Urology Preinvestigations

 

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Haematuria

BOO (Bladder outflow obstruction)

Recurrent UTIís

Erectile Dysfunction

PSA Testing

 These pathways are those I use in my own practice.

They are readily translated to general practice or a one stop visit in most cases.

Haematuria

The presence of haematuria mandates investigation to exclude a urololgical tumour although this is very unlikely in younger patients with microscopic haematuria. Do remember that dipstick testing may give a false positive results so confirmation of dipstick haematuria by microscopy is worthwhile. The investigations listed below can be carried out in primary or sceondary care depending on GP and patient preference

A "Urological" investigation path is recommended for:

  • Patients 40 years or more with frank or microscopic haematuria
  • Patients less than 40 years with frank haematuria
  • Heavy smokers or those with industrial exposure to bladder carcinogens

Most patients less than 40 years with microscopic haematuria can be referred to a nephrologist

Investigations

  1. MSSU for C&S & to confirm red cells
  2. Creatinine
  3. FBC
  4. Urinary tract ultrasound, Plain abdomen X ray
  5. PSA in men
  6. If the above are normal a cystoscopy (flexible or general anaesthesia) will be offered

 

 

BOO (Bladder outflow obstruction)

It is now the case that symptomatic management of lower tract symptoms in men is the rule. The tests listed here will exclude potentially serious problems such as retention and prostate cancer.

All the tests can conveniently be done in one visit.

Investigations

  1. Creatinine
  2. Urinalysis: MSSU for C&S if +ve
  3. Bladder ultrasound and residual, Urinary flow rate
  4. Blood glucose (if glycosuria present)
  5. PSA

 

 Also see referral guidelines for BPH

 

 

 

Recurrent UTIís

Most infections are the result of simple cystitis. A history of pyelonephritis should lead to an IVU being considered.

Investigations

  1. Creatinine
  2. MSSU (fresh) for M, C&S
  3. Urinary tract ultrasound, Plain abdomen X ray

  

 

 

 

Erectile Dysfunction

 It is rare to have a man with a normal libido and secondary sexual characteristics who has a low testosterone. Thus most tests in this area are to screen for co-morbidity

Investigations

  1. Blood pressure check
  2. Urine or blood sugar
  3. Cholesterol
  4. PSA if abnormal rectal exam
  5. Hormone tests (testosterone, SHBG, Prolactin) if:
  6. libido low or

    abnormal secondary sexual characteristics

     

     

 

Chronic prostatic or testicular pain

There may be a considerable stress element involved.

In older men it is important to rule out poor bladder emptying by the tests for BOO. In younger men one should consider STD as a more likely cause.

However most men will have no demonstrable pathology: tests are often to reassure.

  1. Urine culture (prostatic massage increases the yield but is difficult and uncomfortable)
  2. USS scrotum if doubt over testes
  3. PSA if concern over prostate

 

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