If the ICN has helped you
Please Read Our Disclaimer
Created: May 2000
and/or given you comfort
during those difficult nights,
we hope that you will become
a subscriber.
by: Diane Manhattan
Diagnostic Tests & Procedures
- What is a Cystoscope/Cystoscopy?
- What is a Bladder Distention?
- What is a Biopsy?
- What is a Potassium Test?
- What is a Urinalysis?
- What is a IVP?
- What is a Culture of Prostate Secretions?
- What is a Cystogram?
- What is a Radionclide Cystogram?
- What is a Cystometrogram?
- What is a Sphincter Electromyography?
What is a Cystoscope/Cystoscopy?
The cystoscope, is a long thin telescope like instrument fitted with two channels. The first channel consists of a lens and a fibro-optic light source and the second channel allows fluids to be instilled into the bladder. The cystoscope is small enough (approx. the size of a straw) to be inserted through the urethra into the bladder.The cystoscopy enables the urologist to look into the bladder and observe it's general condition to see if there are any signs of abnormalities and to check the neck of the bladder as well the positioning of the ureters. The cystoscopy also enables, the urologist to see if any type of prostate obstruction is present due to prostate enlargement.
Procedure:
- the bladder is filled and distended with gas or liquid
- once the bladder is distended the gas or liquids are released. This allows for sufficient viewing of the bladder wall and the general conditon of the bladder.
What is a Bladder Distention?
(hydrodistention)Bladder distention, is one of the most essential tests for the diagnosis of Interstitial Cystitis. Because the bladder distention is painful in IC patients, and if IC is suggested, this procedure is normally done under general anesthesia.
This procedure consists of distending the bladder, or stretching the bladder, to it's full capacity by instilling gas or liquids through the cystoscope. This test can detect inflammation, a thick stiff bladder wall, Hunners ulcers, and glomerulations (pinpoint bleeding) that may be seen only after the bladder is stretched.
The doctor may also test the patient's maximum bladder capacity, the amount of liquid or gas the bladder can hold under anesthesia. Without anesthesia, capacity is limited by either pain or severe urge to urinate.
Many people with IC have normal or large bladder capacities under general anesthesia. However, a small bladder capacity under anesthesia helps support the diagnosis of IC.
Procedure:
- patient is administered local anesthesia
- irrigation fluid is pumped into the bladder, usually 80-100cm above the patients bladder capacity.
- the irrigation fluid is pumped into the bladder until it comes to a drip, this is when the bladder is filled to capacity.
- pressure is applied to the urethra by pressing in the anterior vaginal wall. This is done to prevent leaking so an accurate volume of fluids can be taken.
- the bladder is observed for possible rupture, although this is very rare.
- the fluids are held for one or two minutes, the bladder is emptied, and the contents of fluids are measured
- the fluid is of clear color, then becomes blood tinged when the last 50-100cc of fluid is released (the bladder capacity is lowered in the classic/ulcerative IC and normal in the non-ulcerative IC
- the bladder is than viewed again in the distended state
- a second therapeutic distention may also be required
- the bladder is distended again and held for approx. 8 to 10 minutes
- biopsies may be taken, usually from two separate spots of the bladder
- catheter is usually placed (if deep biopsy is performed)
- the procedure is complete
What is a Biopsy?
A biopsy is a microscopic examination of tissue. A bladder biopsy is performed with a long tweezer-like instrument which is attached to the cystoscope. Small samples of tissues are removed from different locations of the bladder wall and the urethra. Biopsy is always done after hydrodistention, The biopsy has no pathognomonic
findings for IC, (biopsies can not determine IC) they are done to rule
out other varieties of cystitis or conditions, i.e., malignant or premalignant
diseases.
What is a Potassium Test?
(The Parsons Test)This simple test developed by Dr. C. Lowell Parsons to measure epithelial permeability, is based on the hypothesis that a solution of KCI (potassium) will produce no symptoms of urgency or pain when placed in a normal bladder. However, there will be symptoms of urgency or pain if such solution is placed in an impaired bladder.
Procedure:
- the test is performed by instilling two solutions into the bladder for 3 minutes each.
- Solution #1 is sterile water while solution #2 should contain 40 mEq of KCI in 100 mL of water.
- after the solution is instilled, the patient will be asked "To what extent does it provoke your symptoms on a scale of 1 (low) to 5 (high).
- If the patient has no response to water, but states that KCI solution is causing symptoms to increase by two or more pain levels, this is considered a positive test.
What is a Urinalysis & Sensitivity Test?
These tests can detect and identify the most common organisms in the urine that may be causing symptoms. There are, however, organisms such as the bacteria chlamydia that can't be detected with these tests, so a negative culture does not rule out all types of infection.A urine sample is obtained either by catheterization or by the "clean catch" method.
White and red blood cells and bacteria in the urine may indicate an infection of the urinary tract, which can be treated with an antibiotic. The choice of drug and length of time of treatment depends on the offending bacteria.
The sensitivity test is especially useful in determining the antibiotic,
in which the bacteria is most susceptible to. This test normally takes
approx. 5 days to get an accurate result. If urine is sterile for weeks
or months while symptoms persist, a doctor may consider a diagnosis of
IC.
Procedure:
For a "clean catch urine sample" the patient washes the genital area before
collecting urine "midstream" in a sterile container.
What is a Culture of Prostate Secretions?
In men, the doctor will obtain prostatic fluid from the patient. This fluid will be examined for signs of an infection, which can be treated with antibiotics.The Prostatitis Foundation offers extensive material on prostate massage, culturing and new diagnostic techniques.
Additional information can be obtained by mailing or calling the following address:
Prostatitis Foundation
1063 30th Street Box 8
Smithshire, Illinois 61478
fax 309-325-7184
voice mail 1-888-891-4200
Procedure:
The Urologist inserts his finger into the rectum and with slight pressure, he presses against the prostate. At this point the patient is asked to cough, and the prostate fluid will be collected and placed on a slide for examination.
What is a IVP?
(Intravenous Pyelogram)The IVP is an x-ray examination performed with an intravenous contrast (iodine dye), which is injected into the veins. The contrast, which is concentrated by the kidney, outlines the ureters, bladder and kidneys upon x-ray examination.
The purpose of this test is to evaluate the function and structure of the kidneys, ureters and bladder.
Procedure:
Patient preparation prior to this test is normally required. The preparation of this test includes clearing the colon. This is normally done by taking (4) - 5mg Dulcolax tablets the evening prior to testing however, the method may vary per prescribing physician.
Nothing should be taken by mouth after 12:00 midnight, the night before the procedure.
- you will be positioned on the X-ray table
- preliminary X-rays will be taken
- a sequence of x-rays will be taken
- this test normally can take from 15 minutes - 90 minutes determining on the doctors prescribing directions.
What is a Cystogram/VCUG?
(Voiding Cystourethrogram)A cystogram (VCUG), is a diagnostic x-ray examination of the bladder and urethra using a liquid contrast material which is instilled directly into the bladder through a catheter.
The Cystogram enables the physician to detect abnormalities of the urethra and the bladder. This test also can help determine abnormal voiding.
In males this tests can detect the narrowing of the prostatic urethra
and detect urethral stricture in both male and female.
Procedure:
- a catheter will be inserted into the urethra and passed through the bladder
- the contrast solution will be instilled into your bladder through the catheter and the catheter will be clamped so the contrast stays within the bladder
- x-rays will be taken in various positions
- the catheter is now removed and x-rays are taken while the bladder is emptying (the patient will be asked to void on a special toilet)
- once the bladder is emptied, a final X-ray will be taken.
What is a Radionclide Cystogram?
(Nuclear Bladder Scan)A Radionuclide Cystogram is a diagnostic scanning x-ray examination of the bladder and urethra using radio active materials (liquids) which are instilled directly into the bladder through a catheter.
The Radionuclide Cystogram is performed to evaluate the filling and emptying of the bladder along with evaluation of reflux of urine and obstruction to the flow of urine.
Procedure:
- a catheter will be inserted into the urethra and passed through the bladder
- the radioactive liquid will be instilled into the bladder through the catheter until the patient's bladder feels full. Catheter is removed.
- the bladder is scanned full
- the patient will be asked to empty their bladder (usually allowing the use of the restroom)
- immediately after emptying the bladder another set of scanning x-rays are taken allowing your bladder to be tested for incomplete bladder emptying.
What is a Cystometrogram?
(CMG)A cystometrogram is a test that allows the physician to determine the capability of the bladders compliance, capacity, stability and sensation while filling.
It also enables the physician to determine the ability of the bladder to empty itself, detrusor (the smooth muscle that forms the bladder) contractability and detrusor pressure.
Procedure:
- the patient will be positioned as if having a pelvic exam
- a catheter will be placed through the urethra into the bladder
- a small balloon will be inserted inside the catheter, this causes the catheter to stay in place during the procedure.
- another catheter will be inserted, in the vagina or the rectum (this measures the intra-abdominal pressure) and another small balloon will be inserted into the catheter allowing the catheter to stay in place.
- water is than instilled into the bladder through the catheter and the patient will be asked to let the technician know (1) when they feel the water going into their bladder (2) When they feel that their bladder is full, and, (3) When they feel that their bladder is to full to tolerate.
What is a Sphincter Electromyography?
(EMG)Electromyography is a test that is performed using a combination of electrodes. There are three different types of electrodes, the needle electrode, surface electrode (patch) and the wire electrode.
Surface electrodes are sometimes used, but do not provide the best accuracy. These electrodes are placed in the perianal area.
This test is designed to evaluate the activity of the sphincter muscle (muscle that is used to close the urethra when the urge to void is present).
The electrical activity of the sphincter muscle is picked up by the needle electrodes onto a monitor screen or audio on special speakers.
Procedure:
- positioning will vary as per physicians prescribing information to the technician. The patient can be placed in a supine position, standing position or sitting position. Because a majority of the sensory nerves are located at the bladder base, the positioning of sitting or standing is recommended .
- a catheter will be placed in the bladder
- than the electrodes will be placed. The needle or wire electrodes are placed directly on the sphincter muscle, for the female, they are placed approx. 1" from the vaginal opening, and in the male, between the base of the scrotum and the rectum.
- once the catheter and electrodes are placed in the proper positioning, the bladder is filled, usually with sterile water.
- the electrical activity of the sphincter muscle is registered on a monitor or on special audio speakers.
- steps 4 and 5 may be repeated