A biopsy is a procedure in which a tissue sample is taken from an organ, such as the prostate or kidney, and analyzed. Biopsies are the only definitive way to determine whether a mass is benign (non-cancerous) or malignant (cancerous). The most common biopsy performed by urologists is one that diagnoses prostate cancer. Complications from biopsy are rare, but can include infection, urinary retention, and bleeding.
Blood tests yield information about many different substances found in blood, such as hormones, minerals, and proteins. Drawing blood poses little risk to a person, and test results can be obtained quickly. Numerous tests can be conducted using a single blood sample. In urology, the most frequently ordered blood tests include:
- Blood urea nitrogen (BUN)
- Prostate specific antigen (PSA)
- B-human chorionic gonadotropin (B-hCG)
- Alpha fetoprotein (AFP)
- Uric acid
A computerized tomography (CT) scan, also known as a computerized axial tomography (CAT) scan, is a painless diagnostic imaging test that displays two-dimensional images of internal structures of the body on a computer screen. Patients can receive a CT scan on an outpatient basis or as part of an inpatient hospital stay. In urology, CT scans are often used to pinpoint the location of a cancerous tumor and to estimate if and where any cancer has spread. CT scans are also used in urology to locate an obstruction that might be interfering with urinary flow.
Cystoscopy, the use of a viewing instrument (often called an endoscope or cystoscope) to examine the bladder and urethra, is used to diagnose and treat conditions of the urinary tract. Cystoscopes contain a lens and light to view internal tissues of the body. Cystoscopes are of two types: rigid and flexible. Increasingly, diagnostic cystoscopy is performed with a flexible scope, particularly in men. Rigid cystoscopy is still often used, especially when biopsies are needed or stents (tiny silicone or synthetic tubes) need to be inserted.
When used diagnostically, a cystoscopy usually takes less than 15 minutes and may only require the use of anesthetic gel to prevent discomfort.
Cystoscopy is commonly recommended for patients who:
- Experience frequent urinary tract infections
- Have blood in their urine
- Experience loss of bladder control
- Have an overactive bladder, urinary blockage, or painful urination
Cytology is the study of cells from various body tissues and fluids to help diagnose disease. Urine cytology can help diagnose cancer and viral diseases. Urine cytology studies are useful in:
Digital Rectal Exam
- Initial screening of patients with hematuria (blood in the urine); and
- Follow-up study of patients who have had previously treated superficial bladder cancer.
A digital rectal exam (DRE) is the manual examination of the prostate and rectal lining to feel for abnormalities, such as lumps or hard areas. A DRE can be conducted both on men and women for a variety of conditions, including colon cancer or problems in the urinary tract. However, urologists primarily perform DREs to screen men for an enlarged prostate.
To screen men for prostate cancer, this test is best combined with a PSA test, or a laboratory analysis of how much of a prostate protein exists in a blood sample.
All men should begin these screenings at ages 45 to 50.
Intravenous Pyelogram (IVP)
An intravenous pyelogram (IVP) is a relatively safe and painless test that is used to examine the bladder, kidneys, and ureters. In an IVP, contrast material (dye) is injected into the patient's vein while the physician takes pictures of the internal organs with a type of video x ray called fluoroscopy. The contrast material highlights the organs of the urinary tract so they can be viewed during the test.
An IVP is typically performed to identify a blockage of the flow of urine and help physicians evaluate problems in the urinary tract.
An IVP may be used to help physicians evaluate problems in the urinary tract, such as kidney stones, tumors, or an enlarged prostate.
IVP is relatively safe and painless and typically takes about 1 hour to complete.
Magnetic resonance imaging (MRI) is a diagnostic test that uses radio waves, magnetic fields, and computer software to create highly detailed, cross-sectional images of the body's structures.
MRI is used to detect abnormalities in and around the reproductive organs and urinary tract and is often used to plan treatment.
MRIs typically last between 30 and 90 minutes, although new scanners take as few as 10 minutes.
Metal objects such as jewelry, dental bridges, and cardiac pacemakers interfere with MRI.
Nuclear studies are a type of radiology that allows physicians to diagnose disease by showing the structure and function of a particular organ or organs. To obtain nuclear scans, a physician administers an intravenous (IV) form of a radioactive drug, also known as a radioactive tracer, which is a special type of drug used together with nuclear scanning devices. One part of the tracer is a drug, the other part is a substance called a radioisotope, which emits gamma rays.
A gamma camera detects the gamma rays and sends the detection readouts to a computer for analysis and display.
Nuclear studies allow the physician to see how much of the radioactive drug an area of the body is absorbing.
Post-void residual refers to the amount of urine left in the bladder after urination. Post-void residual testing is used to assess the degree of bladder dysfunction. There are two types of this test: in-and-out catheterization and transabdominal or pelvic ultrasound.
A prostate specific antigen (PSA) test measures and analyzes the level of PSA in a blood sample. It is normal for PSA levels to increase as a man ages and his prostate gland enlarges. Physicians only become concerned when PSA levels increase above what is considered a normal level. A man's PSA level is considered slightly elevated if it is between 4 and 10 (nanograms per milliliter) ng/mL, moderately elevated if it is between 10 and 20 ng/mL, and highly elevated when more than 20 ng/mL. When accurate PSA readings are combined with a digital rectal examination (DRE), a manual examination of the prostate to feel for abnormalities that is performed by a physician, the two tests can detect nearly 90 percent of prostate cancer.
Men should have an annual PSA test according to the following guidelines:
- At age 40 for black men or if a man has a father or brother who had prostate cancer
- At age 50 for all other men
Semen analysis is a tool for assessing male reproductive health. By examining a man's semen, physicians can determine whether a man is producing enough sperm, whether the sperm are healthy, and whether the semen carrying the sperm contains antisperm antibodies or other factors that could interfere with the sperm's ability to fertilize a woman's egg.
Urinary stones, or calculi, are hardened, rock-like accumulations that form from mineral salts that occur naturally in the urine. Most often they form in the kidneys, and for this reason they are often referred to as kidney stones. Stone evaluation is performed after a patient has been treated for a urinary stone. The test either follows surgery to remove the stone or after a patient has passed the stone, collected it, and delivered it to the physician. The test is important to help the patient understand why the stone formed and how to prevent future stones from developing. Urine collections over a 24-hour period, which are used to assess levels of calcium, oxalate, uric acid, citrate, pH, sodium, and total volume, provide valuable evidence for the detection of underlying metabolic problems.
The usual types of stones identified in a stone analysis include:
- Uric acid
Ultrasound is a painless, radiation-free diagnostic test that typically lasts for less than 30 minutes.
Ultrasound equipment consists of a transducer (a device that creates sound waves) connected to a computer. The sound waves reflect off of internal tissues and return as echoes that a computer translates into a two-dimensional black-and-white image.
Some of the common applications of ultrasound in urology include:
Urine Flow Study
- Renal ultrasound
- Urinary bladder ultrasound
- Prostate ultrasound
- Pelvic ultrasound
A urine flow study measures the amount of urine a person expels in a certain period of time, his or her bladder pressure, and the activity of the muscles used to urinate.
The results of a urine flow study help a physician understand:
- How well or poorly a patient is urinating
- If an obstruction or abnormality exists in the urinary tract
- The severity of any obstruction or abnormality
- How well a patient is responding to any urinary treatment
Urine flow studies help to identify the following health conditions:
- An enlarged prostate
- Urethral stricture
The results of a urine flow study are not used to make a definitive diagnosis.
A urine test is the collection of a patient's urine to be examined for indicators of disease or illness. Most urine tests are performed to:
- Screen for, diagnose, or monitor renal (kidney) or urinary tract disease
- Detect metabolic or systemic diseases not related to the kidneys, such as diabetes mellitus
Urodynamics is a series of tests that measure bladder and urethral function performed in patients whose symptoms suggest a problem with the muscles or nerves of the lower urinary system and pelvis. Symptoms that may lead a urologist to order urodynamic testing include:
- Difficulty urinating or emptying the bladder
- Involuntarily leakage of urine
- Bladder control problems
- Pelvic pain
Urodynamic tests assess problems in the bladder, urethra, and sphincter muscles related to such symptoms by examining the storage of urine in the bladder, the bladder's pressure response to being filled with fluid or gas (fluid is preferred), and the flow of urine from the bladder through the urethra. Standard urodynamic tests include:
- Urethral pressure profile
- Abdominal pressure measurement
- Urinary flow rate
A voiding cystourethrogram (VCUG) is a test that is used to examine a child's bladder and lower urinary tract. In a VCUG, the patient's bladder is filled with contrast material to highlight the urinary tract. While the child voids, the physician takes pictures of the internal organs with a type of moving video x-ray called fluoroscopy. The test may be performed if the physician suspects that the child has an abnormality of the urinary tract that can obstruct urine flow or cause it to back up into the ureters or kidneys.
X ray tests show the body's internal structure, and can diagnose or follow up on the following conditions:
- Urinary tract stones
- Urinary obstructions
- Prostate cancer
- Urinary tract infections
- Benign (non-cancerous) masses in the urinary tract