Flow rate and residual ultrasound

As part of the investigation of problems with bladder function, it is often necessary to measure the rate at which urine is passed (the flow rate), and the amount of urine left in the bladder (the residual).

 

Preparation

To get a good flow test you need to pass more than 150 mL of urine. Begin drinking water early on the day, unless you already drink a moderate amount of water, as you need to have a full bladder for the test. To achieve this it is suggested that you:

1. Drink plenty of water on waking
2. Pass urine two hours before the test 
3. Continue to drink approximately 4-5 drinks before your appointment

If you do not have a full bladder at the time you come for the test, you can drink water in the waiting room to fill your bladder. You may be asked to fill out a simple questionnaire upon arrival.

 

Procedure

When you have a full bladder and feel as though you are ready to pass urine, press the button in the waiting room to alert the nurse. They will ask you to pass urine into a machine which measures the rate and volume of your flow and produces a printout. Your urologist will review the data at your next consultation. If the flow test is inadequate, a second flow test may be necessary. There would be no charge for this repeat procedure.

You will then be asked to lie down on a bed for a quick ultrasound scan of your bladder. This is a painless scan where ultrasound gel is placed on your lower abdomen, then the ultrasound probe uses sound waves to produce an image to see how much urine is left in your bladder.

 

Following your procedure

In the couple of hours following the test you can expect to pass a lot of urine. Your urologist will discuss the results with you at the next appointment or later the same day.

Flexible cystoscopy

As part of the investigation for many urological conditions, it may be necessary to look inside the bladder with a small flexible telescopic camera called a cystoscope.  This is performed in rooms as a minor procedure. 

A cystoscope is about the size of a catheter and is introduced up the urethra into the bladder. The urethra is the tube that carries urine from the bladder to the outside. Once the cystoscope has reached the bladder, the inside of the bladder can be inspected. The urethra is also inspected.

The test itself is not usually painful although it can be uncomfortable. Local anaesthetic jelly is used to numb the area and guide the cystoscope into the bladder. Usually, once the instrument has reached the bladder, the discomfort ceases.

 

Preparation

There is no special preparation for this procedure. You may eat and drink before the examination and you may drive home afterwards.

 

Afterwards

Following a cystoscopy:

• In the first few hours after the test, it is useful to drink extra fluids (approximately 2-3 drinks)
• Stinging in the urethra can also be experienced the first couple of times you pass urine after a flexible cystoscopy
• Occasionally there is a small amount of blood the first time you pass urine after this test

Infection is uncommon but can occasionally occur. If you feel you may have an infection, contact Urology Associates, or your GP.

Transrectal ultrasound and prostate biopsy (TRUS Biopsy)

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Transrectal ultrasound showing the volume of the prostate

In case of an elevated PSA blood test or a suspicious finding on digital rectal examination of the prostate, a transrectal ultrasound provides accurate imaging of the prostate. It is possible to take samples of the prostate with a biopsy needle.

To take the biopsy, a probe or a transrectal ultrasound (TRUS) is slipped into the rectum and guides a fine needle into the prostate through the rectal wall.

To reduce the risk of infection after the test, antibiotics will be given. The procedure is performed in the rooms and local anaesthesia can be used. The procedure normally takes 5-10 minutes. Most men can resume work and normal activities the next day.

 

Preparation

To reduce the risk of infection after the test, you will be given some antibiotics. Please start the antibiotics two hours before your biopsy appointment. Check you are not allergic to the antibiotics prescribed.

There is no other special preparation for this procedure, although having the bladder overfull can make the test uncomfortable. You may eat and drink before the examination. We recommend that you arrange for someone to drive you home afterwards.

 

Procedure

You will be asked to lie on a bed on your left side. After performing a rectal examination, the specialist will place the ultrasound probe into your rectum. The probe will display an ultrasound picture of the internal part of the prostate.  If biopsies of the prostate are to be taken, local anaesthetic may be injected into the prostate. Fine needles then take small samples of the prostate from different places within the gland.

Following the biopsy, your samples will be sent to the lab for analysis. It may take up to two weeks to get the results. An appointment will have been made for you to return for your results.

Following the procedure

• Finish your antibiotics as prescribed.
• After a biopsy you may see blood in the bowel motion, urine or with ejaculation.  This is normal and unless there is lots of bleeding, there is no cause for concern.
• While there is blood in the urine, continue to have a good fluid intake. This blood may be present for over a week. Blood may be present in the ejaculate for up to 6 weeks.
• Occasionally swelling may occur within the prostate after the biopsy.  This swelling may slow your urine flow and a catheter may be required until the swelling settles down.

If you develop high fevers, shivering and cold sweats, you may have an infection. This generally happens within the first 48 hours after the biopsy.  An infection is serious and you must contact your urologist.  There is always a specialist on call regardless of the time of day or night. You should contact them on the main phone number, 03 355 5129.

Urodynamic assessment

Urodynamic testing equipment

Urodynamic studies allow your urologist to examine and assess the function of the bladder. Urodynamics takes around 20-30 minutes to perform and does not require any special preparation or anaesthetic. Your study will be performed using imaging of the bladder, either ultrasound or x-rays. The study is performed at either Urology Associates or St George's Radiology.

Please inform us if you could be pregnant or if you have any allergies, particularly to iodine contrast, chlorhexidine, KY jelly, lignocaine gel or latex, as these are often used during this study.

 

Procedure

There is no special preparation for this study and you may eat and drink normally.  Please arrive ten minutes prior to your scheduled appointment time.  On arrival, you will be shown to a cubicle, asked to undress and put on a gown. You will be asked to pass urine before having this test.  You will then be shown to the examination room where the test will be performed.

The specialist will insert a small catheter into your bladder via the urethra and a small tube may need to be placed in your rectum. Once the catheters are in place, the bladder is filled slowly with a contrast solution which will outline your bladder and urethra on x-ray screens. Alternatively, your urologist may assess your bladder and kidneys using an ultrasound probe. If this is the case, some cool jelly will be placed on the skin of your abdomen. The catheter tubes are also attached to the urodynamic computer program which reads bladder pressures and volumes. Once the bladder is filled, the catheter in the bladder is removed and you will be asked to empty your bladder into a specially designed toilet.

You will be able to leave immediately after the procedure.  You are able to return to work if you wish.  After the procedure, we encourage you to drink several glasses of fluid.  This will help flush the residual contrast fluid from your bladder.

 

Following your procedure

Sometimes, your urologist is able to tell you the results of the test on the day of your appointment. Alternatively, a follow-up appointment will be arranged afterwards to discuss the results of your study and discuss options for treatment if needed.