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Office Procedures

A substantial amount of what we do as urologists can be done in the office with light sedation and/or local anesthesia. In this section you will find information about what to expect if you are scheduled for one of these procedures.

Bladder Biopsy

Bladder Biopsy

A biopsy is conducted by removing a sample of skin or tissue from a patient's body for examination under a microscope to diagnose a medical condition.

A biopsy can be obtained of the skin by removing a small amount of tissue with a special instrument. This can be done with local anesthesia to avoid pain. Biopsies of the prostate or kidney are typically obtained with specially designed needles that allow for the removal of small amounts of tissue. The needle is guided with ultrasound or special X-rays such as a CT scan. Biopsies can also be obtained from the bladder or ureter with specially designed endoscopes that are passed into these structures through normal urine passageways.

After the biopsy specimen is obtained, it is sent for examination to a pathologist, who prepares a written report with information designed to help the doctor manage the patient's condition properly.

Cystoscopy

Cystoscopy

Cystoscopy, or cystourethroscopy, is a procedure that enables a urologist to view the inside of the bladder and urethra in great detail. It is commonly used to diagnose bladder tumors, identify obstruction of the bladder and look for any abnormalities of the bladder and its lining.

The procedure is usually performed as an outpatient procedure in a urology clinic or treatment room. Prior to the procedure, the patient will need to empty their bladder and will then be positioned on an examination table. After administration of local anesthesia, a cystoscope is inserted through the urethra into the bladder. The cystoscope is a thin, lighted tube that is either flexible or rigid. Water or saline is then instilled into the bladder through the cystoscope. As the fluid fills the bladder, the bladder wall is stretched thus allowing detailed viewing by the urologist. Under normal conditions, the bladder wall should appear smooth and the bladder should be normal size, shape and position and there should not be any blockages. If any tissue in the bladder wall appears abnormal, a small sample can be removed through the cystoscope to be analyzed.

The average cystoscopy takes about 10 to15 minutes.

After the cystoscope is removed, the patient's urethra may be sore and they may feel a burning sensation for up to 48 hours. If discomfort persists, fever develops or urine appears bright red, a physician should be notified.

Prostate Biopsy

Prostate Biopsy

A biopsy is conducted by removing a sample of skin or tissue from a patient's body for examination under a microscope to diagnose a medical condition, especially cancer.

A biopsy can be obtained of the skin by removing a small amount of tissue with a special instrument. Biopsies of the prostate (or kidney) are typically obtained with specially designed needles that allow for the removal of small amounts of tissue. The needle is guided with ultrasound. Biopsies can also be obtained from the bladder or ureter with specially designed endoscopes that are passed into these structures through normal urine passageways.

After the biopsy specimen is obtained, it is sent for examination to a pathologist, who prepares a written report with information designed to help the doctor manage the patient's condition properly.

Ultrasounds (bladder, renal, prostate, scrotal)

Ultrasounds (bladder, renal, prostate, scrotal)

An ultrasound examination, also commonly referred to as a sonogram, is a painless, diagnostic technique that makes use of the behavior of sound waves in the human body. When these sound waves are transmitted into the body, they are reflected in specific ways by specific tissues and organs. These reflected waves can be used to produce images of internal organs without harm or exposure to radiation.

Depending on the reason for the study and the circumstances, ultrasound imaging may be performed in the urologist's office, in the hospital or in an outpatient facility.

In most cases, very little preparation is needed for an ultrasound examination. Some examinations, such as a bladder scan for residual urine, require limited experience while others, such as ultrasound examinations of the kidneys, testicles or prostate, require more experience or expertise.'

The patient will be asked to lie down on the examination table. A clear, water-based gel is applied to the skin over the area to be examined. This gel helps with the transmission of the sound waves. A transducer, which is a hand-held probe, is then moved over that area. Prostate ultrasound examinations are performed by placing a specially designed probe into the rectum.

There is no risk of radiation with this study and the patient can resume their daily activities immediately following this test.

What can be expected with a bladder ultrasound?

The bladder is an organ made of smooth muscle that stores urine until ready for release. The most common reason for bladder ultrasound is to assess bladder emptying by measuring residual urine after urination. Many conditions may result in disorders of bladder emptying and these include an enlarged prostate, urethral stricture or bladder dysfunction. Bladder ultrasound may also provide information about the bladder wall, the presence of diverticula of the bladder, the size of the prostate, the presence of stones or large tumors in the bladder. Bladder ultrasound as performed for urologic purposes usually does not assess the ovaries, uterus or colon.

Bladder ultrasound does not require fasting or bowel preparation. For diagnostic purposes other than measuring for post void residuals, a full bladder is required. Drinking several glasses of water one hour prior to the exam is the usual preparation for adequate bladder filling.

The patient should not empty their bladder prior to arriving at the physician's office for a full bladder is essential for the examination.

The examination is performed with the patient lying on his/her back on the examination table. A conducting gel is placed on the skin to facilitate transmission of the sound waves. The transducer is placed on the lower abdomen between the umbilicus and the pubic bone. The image is viewed on a monitor and interpreted in real time. To assess bladder emptying, the patient is asked to void and the bladder is imaged a second time.

What can be expected with a kidney ultrasound?

The kidneys are fist-sized organs located in the retro peritoneum—the space behind the intestines and other abdominal organs. They are responsible for cleansing the blood of waste products and producing urine. They also balance electrolytes in the body, such as sodium and potassium, while providing hormones necessary to regulate blood pressure and red blood cell production.

There may be many indications for a renal ultrasound examination. Renal ultrasound studies are useful for demonstrating the size and position of the kidneys and are helpful in identifying obstruction of the kidney, kidney stones or masses in the kidney.

Renal ultrasound does not require fasting, bowel preparation or a full bladder. The test is performed with the patient lying on their back on the examination table and a conducting gel is placed on the skin to facilitate transmission of the sound waves. The kidneys are imaged by placing the transducer over both flanks of the upper abdomen.

What can be expected with a scrotum ultrasound?

The testicles (testes) are contained in a skin-covered muscular sac called the scrotum. The testicles manufacture sperm cells for reproduction and also produce testosterone. The primary indication for scrotal ultrasound is the evaluation of swelling or pain of the scrotum, as well as masses in the scrotum or in the testes themselves. The most common anomaly in the scrotum is a benign collection of fluid around the testis called a hydrocele. Other common conditions include the formation of a cyst in the epididymis called a spermatocele, and an abnormal enlargement of veins within the scrotum called a varicocele. Ultrasound studies are also very helpful in investigating solid masses within the testes, which may represent testicular cancer.

A scrotal ultrasound examination does not require fasting, bowel preparation or a full bladder. The test is performed with the patient lying on his back. The scrotum is elevated on a towel and warm gel is applied to the scrotum to help conduct the sound waves.

What can be expected with a prostate ultrasound and biopsy?

The prostate is located at the base of the bladder and encircles the urethra like a napkin ring. The prostate provides a portion of ejaculatory fluid, which is important for reproduction. Enlargement of the prostate may cause obstruction of the bladder. The most common indication for a prostate ultrasound (also known as a transrectal ultrasound) is to evaluate men considered at risk for prostate cancer (see prostate cancer screening). Because early prostate cancer cannot be reliably diagnosed by the ultrasound appearance of the prostate alone, the study is usually performed in association with a simultaneous prostate biopsy (see biopsy).

Another common indication for ultrasound is obtaining the volume or size of the prostate for treatment planning purposes. Patients being considered for radioactive seed implantation to treat prostate cancer (brachytherapy) undergo transrectal ultrasound of the prostate to determine prostatic volume. This is necessary to plan the distribution and number of radioactive seeds needed for treatment of the tumor. Transrectal ultrasound may also be performed when transurethral resection of the prostate or thermal therapies of the prostate are planned. Finally, the study may be used to determine prostate specific antigen density.

The patient may be asked to use an enema prior to the procedure to better facilitate an adequate examination. The procedure is performed with the patient lying on his side on the examination table.

The ultrasound probe (transducer) is inserted into the rectum to obtain the image of the prostate. Local anesthesia may or may not be used when performing a biopsy. After measuring the prostate volume and identifying any suspicious areas, biopsies are obtained by inserting a special needle through a channel on the transducer. The needle is inserted and the biopsy is obtained quickly. The number of biopsy "cores" obtained is variable but averages six to eight.

The procedure requires 10 to 20 minutes and the main risks are infection and bleeding from the rectum or bladder. Patients are asked to refrain from heavy physical activity for 24 to 48 hours after the procedure. Oral antibiotics are administered prior to and after the biopsy to reduce the likelihood of infection. Some patients may notice blood in their ejaculate for several weeks after the procedure. This is common and not a cause for concern.

Results of the biopsy often take several days. It is important for patients to discuss the results of the biopsy with their urologist. If cancer is diagnosed, a discussion of treatment options is needed. If the biopsy shows no cancer, a strategy for follow up will be discussed. The pathologist may report a precancerous condition on the biopsy that may prompt more frequent follow up or even repeat biopsy.

What are some additional uses of urologic ultrasound?

Evaluation of infertility: Under some circumstances, transrectal ultrasound may be useful in demonstrating the presence of abnormalities of the seminal vesicles and prostate. Examination of the testes may also be of value.

Evaluation of the female urethra: Transvaginal ultrasound may be useful in demonstrating a urethral diverticulum. A urethral diverticulum may be associated with urethral pain and recurrent urinary tract infection.

Pediatric urology: The painless and noninvasive nature of ultrasound and the immediacy of the results make it ideal for working with children. Ultrasound is particularly well suited to pediatric patients. Ultrasound provides excellent images of the kidneys and bladder. It is useful in the evaluation of congenital abnormalities of the urinary tract, the evaluation of problems with urination and the workup of recurrent urinary tract infections.

Evaluation of blood flow: A Doppler ultrasound may be used to determine blood flow in urologic organs especially the testes and kidneys.

Urodynamics

Urodynamics

Urodynamics is a group of tests that allow your healthcare provider to look at how your lower urinary tract works. Your lower urinary tract includes the bladder (which stores urine) and the urethra (which is the tube that carries urine from your bladder to the outside). This is the only form of testing we have to look at the function of the lower urinary tract.

How does the lower urinary tract work?

The bladder's responsibility is to store and empty your urine. The bladder is made up of muscle that should work to store and empty urine in a way that keeps urine from backing up into the kidneys. As the kidneys fill the bladder, the urine is stored there. The bladder muscle (called the detrusor muscle) should stretch easily to allow the bladder to fill. The sphincter muscles at the bottom of the bladder should be tight and not let the urine leak out. Urine can leak out for several reasons. Sometimes it is because the sphincter muscles are weak or because the bladder muscle is overactive.

When the bladder is full, a message is sent to the brain that it is time for you to empty your bladder. Your bladder muscle then squeezes while the sphincter muscles and pelvic floor muscles relax and let the urine out. Sometimes a blockage in the urethra can cause the urine flow to be weak. Different things, such as an enlarged prostate or a bladder that has dropped in women, can cause this.

After your bladder empties, your sphincter muscles tighten up again so that the urine stays in the bladder.

Why would I need urodynamics?

After your healthcare provider has spent some time going over your symptoms and complaints, performed a physical exam and possibly done some simple urine tests, he or she may feel the puzzle isn’t complete and may order urodynamics. Urodynamics helps identify specific problems related to:

  • Controlling your urine
  • Not emptying your bladder completely
  • Feeling of frequent and/or urgent need to urinate
  • Weak or intermittent (stopping and starting) urine flow
  • Frequent urinary tract infections

What is urodynamics?

There are several pieces that make up urodynamics. Patients should come for the test with a full bladder (if possible). You will be asked to urinate into a special commode chair or funnel. This will measure how much urine comes out and how fast it comes out. The test is called a Uroflow.

Next, a catheter (a small soft tube) will be placed into your bladder to drain out all the leftover urine. This will show how well your bladder emptied. Through a catheter, your bladder will be filled and the pressure of your bladder muscle and its response to being filled will be measured. At the same time, an estimate of the pressures outside the bladder will be measured by inserting another small soft tube, or catheter, into the rectum or the vagina. This tube is about the size of a spaghetti noodle and doesn’t do anything except measure pressure. The measurement of these pressures during filling is called a Cystometrogram (or CMG).

As the bladder fills, the different pressure measurements will be recorded and you will be asked questions about the way your bladder feels as it is filling. Your bladder will be filled with either a sterile water type fluid or a fluid that can be seen on x-ray. Filling your bladder should not hurt. You may also be asked to cough and push or bear down to check for any leakage.

Small sticky patches are often placed on either side of the bottom to measure the electrical activity of certain muscles. This is called an Electromyogram (or EMG).

When you feel your bladder is full, you will be asked to empty your bladder into the special commode again. This time you will urinate with the tubes in place. The tubes are specially designed to let the fluid come out around them. This lets us look at the function of your bladder as it empties. This is called a Voiding Pressure Study or a Pressure Flow Study.

Other things that might happen during urodynamics include:

X-ray pictures may be taken with any or all parts of these tests.

The catheter might be moved back and forth in the urethra or urine channel to get more information about the outlet. This is called a Urethral Pressure Profile (or UPP)

Before and/or after your test you may receive an antibiotic as a precaution to prevent infection.

After your urodynamics are completed, your healthcare provider will review all the information and discuss the results with you. Then you and your healthcare provider will decide on the best plan of treatment for you.

*Some of the information on our pages are provided by UrologyHealth.org, the official Web site of the American Urological Association Foundation. 

The AUA Foundation is the world's leading nonprofit urologic health foundation and the Official foundation of the American Urological Association.  Our goal is to promote health, provide hope and promise a future free of urologic disease, including cancer. The AUA Foundation partners with physicians, researchers, healthcare professionals, patients, caregivers, families and the public, established to support and promote research, patient/public education, and advocacy to improve the prevention, detection and cure of urologic diseases.

The vision of the Foundation is to be the premier provider and resource for the most current, comprehensive and reliable urologic health information for patients and the public.

 

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