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Advanced Diagnostic Services

Urologists now have many tools to help diagnose disease in our kidney, ureter, bladder and urethra. Precision Urology Hospital has separate Radiology and Pathology departments that aid the treating consultant to come to a precise diagnosis. Patients coming to the Outpatient department are directed to the Diagnostic suite after initial counselling. Once the diagnostic tests and imaging are carried out, the treating consultant reviews the results and then the final diagnosis is made. All the tests and imaging required to come to a specific diagnosis are made in a single OPD day visit to reduce the visit-to-diagnosis time. Generally, these diagnostic tests and imaging are detailed, often pain-free, and quick. Some of the diagnostic tests and imaging that we do at PUH are:

Ultrasound uses high-frequency sound waves to create real-time images. It is a simple and painless way for urologists to look at many organs. It is flexible and offers helpful information, without using dyes or radiation.

A small probe and gel are placed on the skin. The transducer can then collect the sound waves from organs to create an image. The images look like thin, flat sections of the body on a computer screen. This examination helps your doctor diagnose many things, including organ damage. It can show the bladder, ureters and the lower part of the kidney. Ultrasound is a painless, safe, and generally, risk-free procedure. USG is also called the stethoscope of urologists/nephrologists.

At Precision Urology Hospital, all your treating doctors have special training to perform and interpret USG results. Clinicians doing this test have the added advantage of knowing you and your organs better than radiologists.

One of the basic imaging methods in urology is X-ray. An x-ray (or conventional radiology) is a form of radiation produced by special machines that take pictures of the inside of your body. Structures that are dense, like bones/stones, look white on the film. Structures that contain air, like your lungs, look black. Muscle, fat, and fluid appear as different shades of grey.

Since soft tissues, like the kidneys, ureters, and bladder are not easily seen with x-ray, contrast agents or dyes can be used to help identify those structures. These dyes are injected directly into the organ or into a vein before the x-ray is taken. The dye helps your doctors see the shape of the urinary tract and soft tissue organs better on film.

How is X-ray done?

The x-ray test is done in a hospital’s radiology department. A radiology technician who is an expert in Urology care, usually does the x-ray under the guidance of your treating doctor.

Generally, no prior preparation, such as fasting or sedation, is required. Most x-rays are simple and take only a few minutes. Results can be seen and discussed right away.

You may be asked to remove parts of your clothing and jewelry to create a clear image. Depending on the type of test, you may be asked to stand, lie down, sit or assume a combination of these positions. A lead shield may be used to cover parts of your body. This shield can absorb some x-rays and protect areas of your body that are not being imaged. You may be asked to stay still and hold your breath for a few seconds at different stages of the test.

What is the risk of X-ray?

If you are pregnant or may be pregnant, you should let your doctor know before having an x-ray. X-ray radiation can be dangerous for a foetus. X-ray tests expose the body to radiation. Fortunately, modern x-ray equipment uses much smaller amounts of radiation than in the past.

Intravenous pyelography (IVP) is an x-ray exam that uses contrast dye to outline the kidneys, ureters, and bladder. It provides information about renal function and excretion. This test can help your treating doctor to identify causes, level and degree of obstruction in your urinary tract. The exam is used to diagnose why a patient has blood in their urine or pain in their side or lower back. In urology, the most common reason to perform IVP is imaging during evaluation of urinary stones or finding birth defects of the urinary tract.

Typically, an x-ray image of the abdomen is taken first, without dye. This helps the radiologist know the best way to position and give the actual test. A full set of kidney images may be done if small kidney stones are suspected.

Then, a contrast dye is injected once through a vein. The amount of dye given is based on the patient's kidney function and body weight. Children get less, and larger people get more. After the contrast dye is in the urinary tract, a series of X-rays are taken. These are taken at specific times, from two to ten minutes apart. These X-rays can show tumors, cysts, stones, or other problems.

The main risk of IVP is a reaction to the contrast dye. A small number of people can have an allergic reaction, which can result in hot flashes, nausea and vomiting. These are treated with anti-allergy drugs. Rarely, more severe reactions (breathing trouble, low blood pressure, swelling of the mouth or throat, and even cardiac arrest) can occur.

Patients with a history of hay fever, asthma or hives are at greater risk. Same is true for people with congestive heart failure, diabetes, or past reactions. Tell your doctor if you have a history of these things, so care is taken to prevent a reaction.

What are the risks of IVP?

The main risk of an IVP test is a reaction to the dye. Such reactions are not common. Reactions occur in anywhere from 3 to 13 out of 100 people having an IVP. In general, reactions are minor, and consist of feeling flushed (a sudden, temporary reddening of the face, neck or chest), nausea, vomiting. These are often treated with antihistamines (drugs that reduce the histamines in your body from an allergic reaction). In very rare cases, more severe reactions can occur. These can include breathing difficulties, low blood pressure, swelling of the mouth or throat, and cardiac arrest.

What can you expect before IVP?

Before your intravenous pyelogram, the technician would 

  • ask you questions about your medical history

  • check your blood pressure, pulse and body temperature

  • ask you to change into a hospital gown and remove jewellery, eyeglasses and any metal objects that may obscure the X-ray images

  • ask to urinate to ensure your bladder is empty for the exam

An intravenous (IV) line shall be placed into a vein in your arm through which the X-ray dye will be injected

What to expect during IVP?

For an IVP, you lie on your back on an examination table. The X-ray machine usually is either attached to or part of the table. An X-ray image intensifier — the part of the machine that obtains the images — is positioned over your abdomen. After you're positioned comfortably on the table, the exam progresses this way:

  •  X-rays are taken of your urinary tract before any dye is injected

  • X-ray dye is injected through your IV line

  • X-ray images are taken at timed intervals as the dye flows through your kidneys to the ureters and into your bladder

  • Toward the end of the exam, you may be asked to urinate again

  • You then return to the exam table, so that the health care team can get X-ray images of your empty bladder

What to expect after IVP?

When your IVP is complete, the IV line is removed from your arm and you may return to your normal activities. You will be called by your treating doctor who will review and interpret the X-ray images from your IVP and prepare a report.

Cystography uses X-rays and iodine contrast dyes to look at the bladder for a blockage or birth defect. It can find a congenital bladder problem, a bladder rupture , or urethral obstruction. There are different causes to be diagnosed when this is done in either paediatric or adult age groups.

How does an MCUG work?

To insert the dye, the doctor will first insert a catheter through the urethra to the bladder. The dye is injected into the bladder. X-ray pictures from different angles are taken as the bladder fills. More images are taken after the dye drains. The test takes about 1.5 hours and the patient may have to wait while the films are developed.

What happens during MCUG?

You will be able to stay with your child throughout the scan, unless you are pregnant. Anyone staying with the child in the X-ray room will be given a lead apron to wear to protect them from X-ray exposure. All the steps are the same for adults, except the presence of an attendant during examination. 

Your genital area will be gently cleaned with an antiseptic solution by the nurse. Then a small, flexible tube (a catheter) will be gently pushed into the urethra and up into the bladder. Once this is in place, the dye (contrast agent) will be injected into the bladder through the catheter. In paediatric cases, your child will be asked to pass urine into a jug or pan, whilst still on the table. After this, your child can get dressed and go home.

Are there any side-effects or complications from an MCUG?

Most people have an MCUG without any complications. Rarely, a person may have an allergic reaction to the dye (contrast agent) used. It is also possible, although uncommon, that damage to the bladder or urinary tract could be caused during injection of the contrast agent. The most common complication is a urinary tract infection. The test would not be done if the person having it has a urinary tract infection, so let the hospital know if you/your child have any of the signs of an infection.

Retrograde urethrogram is a tool used to evaluate trauma to the penile urethra or urethral disease.

For this test, a catheter is inserted about two centimetres into the penis. Contrast dye is injected through a tiny balloon on the catheter. Several X-rays are taken, or a fluoroscope is used to clearly see details on a special screen. If needed, the catheter is moved to fill the bladder. The patient is instructed to urinate while several more X-rays are taken.

Uroflowmetry measures the flow of urine. It tracks how fast urine flows, how much flows out, and how long it takes. It’s a diagnostic test to assess how well the urinary tract excretes urine. Your doctor may suggest uroflowmetry if you have trouble urinating, or have a slow stream. By measuring the average and top rates of urine flow, this test can show an obstruction in your urinary tract such as an enlarged prostate. When combined with the cystometrogram (CMG) it can help find problems like a weak bladder.

What to Expect?

There is no need to fast or adjust your normal food intake prior to the test. You should be doing this test with a full bladder. The procedure usually takes less than 30 minutes. You may be instructed to drink several glasses of water in the hours before the test is performed. Please arrive for your appointment with a comfortably full bladder. If you become uncomfortable from the urge to urinate before you are brought into a testing room, please inform the receptionist, who will inform the technician. You will be asked to urinate into a funnel connected to the electronic uroflowmeter. This records information about your urine flow on a flow chart. The flow rate is calculated as millilitres (ml) of urine passed per second. Both average and top flow rates are measured. Your doctor will know your test results right away. Average results are based on your age and gender. Your urologist will create a treatment plan based on test results and your health history

Urodynamic tests are used to diagnose patients who have urinary incontinence or other lower urinary tract symptoms. These tests are given to both men and women. Urodynamic tests are used to measure nerve and muscle function, pressure around and in the bladder, and flow rates and other factors. These tests look at how well the bladder, sphincters, and urethra are storing and releasing urine.

What to expect?

A cystometric test measures how much urine the bladder can hold, how much pressure builds up inside the bladder as it stores urine, and how full it is when the urge to urinate occurs. A catheter is used to empty the bladder completely. Then a special, smaller catheter is placed in the bladder. This catheter has a pressure-measuring device called a manometer. Another catheter may be placed in the rectum to record pressure there. Once the bladder is emptied completely, the bladder is filled slowly with warm water. During this time, the person is asked to describe how the bladder feels and indicate when the need to urinate arises. When the urge to urinate occurs, the volume of water and the bladder pressure are recorded. The person may be asked to cough or strain during this procedure to see if the bladder pressure changes. A cystometric test can also identify involuntary bladder contractions. After the cystometric test, the person empties the bladder, during which time a manometer is used to measure bladder pressure and flow rate. This pressure flow study helps identify bladder outlet blockage that men may experience with prostate enlargement. Bladder outlet blockage is less common in women but can occur with a cystocele or, rarely, after a surgical procedure for urinary incontinence.

What to do before UDM?

  • If you are pregnant, please call the hospital right away. Your urodynamics evaluation may need to be postponed.

  • If you have symptoms of burning or stinging with urination the day before the test, please call us, as your test may need to be postponed.

  • If you have chronic constipation, use enema (available over the counter) the day before your appointment.

  • If your urologist gave you antibiotics, take them as prescribed. If they did not give you an antibiotic, the urodynamics staff will provide one.

  • Eat a normal meal the day of the study, but remember no tea/coffee

After Urodynamics Testing

After having urodynamic tests, a person may feel mild discomfort for a few hours when urinating.

Urodynamics testing involves a small risk of developing a urinary tract infection or experiencing urinary frequency and/or urgency. You may also notice a small amount of blood in the urine. Should any of these symptoms continue for more than 24 hours after the testing, please call your consultant for instructions.

An antibiotic may be prescribed for 1 or 2 days to prevent infection, but not always. People with signs of infection—including pain, chills, or fever—should call their healthcare provider immediately.

Results and Follow Up

Results of urodynamic testing are available immediately after the test. You need to meet your doctor for further advice and action.

The CT scan is used by doctors to see and evaluate cross-sectional slices of tissue and organs. It is one of the best tools for diagnosing problems in the urinary tract and renal systems. It combines X-rays and computer calculations for detailed images. CT scans are often combined with radiopaque dye, injected into a vein to create clearer images. Specialized CT scans can make 3-D images of the kidney and blood supply. These can show problems with blood flow and offer a "road map" for planning surgeries.

Why is a CT scan done?

Your doctor may recommend a CT scan to help:

  • Locate the stone in your urinary tract

  • Pinpoint the location of a tumor, infection or blood clot

  • Guide procedures such as surgery, biopsy and radiation therapy

  • Detect and monitor diseases and conditions such as cancer, heart disease, lung nodules and liver masses

  • Monitor the effectiveness of certain treatments, such as cancer treatment

  • Detect internal injuries and internal bleeding

What are the risks of CT scan procedure?

During a CT scan, you're briefly exposed to ionizing radiation. The amount of radiation is greater than you would get during a plain X-ray because the CT scan gathers more detailed information. Doctors use the lowest dose of radiation possible and also faster newer machines to obtain the needed medical information. Although rare, the contrast material can cause medical problems or allergic reactions. Tell your doctor if you've ever had a reaction to contrast material.

How do you prepare for a CT scan ?

  • Take off some or all of your clothing and wear a hospital gown

  • Remove metal objects, such as a belt, jewellery, dentures and eyeglasses, which might interfere with image results

  • Refrain from eating or drinking for a few hours before your scan

Contrast material might be given to you:

  • By mouth. If your oesophagus or stomach is being scanned, you may need to swallow a liquid that contains contrast material. This drink may taste unpleasant.

  • By injection. Contrast agents can be injected through a vein in your arm to help your gallbladder, urinary tract, liver or blood vessels stand out on the images. You may experience a feeling of warmth during the injection or a metallic taste in your mouth.

  • By enema. A contrast material may be inserted in your rectum to help visualise your intestines. This procedure can make you feel bloated and uncomfortable.

How is CT scan done?

You can have a CT scan done in a hospital or an outpatient facility. CT scans are painless and, with newer machines, take only a few minutes. The whole process typically takes about 30 minutes. You lie on a narrow, motorised table that slides through the opening into a tunnel. Straps and pillows may be used to help you stay in position. During a head scan, the table may be fitted with a special cradle that holds your head still. While the table moves you into the scanner, detectors and the X-ray tube rotate around you. Each rotation yields several images of thin slices of your body. You may hear buzzing and whirring noises. A technologist in a separate room can see and hear you. You will be able to communicate with the technologist via intercom. The technologist may ask you to hold your breath at certain points to avoid blurring the images.

After the procedure

After the exam you can return to your normal routine. If you were given contrast material, you may receive special instructions. In some cases, you may be asked to wait for a short time before leaving to ensure that you feel well after the exam. After the scan, you'll likely be told to drink lots of fluids to help your kidneys remove the contrast material from your body.

Magnetic resonance imaging (MRI) uses radio waves and a strong magnetic field to create highly detailed pictures. It can show soft tissues so specifically that it can detail blood vessels and other structures. It is so accurate that it can show a hollow cyst from a solid mass.

Since the MRI can create three-dimensional images of a tumor's shape, it is often used for diagnosis and treatment. For kidney cancer, it can show if and where cancer has spread. On the other hand, the MRI may not be helpful for the urinary tract. It cannot show abnormalities in the bladder, for example.

The MRI doesn’t use radiopaque contrast dye. MRI is unique because it does not use ionizing radiation. Instead, it uses a strong magnet, radio waves and computers to create detailed images. The patient lies down within the MRI’s huge, hollow magnet. This magnet finds the nuclei of hydrogen or water atoms in a patient’s body. Radio signals created by first "exciting" and then "relaxing" protons, create digital images, showing different types of tissue.

An MRI exam can last from two to fifteen minutes. For healthy people, the MRI offers no risk. People with pacemakers, aneurysm clips, ear implants, or other metallic pieces should not get an MRI.

A bone scan is a specialised radiology procedure used to examine the various bones of the skeleton. It is done to identify areas of physical and chemical changes in bone. A bone scan may also be used to follow the progress of treatment of certain conditions.

Why might I need a bone scan?

Bone scans are used primarily to detect the spread of metastatic cancer. Because cancer cells multiply rapidly, they will appear as a hot spot on a bone scan. Bone scans are done to stage the cancer before and after treatment in order to assess the effectiveness of the treatment.

What are the risks of a bone scan?

The injection of the tracer may cause some slight discomfort. Allergic reactions to the tracer are rare, but may occur. Patients who are allergic to or sensitive to medications, contrast dyes, or latex should notify their doctor. If you are pregnant or suspect that you may be pregnant, you should notify your healthcare provider.

How do I prepare for a bone scan?

You may be asked to change into a patient gown. A gown will be provided for you. Lockers are provided to secure your personal belongings. Please remove all piercings and leave all jewellery and valuables at home. Generally, no prior preparation such as fasting or sedation is required. You may be asked to sign a consent form that gives your permission to do the test. A bone scan may be performed on an outpatient basis or as part of your stay in a hospital.

What happens during a bone scan?

An intravenous (IV) line will be started in the hand or arm for injection of the tracer. The tracer will be injected into your vein. The tracer will be allowed to concentrate in the bone tissue for a period of one to three hours. You may be allowed to walk around or even leave the facility during this time. During the waiting period, you will need to drink several glasses of water (four to six glasses) to help flush out any tracer that does not concentrate into the bone tissue. When the tracer has been allowed to concentrate in the bone tissue for the appropriate amount of time, you will be asked to empty your bladder prior to the start of the scan.

You will be asked to lie still on a scanning table, as any movement may affect the quality of the scan. The scanner will move slowly over you several times as it detects the gamma rays emitted by the tracer in the bone tissue. When the scan has been completed, the IV line will be removed.

What happens after the bone scan?

You will be instructed to drink plenty of fluids and empty your bladder frequently for 24 to 48 hours after the procedure to help flush the remaining tracer from your body. If you notice any pain, redness, and/or swelling at the IV site after you return home following your procedure, you should notify your doctor as this may indicate an infection or other type of reaction. The results of the scan are available on the same day. You can meet your doctor for post procedure diagnosis and further treatment on any available next date.

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