Urological Diagnostics

Overview

Sometimes it is difficult to know what might be wrong, but they may be one or more symptoms that are concerning, or that could point to an illness. In these scenarios, it is best to seek medical attention as soon as possible, to ensure that any serious conditions are ruled out and to try and find the right treatment. We can carry out a number of diagnostic tests and procedures to help find out whether there are any illnesses, and what these are.

Diagnostics

Urine Dipstick

A chemical strip is dipped into a mid stream sample of urine to look for abnormalities

Urine Culture

A mid stream urinary sample is sent to the microbiology laboratory to look for evidence of a urinary infection. If an infection in the urine is shown, the lab technicians will also report on which antibiotics the bacteria are sensitive to.

Urine Cytology

A urine test to exclude the presence of abnormal looking cells.

Urea and Electrolytes

A blood test for assessing kidney function

Prostate Specific Antigen (PSA)

This test measures the amount of this in the blood. PSA is produced by normal cells in the prostate but also by prostate cancer cells. This means it is normal to have a small level of PSA in the blood, but a raised PSA may indicate a problem with the prostate. As a man gets older, the prostate does get bigger and so more PSA may be produced. If a PSA is raised, then more investigation may be needed, such as a biopsy.

Intravenous Urography (IVU)

This involves the injection of an Xray dye (contrast) that is filtered from the blood by the kidneys and concentrated in the urine. A series of Xray pictures are then taken to capture the outline of the kidney collecting system, ureters and bladder.

Ultrasound Scan

A painless scan that does not involve any radiation. It allows the operator to look at the organs inside the body using high frequency reflected sound waves. It is precisely the same technology used to image the unborn baby in pregnancy. The operator will generate a report for the radiologist.

Computerised Tomography (CT scan)

An Xray test that involves lying in a narrow tunnel. The CT scan machine takes virtual slices of the body and then the computer ‘reconstructs’ the images of the organs.  The radiologist (the doctor who specialises in the diagnosis and treatment of disease using these technologies) will then produce a report for the urologist.  Occasionally an injection of Xray dye is necessary, similar to an IVU, to help improve the accuracy of the test.

MRI Fusion Prostate Biopsy

A biopsy is a sample of tissue taken from the body to be analysed in the laboratory under a microscope. Biopsies of the prostate gland (located near the rectum in males) are usually performed to identify prostate cancer, which is the only definite diagnosis. The technique of obtaining a prostate biopsy is to insert a biopsy needle transrectally (through the rectal wall) or transperineally (through the space between the anus and penis) to reach the prostate. These needles are usually guided by ultrasound imaging, but for better clarity of soft tissues, MRI imaging or a new technique that combines both ultrasound and MRI is now used for accurately identifying cancerous areas in the prostate.

The MRI fusion prostate biopsy is performed under sedation by first obtaining an MRI of the prostate. The ultrasound procedure is then commenced and a fusion computer software overlaps the MRI and ultrasound images to create a clear 3D picture that precisely guides the biopsy needle to the suspicious areas of the prostate. The procedure may take about 30 to 90 minutes to obtain an adequate number of tissue samples. A patient is provided with pain medication to keep them comfortable.

TRUS Prostate Biopsy

A TRUS prostate biopsy may be used to evaluate the prostate for abnormalities such as enlargement, cancer or male infertility. In order to try and provide a diagnosis, the is biopsy is performed where a small sample of the suspicious tissue is removed from the prostate for further examination. Transrectal ultrasound (TRUS) is a type of prostate biopsy that involves inserting an ultrasound probe through the rectum to guide a biopsy needle to collect a tissue sample for examination.

Transperineal Prostate biopsy

While prostate biopsies are usually performed through the rectum, this sometimes results in the inadequate sampling of certain parts of the prostate. A transperineal prostate biopsy goes through the skin between the scrotum and anus and can overcome these drawbacks.

A prostate biopsy is ordered in the following situations:

• A doctor finds the prostate abnormal on palpating through the rectum
• The patient has a high prostate-specific enzyme in the blood, indicative of prostate cancer
• To monitor existing prostate cancer that does not require treatment yet
• To identify other prostate conditions such as benign prostatic hyperplasia (enlargement) and prostatitis (bacterial infection of the prostate)

A transperineal prostate biopsy is performed under local or general anaesthesia. The ultrasound imaging probe is lubricated and inserted through the anus into the rectum. It creates images that guides the doctor throughout the procedure. The skin over the perineum is sterilised and biopsy needles are inserted through this region to enter different parts of the prostate gland, including those inaccessible through the trans-rectal approach. Multiple biopsies are thus obtained. These are sent to the laboratory for further examination.

As with any procedure, a transperineal prostate biopsy may be associated with certain risks such as infection, bleeding and damage to the urethra, which can result in a temporary difficulty with urination.

Flexible Cystoscopy

During this test, a thin and bendy cystoscope is inserted into the urethra and into the bladder. A local anaesthetic will be applied before, to numb it and allow the cystoscope to move more easily. After this, water may be pumped into the bladder to allow it to be visualised. A camera in the cystoscope will take images that are transmitted to the monitor, which will be assessed by the doctor. Sometimes a small tissue sample may be removed for testing, which may take a couple of weeks to process for results.

Urodynamics

This is a test that helps to provide information about bladder function, by showing what happens when the bladder fills and empties.

• Flow Rate – men are invited to pass water in a private setting into a machine that records the urinary flow. This is rather like passing water into a urinal. A comfortably full bladder is needed in order for this test to produce a meaningful result.
• Post Void Residual – a quick and painless ultrasound scan is used to check how much urine is left behind in the bladder after passing urine.
• Cystometerogram (CMG) – this investigative procedure is used to diagnose abnormalities of bladder function.  A tiny transducer (pressure sensor) is introduced into the bladder alongside a urethral catheter. Another transducer is introduced into the back passage.  It is very slim and not painful. The transducers are used to measure the pressure within the bladder as it is slowly filled and when water is passed. This is helpful in identifying the presence of any obstruction (blockage of the urethra) and in assessing the advisability of bladder outlet surgery, such as TURP.
• Frequency / Volume Chart – patients are asked to complete a voiding diary, otherwise known as a frequency volume chart. Record is made of the amount of urine passed (in millimetres) and the time it is passed over a three-day period. This gives the urologist useful information about a patient’s bladder habit.

Diagnostic ureteroscopy

A diagnostic ureteroscopy is usually performed under a general or spinal anaesthetic, as the bladder is examined with a small telescope and a guidewire is inserted into the opening of the ureter. From there it goes to the kidney and an instrument or flexible telescope is inserted, with the guidewire to follow in order to inspect the ureter and/or kidney.

This technique allows a biopsy to be taken or for an abnormality to be removed, and stones can also be extracted or fragmented with a laser.