Diagnostic Procedures in Urogynaecology

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Medical histories and physical examinations do not always correlate with final diagnosis in women with urogynaecological conditions. A number of diagnostic procedures are available to help determine the correct diagnosis.

Mid-stream specimen of urine (MSU)

A mid-stream specimen of urine is tested to identify bladder infection and to decide on the appropriate treatment.  A dip stick test may also be performed prior to carrying out a MSU by your GP or specialist.

Bladder diary

A bladder diary is a very helpful tool to keep track of your bladder’s behaviour.  Urinary issues sometimes develop over time and often leave women completely unaware of their urinary frequency, bladder capacity or activity changes they make. An accurate bladder diary provides useful information to the doctor that can help stop the leakage of urine.

Urodynamics

What is Urodynamics?

Urodynamics is a way of testing the functions and behaviours of the bladder and the urethra (the tube that leads from your bladder to the outside).  The test usually involves the placement of a very small catheter, or tube, in the bladder, and another small tube in the vagina or the rectum. Sterile fluid is then used to fill the bladder, so that the doctor can see how the bladder behaves as it is getting full.

Why is it necessary?

The result of an urodynamics test is very helpful to assess the functioning of your bladder and urethra. The reasons that a woman might be experiencing incontinence, urgency, or difficulty in emptying her bladder can be very complex. These tests help to figure out what might be going on, and the best way to help get better.  The results of these tests will often help to determine the best treatment for your condition.

Are Urodynamic tests uncomfortable?

The testing should not be painful.  An anaesthetic gel solution may be used, and the catheters are generally very small.  As your bladder is filled with sterile fluid, you may feel as though you have the urge to urinate.  These sensations are an important part of the test itself, so make sure that you provide feedback on  what or how you feel.  You may be asked to cough, bear down, or perform other manoeuvres which might make you leak urine; do not worry about this.  It is important to remember that these tests can often help to identify the right treatment.

Some people experience mild burning or irritation when they urinate after the test; this should go away within a day.  You should be able to resume your normal activities after testing is done.

What preparation is required before testing?

You may be requested to come to the clinic with a full bladder, if you can.  You may also be checked for a urinary tract infection in the days before the test, which will require leaving a sample of Urine.

Cystoscopy

What is a cystoscopy?

Cystoscopy is a way to look at the inside of your bladder.  Numbing gel may be placed in the urethra, which is the tube between your bladder and the outside world.  After this, a tiny telescope is passed into the bladder. Sterile fluid is then used to fill the bladder, so that your doctor can see the inside. This allows your doctor to make sure that there are no abnormalities or other problems which might be causing your bladder symptoms. The test generally takes between 10 and 20 minutes.

Why is a cystoscopy necessary?

Sometimes, it is important to know if the inside of the bladder or urethra has any problems, such as stones, tumours, inflammation, or other problems which might be contributing to the bladder not working properly.

Is a cystoscopy uncomfortable?

The testing should not be painful. The numbing gel helps to reduce any irritation; there is slight discomfort, but generally no pain.  As your bladder is filling with water, you may feel the need to urinate. Some people have mild burning or irritation with urination after the test; this should go away within a day.  You should be able to resume your normal activities after a cystoscopy procedure is done.

What preparation is required before testing?

Generally, no preparation is required. Your doctor may also check for a urinary tract infection in the days before the test, which will require leaving a sample of urine.

Are there any risks associated with urodynamics and a cystoscopy?

There is a small chance of an urinary tract infection after the procedure. Sometimes, you may experience a burning sensation and frequency of urination. This is normal and should settle down with drinking plenty of fluids during the first 24 hours. Otherwise the test is considered routine and safe.