Investigative Urology 3

You will normally have tests of kidney function, bone function, liver function and your GP may check your blood cells for anaemia or other abnormalities. Newer tests for prostate cancer, which are thought to be more specific e. This should not, however, be used as a substitute for a full discussion of risks with your urologist.

If your PSA is greater than , your GP may start you immediately on hormone treatment before you are seen in the urology clinic. This PSA level means it is likely that prostate cancer is present and that it is no longer confined to the prostate gland.

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Your GP may also arrange a bone scintigram bone scan if this is possible. If your PSA remains raised or your GP suspects that your prostate feels abnormal, a referral will be arranged for you to see a urologist using the fast-track 2-week wait system. In the fast-track urology clinic, you will be assessed carefully by a urologist or a urology nurse specialist.

Based on this assessment, you may be advised to have further investigations which include:. This is a relatively new scanning technique that uses strong magnetic fields and radiowaves to produce a detailed image of the prostate. Experienced radiologists can examine these images and see whether there are any suspicious areas within the prostate that may be prostate cancer; any abnormal areas can then be targeted by a prostate biopsy. Recent evidence suggests that mp-MRI may be especially useful in identifying high-risk significant prostate cancers.

It is important to note, however, that some prostate cancers including low-risk cancers are not visible on MRI scans. Your urologist will discuss your individual situation with you and may then arrange for you to have a mp-MRI before arranging a prostate biopsy. Although many hospitals have mp-MRI, and skilled radiologists who are experienced at interpreting the images, not all do; work is ongoing within the NHS to address the training and capacity challenges.

Raised PSA

Patients wanting further information about their options should contact their doctor, a Prostate Cancer UK nurse or a Cancer Research UK nurse for further information about their options. It may take up to a week before you get the final results of your prostate biopsies. The biopsies are analysed under a microscope pictured right to determine whether prostate cancer is present. If it is, the tissue is examined in more detail to determine the grade of cancer the Gleason grade.

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This is done by looking at the characteristics of individual groups of cancerous cells. Once the biopsies have been examined carefully, the results will be discussed in a multi-disciplinary meeting where a number of specialists will consider them in detail. Click here to see a calculation of your risk of biopsy-detectable prostate cancer.

You will normally be advised about treatment of any prostate symptoms you may have and your urologist will arrange for you to have regular 6-monthly blood tests to check your PSA. If the PSA level remains raised or increases with time, you may be advised to have repeat biopsies or to have biopsies performed under a general anaesthetic saturation biopsies. The latter allows more extensive sampling and is more likely to detect prostate cancer if it is present.

More accurate still is a technique where your ultrasound scan is superimposed on an MRI scan. This technique is probably more sensitive in detecting prostate cancer but is still under assessment.

Download a leaflet about biopsies performed under general anaesthetic. To find out the extent of your prostate cancer, your urologist may arrange a CT scan, an MRI scan see above or a bone scintigram bone scan, pictured.

Together with the Gleason grade found on the biopsies, these will determine what treatment is needed. Not all patients, however, require staging investigations before treatment. Once the results of all the tests are available, your urologist will discuss what treatment options are available and what is best for you.

This will take into account your age, general health, PSA level, Gleason grade and stage of the tumour. Based on their results, the authors suggested that the rider's position has a greater role than seat design in potential compression. Solomon S, Cappa KG: Andersen KV, Bovim G: Impotence and nerve entrapment in long distance amateur cyclists.

Impotence and genital numbness in cyclists. Int J Sports Med. Comparative study of degree of renal trauma between amplatz sequential fascial dilation and balloon dilation during percutaneous renal surgery in an animal model. To compare two commonly used methods of dilation, the Amplatz sequential fascial ASF and the balloon dilator, in a porcine model.

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Fourteen kidneys from 9 female pigs were used for this experiment. One kidney of each pig underwent ASF dilation and the other underwent balloon dilation using the Nephromax balloon. The effects of both methods of dilation were assessed immediately in 1 pig, after 24 hours in 3 pigs, at 4 weeks in 4 pigs, and at 6 weeks in 1. The animals were killed, and the kidneys were removed for gross and histologic examination.

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No obvious gross differences were noted at 4 to 6 weeks between the two methods of dilation, with both appearing as fine scars. Histologically, minor differences were seen at 4 to 6 weeks, with slightly more abscesses and larger scar formation in the kidneys that underwent ASF dilation than in the balloon dilation group. In this porcine animal model, the degree of renal trauma induced by the ASF dilators and the balloon dilators during percutaneous renal surgery seems to be comparable.

The acute and chronic renal parenchyma effects of both methods of tract dilation were almost similar. The choice of nephrostomy tract dilation should be by physician preference. This is an interesting animal model study comparing the two most common methods of nephrostomy tract dilation in USA; Amplatz sequential fascial ASF dilators and balloon dilators. The study aimed to determine whether any significant differences in renal trauma were present between the two techniques both acutely immediate to 24 hours and chronically at 4 to 6 weeks in pgs.

The authors chosen the best animal model for this kind of analysis, since the renal collecting system, the intrarenal arteries and the kidney morphometric parameters are very similar between pigs and humans 1,2.

Diagnostic investigations in urology – Knowledge for medical students and physicians

The analysis was macroscopic and microscopic. The histologic examination at 24 hours showed no apparent differences, except for the degree of hemorrhage, which was slightly more in the ASF dilated tracts. The slight differences were not significant and the authors demonstrated that the use of either method of dilation had no difference in terms of the degree of renal parenchymal trauma.