This is an office procedure in which a small, flexible telescope is used in a man to inspect the urethra and bladder. In a woman, a small, rigid telescope is used. This inspection is done with the aid of a fiber optic light source connected to the telescope. Running water allows one a clear view down the telescope into the bladder. The water gradually fills the bladder and smoothes out the bladder walls, enabling a clear inspection of the inside of the bladder.
This procedure allows the doctor to detect causes of urinary bleeding (whether microscopic or gross hematuria) from problems such as tumors or obstruction from strictures, prostate enlargement, stones, etc.
No special preparation is needed, and the procedure is short and easily tolerated after numbing the urethra with topical anesthetic jelly. Rarely, a patient may experience some burning or minor bleeding after the procedure, but most will resume their normal daily activities immediately after this investigation.
Transrectal Ultrasound (TRUS)
This test involves placing a specialized probe into the rectum in order to obtain an ultrasound study of the prostate. This study is primarily useful for two things: (a) obtaining an estimate of the size of the prostate, and (2) insuring that the biopsy needle actually penetrates a representative sample of the prostate when biopsying the gland. Ordinarily, an ultrasound study without a biopsy is not very helpful in the diagnosis of prostate cancer.
The study may be indicated in those who have an abnormal PSA level, an abnormal digital examination of the prostate, or when attempting to obtain a size estimate of the prostate in anticipation of surgery.
Normally, the patient would prepare for the TRUS and needle biopsy of the prostate by stopping all blood thinners for at least a week before the study and self-administering a Fleet enema about an hour or two prior. Patients with certain heart conditions or who have prostheses may be given antibiotics before the procedure. Other patients will be given their antibiotics immediately after the biopsy.
The procedure takes about 15 minutes and is usually
not very uncomfortable. Patients can resume their daily activities
immediately after the study. Following the procedure, you may notice a
little blood in the urine, semen, and in the stool for a few days and
rarely for several weeks.
Transurethral Needle Ablation (TUNA) Therapy
(Of The Prostate)
(Of The Prostate)
The TUNA (Medtronic) System is a minimally invasive technique, similar in setup to an office cystoscopy whereby a low-level radiofrequency (RF) energy is delivered directly through the cartridge into the prostate. Twin needles deliver the RF energy into the prostate to destroy areas of the prostate through coagulative necrosis.
This office procedure takes about an hour and is designed to improve a man's voiding function to the point where we may stop his prostate medications and/or avoid the possibility of inpatient prostate surgery.
Catheterization may be needed for a few days. The TUNA therapy has few side effects and is covered by Medicare.
Urodynamics
Urodynamics is the study of bladder function as it relates to control (continence) and urination or voiding. This evaluation can be performed on both men and women through the use of small catheters and electrodes. Sometimes, x-rays are taken during this study (video urodynamics). The equipment used to perform the urodynamic studies is manufactured by Life-Tech, Inc.