to show up very clearly, which is not seen on regular x-rays. Although this has largely been replaced by a CT-urogram, an IVP may be done for many reasons, including:
- Detect kidney tumors
- Identify blockages or obstructions of the normal flow of urine
- Detect kidney or bladder stones
- Determine if the prostate gland is enlarged
- Detect injuries to the urinary tract.
Laboratory tests of the blood and urine are common. Laboratory analyses help urologists detect and evaluate many conditions.
Complete blood count (CBC)
This checks the hemoglobin level in the blood using a microscope.
Basic metabolic panel (BMP)
Measures kidney function and electrolytes. Creatinine levels are elevated when kidney function is impaired.
Liver function tests (LFTs)
LFTs are blood tests to check for liver damage and evaluate its efficiency. LFTs measure liver enzyme levels, which spike when the liver is damaged by conditions such as hepatitis or alcohol and drug abuse.
Prostate-specific antigen (PSA) test
The PSA test is useful for diagnosing and monitoring prostate diseases. PSA is a protein produced in the prostate. Most PSA is released in semen ejaculate, but small amounts are also released into the blood stream. Increased PSA levels in the blood may indicate prostate abnormalities or diseases. Further tests are required for a specific diagnosis.
When analyzing urine, a series of physical, microscopic and chemical tests are performed. These tests may screen for kidney disease, presence of blood and urinary tract infections.
If an infection is suspected, a urine culture test will likely be ordered. These typically take at least 48 hours before an initial result is available. Antibiotic testing can aid in the use of antibiotics.