Diagnostic Procedure

Cystoscopy-

A cystoscope is a slim tube with a camera and light on the end. During a cystoscopy, a doctor inserts this tube through your urethra and into your bladder so they can visualize the inside of your bladder. Magnified images from the camera are displayed on a screen where your doctor can see them.

Reasons for having a cystoscopy-

Your doctor might also order the procedure to investigate reasons for:

•blood in your urine
•frequent urinary tract infections
•an overactive bladder
•pelvic pain

A cystoscopy can reveal several conditions, including bladder tumors, stones, or cancer. Your doctor can also use this procedure to diagnose.

•blockages
•enlarged prostate gland
•noncancerous growths
•problems with the ureters

Risk and complication-

Cystoscopy is usually well tolerated as a day procedure. Potential risks include:

•Bleeding: it can reason some blood in the urine for up to one week after the procedure, serious bleeding is very rare.
•Pain: you may notice a burning sensation during urinating after the procedure, but these symptoms are mild and will usually resolve after 24-48 hours.
•Infection: there is a less than 5% risk of a urine infection after cystoscopy. Please let your doctors know if burning during voiding is not improving or persists after 48 hours. Drinking abundance of water following the cystoscopy will reduce the risk of having a urine illness.

TURP-

 

TURP (transurethral resection of the prostate): This is the most common surgery for an enlarged prostate, and considered to bring the greatest reduction in symptoms. Only the tissue growth that is pressing against the urethra is removed to allow urine to flow easily.
Benign prostatic hypertrophy, or BPH, is usually NOT dangerous and often not progressive. BPH may occasionally lead to urine infections and blood in the urine. BPH is not the same as prostate cancer, although the two conditions may coexist.

Treatments-

The main treatments are:

•lifestyle changes
•medication
•catheters
•surgery

Medicines-

•If lifestyle changes don’t help or aren’t suitable for you, you may be offered medicine.
•Alpha blockers relax the muscle in the prostate gland and at the base of the bladder, making it easier to pass urine. Commonly used alpha blockers are tamsulosin and alfuzosin.
•Anticholinergics relax the bladder muscle if it’s overactive.
•5-alpha reductase inhibitors shrink the prostate gland if it’s enlarged. Finasteride and dutasteride are the two 5-alpha reductase inhibitors available.
•Diuretics speed up urine production. If taken during the day, it reduces the amount of urine produced overnight.
•Desmopressins slow down urine production so less urine is produced at night.

Surgery

Most men with urinary symptoms don’t need to have surgery, but it may be an option if other treatments haven’t worked.
Transurethral resection of the prostate (TURP). TURP involves removing part of the prostate gland, generally using a tube that passes through the urethra. It’s suitable for men who have an enlarged prostate.
Open prostatectomy. An open prostatectomy involves removing the prostate gland through a cut in your body. This procedure is suitable for men who have an enlarged prostate over a certain size.
Cystoplasty. Cystoplasty is a procedure to increase the size of the bladder by sewing a piece of tissue from the intestine into the bladder wall. This intervention may help men whose bladder muscle contracts before it’s full.
Botulinum toxin. This procedure involves injections of botulinum toxin into the walls of the bladder. This intervention may help men whose bladder muscle contracts before the bladder fills.

Urodynamics

Urodynamic studies (UDS) test how well the bladder, sphincters, and urethra hold and release urine. These tests can show how well the bladder works and why there could be leaks or blockages.

 

There are many types of urodynamic tests. A health care provider may recommend one or more based on your symptoms, but they are usually performed together as one test.

Need of Urodynamics-

Urodynamics help find the cause of problems related to:

•Urine leaks/controlling your urine
•Bladder not emptying all the way
•The need to go too often
•The need to go rapidly
•Weak urine flow
•Urine flow stopping and starting
•Getting urinary tract infections

Urodynamic testing–

Urodynamics is a series of tests conducted in an outpatient setting that evaluates the function of the bladder, including how totally the bladder, sphincter and urethra are storing and releasing urine. Urodynamic tests can also determine if the bladder is having involuntary contractions that cause leakage (urge incontinence).
Your doctor may recommend urodynamic testing if there are problems associated with any of the following conditions:

•urine leakage
•frequent urination
•painful urination
•sudden, strong urges to urinate
•problems starting a urine stream
•problems emptying the bladder totally
•recurring urinary tract infections.

Retrograde Pyelogram-

Retrograde pyelogramis used to evaluate lining renal collecting system; it is also performed prior to ureteroscopy or placement of urethral stents. The procedure is generally performed when an intravenous pyelogram (IVP) is not capable to supply a definitive diagnosis. It is also performed in patients with chronic kidney disease who cannot tolerate intravenous contrast dyes and in those who are allergic to the contrast dyes. After the patient has been anesthetized, the procedure begins by ensuring proper positioning of the patient in the dorsal lithotomy position.

Once positioning is full a cystoscopy is performed. The physician uses the cystoscope to identify the left and right urethral orifices.

The physician then uses a 5F or 6F open-ended or cone-tipped catheter to cannulate the ureter that needs to be imaged. Prior to cannulating the urethral orifice, the urethral catheter is flushed to ensure that there are no air bubbles within the lumen of the catheter. By doing this, false readings of filling defects in the collecting system are prevented.

Retrograde xylography is a form of x-ray used to get detailed pictures of the ureters and kidneys.Retrograde xylography uses a special dye (“contrast agent”) injected into the ureters. The dye makes the ureters and kidneys more easily seen on the x-ray. This test is like an intravenous pyelogram (IVP). But with IVP, the dye is injected into a vein instead of the ureter.Newer tests have mostly replaced retrograde xylography. But, retrograde xylography can sometimes show better detail in the upper urinary tract. Retrograde xylography is used when IVP doesn’t give a very good picture. It’s also useful along with cystoscopy to check for a reason of hematuria, like cancer.

 

 

 

 

 

 

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