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Diagnostic Testing

If additional evaluation is necessary after your initial exam and patient history, all of our advanced diagnostic technology is available in a discreet and relaxing setting under one roof at Capital Health Medical Center – Hopewell. Here are some of the tests we use to accurately diagnose your condition and develop a plan for your care:

Imaging

Computerized tomography (CT or CAT scan)

A computerized tomography scan, sometimes called CT scan or CAT scan, uses special X-ray equipment to obtain image data from different angles around the body, and then uses computer processing of the information to show a cross-section of body tissues and organs.

CT imaging is particularly useful because it can show several types of tissue—lung, bone, soft tissue and blood vessels—with great clarity. Using specialized equipment and expertise to create and interpret CT scans of the body, radiologists can more easily diagnose problems such as tumors, masses, stones, and cysts. In some cases, a special dye may be injected into the patient to improve image sharpness. Images from CT scans can also help surgeons plan procedures.

The Spiral CT at Capital Health provides extended coverage of the body, produces images with much greater detail, and allows for fast and accurate assessment of injuries. Whereas most scanners offer one-slice images, this new generation scanner shows 16, providing more data to radiologists with less wait.

The amount of radiation used in a CT scan is rather low and it is generally considered to be a safe diagnostic tool. Women who are known to be pregnant (or think they might be) should inform their provider before the test.

Magnetic Resonance Imaging

Magnetic Resonance Imaging (MRI) uses a magnetic field and pulses of radio wave energy to make 3-D pictures of organs and structures inside the body. MRI provides good contrast between the different soft tissues of the body, which makes it especially useful in imaging the brain, muscles, the heart, and cancers compared with other medical imaging techniques such as computed tomography (CT) or X-rays. Using MRI, a urologist or radiologist can more accurately determine if a mass is cancerous or benign.

Unlike CT scans or traditional X-rays, MRI does not use ionizing radiation. Additionally, MRI does not usually require the use of a dye for contrast (like CT does), which is beneficial for those with kidney problems. This test is performed in the Radiology Services Department at Capital Health Medical Center - Hopewell.

For this test, patients are required to lay still on a table that is rolled into a narrow tube. Talk to your doctor if you have become anxious or afraid in closed spaces. This test cannot be done if you have any metal in your body, such as metal joint replacements, brain aneurysm clips/coils, ear implants, or cardiac pacemaker/defibrillator or other implanted devices.

It takes 30 to 60 minutes to complete an MRI, after which you can immediately resume your normal daily activities.

Ultrasound

Ultrasound imaging, also called ultrasound scanning or sonography, is a painless method of obtaining images from inside the human body through the use of high frequency sound waves. The reflected sound wave echoes are recorded and displayed as a real-time visual image. No ionizing radiation (X-ray) is involved in ultrasound imaging.

Ultrasound is a useful way of examining many of the body's internal organs, including the kidneys, bladder, prostate. Because ultrasound images are captured in real-time, they can show movement of internal tissues and organs and help to diagnose a variety conditions, such as:

  • bladder dysfunction
  • enlarged prostate
  • urethral stricture (narrowing)
  • blockages
  • stones
  • tumors

In most cases, very little preparation is required before an ultrasound study. The patient lies on the exam table and a clear, water-based gel that helps conduct the sound waves through the body is applied to the skin over the area to be checked. The ultrasound technician then moves a hand-held probe called a transducer over the target area to collect imaging information. Patients can return to their normal daily activities immediately after the test.

Cystoscopy

Cystoscopy is used to perform a visual inspection of the patient’s bladder and urethra. A cystoscope is a thin tube equipped with a white light and lens that allows your urologist to view suspicious areas.

After a numbing gel is applied to the urethra and the patient is relaxed or asleep (if anesthesia is used), the cystoscope is inserted through the urethra and into the bladder. A sterile solution (water or saline) is then passed through the cystoscope to fill the bladder and stretch the bladder wall so your urologist can see clearly.

Because bladder cancer is the fifth most commonly diagnosed cancer in the United States and is the fourth most common cancer found in men, Capital Health also offers blue light cystoscopy (BLC) with Cysview, a breakthrough technology that improves bladder cancer detection so doctors can remove more cancerous tumors than previously possible with standard cystoscopy. Instead of filling the bladder with sterile water or saline, the Cysview solution is injected into the bladder and absorbed by any cancerous cells that are present. Under the blue light of the BLC cystoscope, infused cells appear hot pink, making it much easier to identify smaller tumors and lesions that might not be visible under the white light of a standard cystoscopy.

A cystoscopy is usually performed as an outpatient procedure and can take up to 30 minutes to complete. If you are given a sedative or anesthesia for the procedure, you will be taken to a recovery area after the cystoscope is removed to allow the medication to wear off. After that, you are immediately able to resume your daily routine. Some patients experience soreness, blood in the urine, or a burning sensation while urinating, but these side effects typically end within 12 to 24 hours.

Urodynamic Studies

Urodynamic testing is a group of tests that are performed to detect problems with storing or releasing urine. They look at the function of the bladder (where urine is stored, the urethra (the passageway where urine exits the body), and the sphincters of the urethra (muscles that open and close to control urine flow).

Testing begins with a small catheter carefully being placed in the bladder through the urethra to measure the pressures in the bladder. A small catheter is also placed in the rectum to measure belly pressure, with tiny sensors placed around the rectum to tell us how the sphincter muscles are working while your bladder is filled and when you urinate. Aside from the sensitive locations of the catheter placements, no sedation is required. The tests that are part of your urodynamic study may include:

  • For uroflowmetry, you will be asked to urinate in a special commode that measures the amount of urine you produce and tells us about your flow. For this test, it is important to have a normal urge to urinate.
  • Cystometrogram measures how full your bladder is when you feel the need to urinate. As your bladder is filled slowly with water through the catheter, you will be asked to indicate your need to urinate, ranging from a slight sensation of filling to an extreme urge to urinate. To determine how your sphincters are working, at certain times you will be asked to bear down and cough. If you have vaginal or uterine prolapse, the tissue bulging from the vagina will be reduced to check for leakage with the prolapse corrected.
  • A urethral pressure profile measures the length of the urethra along with the pressure in the urethra. Typically limited to female patients, this is done by slowly pulling the catheter out of the urethra.
  • During a pressure flow study, when your bladder is full, you will be asked to empty your bladder with the catheters in place. This tells us about your flow and how your bladder and sphincters/pelvic muscle work during urination.
  • Electromyography measures the muscle activity in and around the urethral sphincter during bladder filling and emptying.

Preparing for Your Urodynamic Study

  • Do not drink a lot of fluid before the procedure.
  • Arrive with a normal urge to urinate.
  • Because a catheter is placed in the rectum, it is best if the bowel is empty. You can use an enema the night before or morning of testing.
  • If you are taking bladder medication, your provider will tell you whether or not you need to stop the medication before the test.
  • If you have signs of an infection, please call the office so we can treat it before the test. You cannot have this testing if you have a urinary tract or bladder infection.

For a few hours after the study, you may have some mild discomfort with urination. Increase your water intake to dilute the urine and reduce irritation. You may be prescribed an analgesic if you are experiencing discomfort. According to national guidelines, antibiotics are not needed after testing, but if you have any signs of an infection (pain with urination, chills or fever), call the office at 609-303-4460.

Within 72 hours of the test, we will call you to review the results and discuss your plan of care.

Manometry

Anorectal manometry is used to assess chronic constipation and fecal incontinence by measuring the pressure of the anal sphincter muscles, sensation in the rectum, and neural reflexes involved in bowel movements. A small flexible tube (or catheter) with a balloon on the end is inserted in the anus, past the anal sphincter and into the rectum. The small balloon is gradually inflated, causing the nerves to react and the muscles in the rectum and anus to contract. The end of the catheter outside of the body is connected to a machine that measures and records the contractions and relaxations of the anus and rectum.