Diagnostic

A flexible cystoscopy involves examining the inside of a man's bladder using a small, flexible scope, which is displayed on a screen. The procedure, similar in size to a catheter, typically causes minimal discomfort. It is conducted for various reasons such as blood in the urine, bladder tumors, prostate enlargement, obstruction, chronic infections, bladder stones, urinary leakage, and difficulty urinating. Before the procedure, the urethra is numbed with an anesthetic jelly, and antibiotics are administered afterward to prevent infection due to the sterilization of instruments before use.

Prostate biopsies are performed upon detecting abnormalities in the prostate via ultrasound or palpation. An anesthetic jelly is applied to the rectum beforehand, along with antibiotics to prevent infection. Guided by ultrasound, 10-12 needle biopsies are swiftly taken from the prostate through the rectal wall. Discomfort is minimal, typically resulting in a dull ache for 24-48 hours post-procedure. Sexual activity should be avoided for 72 hours to allow for healing. Patients may experience blood in urine and stool for up to a week, with potential semen discoloration for months. Discontinuation of aspirin or blood thinners is advised a week prior to the biopsy. 

General Biopsy Procedure

The prostate biopsy is a procedure that is performed because an elevated PSA or abnormal area has been identified in your prostate gland. It is impossible to determine the nature of such irregularities without obtaining a small amount of tissue with a needle biopsy for examination under a microscope. Our goal is to determine whether these abnormalities are the signs of early or late-stage prostate cancer. You will receive at the minimum 10 biopsies and possibly more during this procedure. It may need to be repeated in 3 months if negative since there is a 20-40% reported second positive biopsy rate if the first is negative for cancer.

How Is Prostate Cancer Diagnosed?

The diagnosis of prostate cancer involves a comprehensive four-step process, starting with the assessment of PSA levels to determine the need for further investigation. Through these steps, healthcare professionals can accurately diagnose prostate cancer and develop personalized treatment plans tailored to each individual's condition and needs.  Learn more about how prostate cancer is diagnosed.

A rigid cystoscopy is where our physicians look inside a woman's bladder and this can be viewed on a television screen. This is done through a scope that is no larger than a catheter. Very little discomfort is associated with this procedure.

Some of the reasons for having this procedure are blood in the urine, bladder tumors, repeated infections, urinary leakage and difficulty urinating. The urethra is medicated with an anesthetic jelly before the procedure. An antibiotic is given afterwards to prevent infection. This is done as a precaution since all our instruments are sterilized just before the procedure.

Biopsies for testicular issues are conducted in various ways depending on the patient's needs and preferences. An open biopsy involves a small incision, typically performed in a healthcare provider's office, surgical center, or hospital. Local anesthesia is administered, and a small piece of tissue is removed from the testicle. Alternatively, a needle biopsy, also performed in a healthcare provider's office, involves obtaining a tissue sample using a special needle without making an incision in the skin. The choice between these methods depends on the specific circumstances and the physician's recommendation.

Transrectal Ultrasound (TRUS) is a 5 to 15 minute outpatient procedure that uses sound waves to create a video image of the prostate gland. TRUS is essentially a painless procedure. 

Transrectal Ultrasound Imaging

The rectal probe sends sound waves to the prostate gland; normal and abnormal tissue bounce back different kinds of echoes that are relayed to the computer, which translates their pattern into a video picture of the prostate.

Most men in the age group for prostate cancer usually have some BPH as well, which can elevate PSA levels and make prostate cancer diagnosis more difficult. PSA density is the blood PSA level divided by the weight of the prostate, as determined by TRUS, which can help distinguish between BPH and prostate cancer. Basically, with BPH, the PSA level should not be more than 15 percent of the weight of the prostate. PSA levels exceeding 15 percent of the weight of the prostate are more likely to indicate the presence of prostate cancer and the need for a biopsy.

Renal, Bladder, Scrotal, and Testicular Ultrasounds. If your signs and symptoms require a kidney or bladder ultrasound, we can do this in our office. It is a painless way of imaging these structures using sound waves. We place jelly over the area to be scanned and the probe is then rocked over the area to obtain the ultrasound image of the organ.

Urinalysis can reveal diseases that have gone unnoticed because they do not produce striking signs or symptoms. Examples include diabetes mellitus, various forms of glomerulonephritis, and chronic urinary tract infections.

Macroscopic Urinalysis

The first part of a urinalysis is direct visual observation. Normal, fresh urine is pale to dark yellow or amber and clear. Normal urine volume is 750 to 2000 ml/24 hr.

Urine Dipstick Chemical Analysis PH

The glomerular filtrate of blood plasma is usually acidified by renal tubules and collecting ducts from a pH of 7.4 to about 6 in the final urine. However, depending on the acid-base status, urinary pH may range from as low as 4.5 to as high as 8.0. The change to the acid side of 7.4 is accomplished in the distal convoluted tubule and the collecting duct.

Urinary Tract Infections (UTIs) are a prevalent issue, causing over 8.1 million healthcare visits annually and affecting up to 60% of women and 12% of men in their lifetimes. UTIs occur when bacteria enter the urinary tract, leading to symptoms like burning urination, urgency, and potentially severe issues like kidney infections. Traditional diagnostic methods include urinalysis and urine cultures, but the newer Urine PCR test is gaining prominence for its accuracy and speed. This test, using multiplex polymerase chain reaction (PCR), can detect bacteria that are often missed in standard cultures, providing results within a day compared to up to a week for cultures. This rapid, sensitive method is becoming essential in diagnosing and managing UTIs effectively, especially for those with recurrent symptoms, and is available at Metro Chicago Surgical Oncology (MCSO). If you suspect a UTI or are experiencing ongoing symptoms, consider scheduling a visit to take advantage of the advanced diagnostic capabilities of the Urine PCR test.

CMG, or cystometrogram, is a diagnostic test that evaluates bladder function by measuring the pressures exerted within the bladder during various stages of the urination process. This involves instilling sterile water into the bladder via a catheter while monitoring pressure using sensors placed in the bladder and rectum. The test helps assess bladder, prostate (in males), and urethral function, particularly in conditions affecting bladder control like urgency, frequency, incontinence, and obstruction. Results guide treatment recommendations tailored to the specific condition identified.

The Uroflow device tracks urination patterns, including peak flow, average flow, and total voided volume, using a specialized urinal. Patients are advised to arrive with a partially full bladder and continue drinking fluids to induce urination upon arrival. Overfilling may lead to inaccurate results, necessitating a repeat study. A good evaluation study requires voiding at least 200cc unless there's a significantly large post-void residual volume. Post-Void Residual (PVR) volume, indicative of bladder emptying efficiency, is typically minimal but may increase with obstructive outlet diseases. PVR can be measured accurately using a catheter or non-invasively via bladder ultrasound, which involves placing a probe over the abdomen. The procedure is discomfort-free.

Pediatric urology is the diagnosis and treatment of congenital (i.e., present at birth) and acquired urological conditions and diseases in children. Pediatric urologists treat conditions of the male reproductive tract (e.g., undescended testicle) and the male and female urinary tracts (e.g., urinary tract infection).

The most common condition treated by pediatric urologists is urinary tract infection (UTI). Other conditions include the following:

• Abnormally located urethral opening (hypospadias)
• Backup of urine from the bladder into the ureter (vesicoureteral reflux [VUR])
• Bedwetting (nocturnal enuresis)
• Distention of the kidney in utero (antenatal hydronephrosis)
• Ureteropelvic junction obstruction (UPJ obstruction; may cause kidney damage)

Pediatric Urological Examination

MCSO urologic physicians generally do not see patients under the age of 18 years old. Many of our physicians will see children (under 18 years of age) for common and simple urologic procedures. Most children need the care of a pediatric urologist who specializes in school-aged and younger children. MCSO has a wide array of pediatric urologists that we can refer you to, if such a referral is necessary.