The 5 Most Common Urology Tests

Diagnosing Disease, Infertility, and Erectile Dysfunction

So you've taken your first step and made an appointment to visit a urologist. While you know that it's something you can't avoid (or at least shouldn't), you still feel uneasy about what to expect.

While these feelings are not uncommon, they're mostly unwarranted. Generally speaking, urology exams are pretty straightforward and usually no more evasive than a general physical you may have been asked to take. 

Whether you are dealing with an infection or experiencing problems with your prostate, there are 5 diagnostic tools commonly used in a urologist's office:

1
The Physical Exam

If you think you may have a urinary tract infection or are experiencing erectile dysfunction, your urologist will start with a series of questions to assess your symptoms, current health, medical history, and any medications you may be taking.

These questions will lead to an in-office physical examination of the kidneys, ureters, and bladder (if you are having urinary tract issues) or an examination of the penis and testis (if you are having erectile dysfunction or other symptoms related to the penis or testicles).

Other physical examinations include the digital rectal exam (DRE) used to manually evaluate the prostate gland. This is done by inserting a lubricated, gloved finger into the rectum. By doing so, the urologist can then feel the size of the prostate, assess its firmness, and detect any abnormal nodules that may be present. 

2
Blood Tests

Urologists rely on several blood tests to help determine the health of the urinary system or to better pinpoint the causes of male erectile dysfunction or infertility. Among them:

  • Prostate-specific antigen (PSA) tests can aid in the detection of prostate cancer or non-cancerous inflammation of the prostate. PSA is a protein released from the prostate gland which can increase whenever there is inflammation.
  • Creatinine and blood urea nitrogen (BUN) tests help assess kidney function. A high level of creatinine in the blood may mean that the kidneys are not functioning properly. A creatinine-to-BUN ratio is often used to help diagnose conditions that alter the blood flow to the kidneys, such as dehydration or congestive heart failure. 
  • Testosterone tests are important in checking the levels of testosterone in the blood when evaluating male erectile dysfunction. To evaluate infertility, a battery of other blood tests are used.

3
Urine Tests

To help diagnose the cause of your symptoms, your urologist may choose to order different types of urine analysis tests. Among them:

  • A urinalysis is performed in the urologist's office and requires you to urinate into a sterile cup. The test can detect for bacteria, blood cells, and other substances that are not meant to be there. Bacteria, white blood cells, leukesterase, and nitrites are suggestive of a urinary tract infection. A high glucose level may point the urologist in the direction of diabetes. Bilirubin, red blood cells, and a high protein level may be an early indication of kidney disease.
  • Urine cultures are used to see if there are any bacteria in a urine sample. The test is done in a laboratory to isolate the type of bacteria causing an infection. Sensitivity tests are performed on the culture growth to see which antibiotics will most likely kill the bacteria to clear up the infection.
  • 24-hour urine tests collect all of the urine you expel within a 24-hour period to check if substances like sodium, potassium, proteins, and hormones are within the normal range expected in people with healthy kidneys. Derivations may be indicative of kidney disease, lupus, diabetes, or preeclampsia in pregnancy.

4
Ultrasound, X-rays, and Other Imaging Techniques

When a problem is not readily visible, there are various imaging techniques we can use to help get a better glimpse inside.

An ultrasound is the imaging tool most frequently used in a urologist's office. Using high-frequency sonic technology, the device can detect problems related to the kidneys, bladder, testicles, and prostate gland (including tumors, cysts, stones, kidney enlargement, and abnormal movement of the bladder or urethra).

To diagnose conditions of the urinary tract, different types of X-ray may be ordered. These can include:

  • Kidney, ureter, and bladder (KUB) X-ray to assess causes of abdominal pain or to evaluate the structures and organs of the urinary system.
  • Intravenous pyelogram X-ray (IVP) in which dye is injected into the bloodstream to help define the structures and help identify disorders of the urinary tract.
  • Voiding cystourethrogram X-ray (VCUG) is done while the bladder fills and empties to examine the bladder and urethra using a special radiopaque liquid which the X-ray is able to highlight.

When a more sensitive imaging is required, a technique called computerized tomography (also known as a CT scan) can help diagnose urologic disorders such as stones, tumors, and cysts.

Another type of exploratory technique is cystoscopy. This is a slightly more invasive procedure that requires a local anesthetic to numb the urethra before a small telescope-like instrument is inserted into the bladder. This procedure can visually identify tumors and other abnormalities of the bladder wall.

5
Semen Analysis

In cases of male infertility, a seminogram (semen analysis) is performed as a first step. For this, you will provide a sample to your urologist's office. The sample is then sent to a lab where a technician will evaluate it for the presence of sperm as well as the motility and quality of the sperm. 

This test is also conducted after a vasectomy to determine whether the sperm has successfully been eliminated from the ejaculate.

Source

  • Kreder, J. and Williams, R. "Urologic laboratory examination." Smith's General Urology, 17th Edition. Tanagho, E. and McAninch, J.-Eds. 2008; New York: McGraw-Hill.

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