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COPYRIGHT 2003 Jannetti Publications, Inc.
This is the second of a two-part article reviewing basic laboratory, imaging, endoscopic, urodynamic, and miscellaneous studies used for screening and diagnosis of urologic disease. Part one dealt with laboratory analysis. This installment deals with diagnostic tests and tools used in urologic disease.
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Investigating urologic disease involves many testing modalities, all driven by a thorough history and physical examination. Laboratory studies including blood and urine tests were reviewed in Part I. Questionnaires and diagnostic tests commonly used in evaluating urologic disease will be reviewed along with their indications for use. Diagnostic tests often define the anatomic and dynamics aspects of disease.
RADIOLOGIC TESTS
A Kidney-Ureter-Bladder x-ray (KUB) is an anterior-posterior noncontrast film of the kidneys, ureters, bladder, and pelvis. It is often performed as a preliminary study for an intravenous pyelography (IVP) of the urinary tract and can evaluate for urinary calculi or masses. An IVP or excretory urography (EXU) is a series of radiologic films taken after an intravenous injection of radiopaque contrast medium, providing information about the entire urinary tract as the contrast moves through.
Procedural care. The patient is asked about allergies to contrast medium or iodine. Bowel preparation includes liquid dinner before 6:00 pm the night before the procedure, followed by a laxative (X-prep). Patients may feel flushing or warmth, a salty taste in their mouth, or nausea as contrast is administered. Observe for allergic reactions such as urticaria, itching, diaphoresis, or respiratory symptoms. Explain that pressure will be applied to the lower abdomen during the procedure to compress the ureters and allow better visualization of the tonal pelvis and proximal ureters. Force fluids after the procedure to help flush the kidneys.
Retrograde Radiologic Studies
Retrograde radiologic studies are usually performed at the time of cystoscopy, under local or IV sedation or general anesthesia. Contrast medium is injected in a retrograde fashion through the urethral meatus. Retrograde pyelogram can be performed in a patient for whom IVP is contraindicated or insufficient, and visualizes the ureters, ureteropelvic junction, renal pelvis, and calices, it is performed to evaluate for filling defects or urothelial pathology. Retrograde cystogram is used to evaluate for anatomical defects in patients with recurrent urinary tract infections, vesicoureteral reflux, hematuria, trauma, postsurgical healing, and stress urinary incontinence. A retrograde urethrogram is helpful in determining a urethral stricture, fistula, trauma, diverticulum, or tumor.
Procedural care. Urine culture or gram stain is collected preprocedure to rule out infection. Patients should be kept NPO after midnight. Inform patients to increase fluids, and that transient flank pain, bladder, or urethral discomfort may occur but should resolve in 24 to 48 hours. Dysuria, fever, or chills should be reported.
Ultrasonography
Ultrasonography, using mechanical vibration at high frequencies usually between 2 to 20 MHZ, is a safe, noninvasive method of imaging soft tissues and structures in urology, such as the kidneys, ureters, bladder, prostate, testes, and penis. Use of Doppler ultrasound allows views of blood flow in vessels.
Renal ultrasound is performed through the abdomen and back in the longitudinal and transverse planes and is used to differentiate between simple and complex cysts or to define masses noted on EXU. Renal ultrasound is also performed for organ mapping prior to biopsy or to evaluate transplanted kidneys.
Bladder ultrasound is performed through the lower abdominal wall, and used to detect residual urine volume, bladder wall thickness, bladder calculi, tumors, and diverticuli.
Prostate ultrasound is performed with a transrectal probe, with images take in the anterior-posterior, coronal, and sagittal planes to estimate prostate volume, shape, and echogenicity.
Scrotal ultrasound is used to evaluate suspected testicular torsion, cryptorchidism, trauma, tumors, varicocele, and epididymitis.
Penile ultrasound is usually part of an evaluation for suspected vasculogenic impotence, because blood flow in the cavernosal arteries can be assessed. Doppler ultrasound can differentiate between nonischemic high-flow priapism and ischemic low-flow priapism.
Procedural...
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