Laboratory Tests and Ancillaries
Diagnostic Tests
Urinalysis
In urinalysis, a urine sample is tested for signs of infections and microscopic hematuria.
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Frequency Volume Chart
The frequency volume chart provides useful information including frequency, total voided volume, functional capacity, fluid intake habits and demonstrates nocturnal polyuria.
Prostate-specific Antigen (PSA)
PSA is performed to detect or rule out prostate cancer. It is a strong predictor of prostate growth and has good predictive value for assessing prostate volume
Optional Tests
Optional tests may be used to screen men >40 years old with LUTS or other comorbidities.
Urodynamic Tests
Urodynamic tests are procedures that check how well the sphincter and urethra and the bladder store and release urine. These mostly focus on the ability of the bladder to hold the urine, as well as to empty steadily and completely. These may include uroflowmetry which measures how rapid the bladder releases urine and postvoid residual (PVR) measurement which evaluates how much urine has remained in the bladder. An increasing PVR may indicate medication failure and the need for surgical intervention or the need for further urodynamics testing. Additionally, a large PVR (>300 mL) must be monitored.
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Pressure Flow Studies
Bladder pressure measured during urination helps differentiate between obstructive symptoms and those resulting from bladder muscle or nerve problems. These may be done before surgical intervention when diagnosis is uncertain.
Cystoscopy
Cystoscopy is used to look inside the urethra and bladder to check for blockage and stones in the lower urinary tract. It is used to find the cause of urinary tract problems such as frequent UTIs, hematuria, urinary frequency, urinary urgency, urinary retention, urinary incontinence, pain or burning sensation before, during or after urination, trouble in starting urination, completing urination or both, abnormal cells such as cancer cells found in the urine sample. It can be used to treat problems such as bleeding and blockage in the urethra, to remove stones and to remove or treat abnormal tissue.
Cystometrogram
Cystometrogram measures pressure, compliance and storage capacity of the urinary bladder, and a uroflowmetry test may be included.
Imaging
Perform prostate imaging when surgical treatment is considered. It must provide sagittal and cross-sectional views with sufficient resolution in order to assess presence or absence of an intravesical lobe or a median lobe configuration (a lobe of hyperplastic tissue which protrudes into the lumen of the bladder causing mechanical obstruction by occluding the bladder neck each time the bladder contracts during voiding) and to calculate prostate volume.
Ultrasound
Abdominal or transrectal ultrasound (TRUS) may be performed to assess prostate size and shape prior to surgical intervention. Assessment of prostate size (volume) is important for the choice of interventional treatment ie enucleation techniques, open prostatectomy, transurethral incision of the prostate, transurethral resection or minimally invasive surgical therapies (MIST). The prostate gland is considered enlarged if the size is >40 cm3. The presence of median/middle or intravesical lobe will guide the treatment of choice for patients planned for minimally invasive therapy.
Computed Tomography (CT) or Magnetic Resonance Imaging (MRI)
CT or MRI may be done prior to surgical intervention to assess prostate size and shape.