Investigations
Urine and Blood tests
Urine can be dip tested in the clinic looking for blood or evidence of infection. A formal microscopic analysis and culture can be performed in the laboratory if required.
Basic blood parameters such as renal function and (for men) PSA (prostate blood test), if necessary, can be checked with a blood sample taken in clinic and the results are usually available within 24 hours
Imaging
Ultrasound is the simplest imaging test. ‘Jelly’ is placed on the side and front of your tummy which allows the radiologist to slide a probe over your skin. It uses sound waves to generate an image. There is no radiation used and therefore it is safe.
Trans rectal ultrasound (TRUS) is sometimes used to get more detail of the prostate including an accurate measurement of size. A probe is placed in the rectum which is adjacent to the prostate allowing excellent images.
Bladder Scan is a simple automatic ultrasound machine that can be used in the clinic to assess whether the bladder is completely empty
MRI scans are often used if there is any suspicion of prostate cancer. They use magnets rather than radiation and for this reason may not be used for some patients with certain types of pacemaker. This scan takes between 30 & 45 minutes. The patient lies on a narrow bed that is moved through a tunnel. It is quite noisy and claustrophobic.
Cystoscopy
This is an endoscopic inspection of the lining of the urethra, bladder and, in men, the prostate. It is usually carried out under local anaesthetic in the endoscopy suite or outpatient clinic. It takes about 30mins in total. The images are on screen and your surgeon would be delighted to show you around if you wish! Patients often experience some mild stinging or burning for the first 2-3 voids and approximately 1 in 100 may see some blood or have an infection. The procedure can also be performed under general anaesthetic, but that takes half a day, requires starvation before hand and you cannot drive for 24 hours afterwards. Your surgeon will advise the best approach for you.
Flow Rate
This is a fairly simple test to assess bladder function. It is most commonly performed when assessing men to predict whether their bladder is blocked by the prostate or narrowing of the water pipe. You would be asked to arrive at the clinic with a reasonably full bladder. Once you feel ready to pass urine you will be asked to void (wee) into a special funnel that measures the volume passed and the rate at which it came. The test is only valid if you pass over 150mls, hence the need for the full bladder. If you are early for the appointment and desperate for the toilet, don’t hesitate to speak with the receptionist or nurse who will be able to get you to do the test before seeing your surgeon. After voiding, a mini ultrasound (bladder scan) is used on your tummy to assess how well the bladder has emptied.
Urodynamics
This is a more detailed test of bladder function, which is required if the clinical situation is more complex or other treatments have not been successful. It allows the pressure within the bladder to be measured while being filled and during voiding.
A catheter (small tube) is placed into the bladder via the urethra (water pipe). This has two lumens and allows filling and pressure measurement. A second probe is placed in the rectum (back passage). This allows the machine to subtract abdominal pressure and calculate the true bladder pressure (without this your abdominal muscles will create erroneous pressure within the bladder).
The bladder is then slowly filled, taking continuous pressure readings, until you are ready to pass urine. You then pass urine, with all the tubes still in place, and the pressures are compared with the flows achieved.
This test takes about 45 mins. It is not painful, but is a little uncomfortable and undignified! Your surgeon will be happy to discuss this in detail if necessary.