Diagnostic Tests and Procedures
This is an imaging study using ultrasound waves commonly used to examine the kidneys, and the bladder. This is often indicated for work up of blood in the urine, flank pain, and incomplete bladder emptying. It is the least invasive of imaging techniques, and it does not require radiation exposure. During this procedure, some clear gel is applied to the skin of the abdomen/flank and a hand-held probe (transducer) is swept back and forth to view the organs being studied. The images are stored on a computer disc or printed on film.
A bladder biopsy is a tissue sample taken from the wall of the bladder that is then examine under a microscope. It is indicated when there is visible suspicion of disease, most often to examine for the presence of cancer cells. The procedure is often done under anesthesia, under direct vision through a telescope (cystoscope) passed into the bladder. It is typically an outpatient procedure if the extent of disease is limited. Mild pain and other symptoms may be experienced after the procedure but they are usually temporary.
BPH Symptom Score
This is a validated questionnaire (using a scoring system) that attempts to determine how bothersome your voiding symptoms due to an enlarged prostate are. It is important to realize that this score does not tell us anything about the size of your prostate or the degree of bladder outlet obstruction due to the prostate. It does provide a reasonable method to follow your outcome after treatment, based only on your voiding symptoms.
This is test using radioactive material injected into a vein to image bones on a computer screen or on film. This study is sometimes indicated for staging of advanced cancer (prostate, kidney, bladder). Radiation exposure is low. Additional tests such as CT scan, MRI, or a bone biopsy may be needed to confirm abnormal findings.
This is a plain x-ray examination of the chest, usually obtained as a pre-surgery evaluation, especially before surgery for a cancer-related procedure. Other indications include patients with long-standing lung disease, and any patient with active respiratory symptoms.
Computerized Tomography (CT) Scan
This is often called a "CAT" scan. As the name implies, it uses a computer to create a series of detailed pictures of areas inside the body, like the abdomen, the pelvis, or the chest. The computer combines the images into pictures of slices of your internal organs and structures. Although increasingly advancing, its ability to accurately characterize small structures (such small lymph nodes or small tumors) can still be limited. There is radiation exposure; therefore, it should be judiciously used with proper indications. It is often used to further evaluate any suspicious kidney lesion or mass, and for staging of advanced cancer.
Using a lighted, fiber-optic telescope (cystoscope), this office procedure is done under local anesthesia usually using a flexible cystoscope. The inner lining of the bladder and urethra is examined. The urethra is the tube through which urine passes from the bladder to the outside. The sphincter control mechanism is located along portion of the urethra. Common indications for cystoscopy include 1) frequent or persistent urinary tract infections, 2) blood in the urine (hematuria), 3) loss of bladder control (incontinence), 4) abnormal cells found in urine sample, 5) painful urination or unexplained pelvic pain associated with urination, 6) poor bladder emptying due to prostate enlargement or stricture of the urethra, and 7) any abnormal growth, lesion, or tumor seen on other imaging studies.
This is a detailed examination of a urine sample looking for abnormal blood cells, inflammatory cells, organisms, and very importantly, cancer cells. This test is sometimes considered as a "pap smear" of the urine. The first morning void is the preferred sample. Abnormal cells can originate anywhere along the urinary tract, from the kidneys, down the ureters to the bladder, and out through the urethra. Thus, other studies are often required to localize the problem. This test is also often used to follow patients with history of superficial bladder cancer or persistent blood in the urine.
Intravenous Pyelogram (IVP) or Urogram (IVU)
This is the classic examination of the upper urinary tract (kidneys, ureters), still the preferred study of many practicing urologists. A proper bowel preparation before the procedure is ideal for a high quality evaluation. During the test, dye is injected into a vein, then a series of films is taken to study the anatomy as the dye is excreted thereby outlining each kidney and ureter (the tube which connects the kidney collecting area down to the bladder). More recently, CT scans are more frequently used for similar purposes. However, there are still certain situations where an IVP is the preferred study. Examination of the lower urinary tract (bladder and urethra) is best by cystoscopy.
For an average size person, this is typically a plain x-ray study of the abdomen and pelvis. It is often used to follow kidney stone(s) after treatment.
Prostate-Specific Antigen (PSA)
This is a blood test measuring the blood level of PSA, a protein predominately made in the prostate gland. Along with a digital rectal examination of the prostate, this test has been used to screen for early detection of prostate cancer since the mid 1980's. It is a good but not perfect test for prostate cancer screening, since other prostate conditions (including inflammation, infection, and enlargement) may also have an abnormally elevated blood level of PSA. There is also a small percentage of prostate cancer diagnosed with PSA in the "normal range". Other adjunct tests designed to improve the screening process are available, but do have limitations. Prostate cancer can only be diagnosed by obtaining tissue (biopsy) for study under a microscope. Currently, the American Urological Association advises that men receive annual PSA test and rectal examination starting at age 50. African-American men and men with a strong family history of prostate cancer should consider testing at the age of 40.
This procedure is usually the eventual requirement for prostate cancer screening in patients with an abnormal rectal examination and/or an abnormally elevated blood PSA level. As stated, a biopsy is advised for an abnormal prostate finding on rectal exam regardless of the PSA value. Since the prostate sits directly in front of the rectum, the approach to biopsy is transrectal (needle passed through the rectal wall into the prostate). Currently, an ultrasound rectal-probe allows clear, accurate visualization of the prostate and guidance for biopsy needle passage. The number of sample to be taken is determined by your particular clinical situation, with the average patient needing 10 to12 biopsy cores (short one cm segments, paper thin samples). Preparation for this procedure usually includes prophylactic antibiotics, a Fleet enema, and stopping aspirin and other blood thinners a week before the scheduled date. It is an outpatient, office procedure done with local anesthesia. You can expect some rectal irritation, blood spotting, and blood in the urine and semen, all of which will clear with time (usually several days to a week). The biopsy samples are sent to specialized labs for pathological examination with results available in about one week.
Urodynamic testing consists of multiple combined tests attempting to evaluate the functional status of the lower urinary tract (bladder and urethra). For women, a common indication is urinary incontinence (urine leakage), especially in women with multiple mixed voiding symptoms and in those who have had prior pelvic surgery and/or radiation treatment directed to the pelvic area. For men, it is increasingly used to confirm the presence of bladder outlet obstruction due to BPH (prostate enlargement) before consideration of prostate surgery. During testing, the functions of the bladder and urethral sphincters are examined using special catheters and sensors. The main goal of the test is to reproduce the patient's symptoms in order to study the function or lack of function of the bladder and sphincters during these specific moments. It has been shown that better treatment outcome is achieved when urodynamics is used to help tailor treatment decisions to the underlying problem.
*  This information is not intended to substitute for a consultation with a urologist. It is offered to educate patients on the basis of urological conditions in order to get the most out of their office visits and consultations. Please see our web page disclaimer for addition information.