London Urology Online

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 MSSU for C&S & to confirm red cells Creatinine FBC Urinary tract ultrasound, Plain abdomen X ray PSA in men 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 Creatinine Urinalysis: MSSU for C&S if +ve Bladder ultrasound and residual, Urinary flow rate Blood glucose (if glycosuria present) 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 Creatinine MSSU (fresh) for M, C&S 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 Blood pressure check Urine or blood sugar Cholesterol PSA if abnormal rectal exam Hormone tests (testosterone, SHBG, Prolactin) if: 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. Urine culture (prostatic massage increases the yield but is difficult and uncomfortable) USS scrotum if doubt over testes PSA if concern over prostate [Practice details][Research News][Publications][Information][Links][Referrals] Copyright (c) 1999-2001 GH Muir. All rights reserved. [email protected]