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Urology examination

On …………....................……… day, ….............................................…………… at …...................................…… hours, an appointment has been made for you at the Urology Outpatients’ Clinic, on the first floor of Bronovo Hospital (route 20).
Please do not forget to bring your appointment card.

Echography bladder and/or kidneys
Echography is an examination which uses sound waves to create images of organs. You lie on the examination table with the lower body unclothed. You can cover the pubic area with the cloth provided. The skin and the probe will be coated with a watery gel. This will feel cold. The sound waves are transmitted via the probe into the body. These are then reflected back by the organs in the body. The reflected waves are sent to a computer and converted into images. In this way, the bladder and kidneys, for example, can be made visible. An echography is harmless (even for pregnant women), simple and painless.
Duration of the examination: 5-10 minutes.

Ultrasound scanning / echography of the prostate
It is sometimes necessary to use ultrasound scanning to examine the prostate. In this way, ultrasound examination gives a reliable assessment of the size of the prostate, the size and form of the sperm ducts and the presence of any cysts in the prostate. A smooth ultrasound tube is pushed up a few centimetres via the anus. The insertion of the tube can give a feeling of pressure but is not painful.
Prior to the insertion, a lubricant is put into the anus. This lubricant is also on a condom fitted on to the echo tube. In order to insert the tube properly, you will lie, with your lower body unclothed, on your left side with your knees drawn up to your abdomen.
An echograpy is not dangerous, simple and painless.
Duration of the examination: 5 -10 minutes.

Urodynamic study (bladder measurement)
This is an invasive procedure, which measures the sensitivity and the response of the bladder to filling. It is therefore an examination of how well the bladder functions. A special pressure-sensing catheter is introduced via the urethra into the bladder. This catheter is connected to a flushing system which fills the bladder. In addition, a thin pressure-sensing catheter is inserted a short distance via de anus towards the rectum. The ‘nurse practitioner’, a specialised nurse, will ask you to say when you feel the urge to urinate or if the bladder is full.
You may also be asked to strain or cough. The results of the examination will be recorded on a graph and the urologist will discuss them with you later. After the examination you may urinate in the toilet.
Duration of the examination: 30 - 45 minutes.

Cystoscopy (looking inside the bladder)
This is an invasive procedure, during which a rigid tube or flexible hose is used to examine the urethra and the bladder. Your legs will be placed in stirrups. Your pubic area will be painted with iodine, and then your doctor will cover the lower half of your body with sterile paper. An anaesthetic gel will be introduced into the urethra, and then the cystoscope inserted into the bladder via the urethra. The inside of the bladder can be visually examined with the scope. As the scope is linked to a camera, you can also watch. To obtain a good image of the bladder, it will be filled with a sterile fluid. Tell the doctor when the urge to urinate becomes overwhelming. After the examination is finished, you will feel the urge to urinate for some time, and there will be a slight burning sensation when urinating. The urine can also appear slightly bloodstained. These symptoms should have disappeared within 24 hours. By drinking large quantities of fluid, you will help the symptoms to disappear more quickly.
Duration of the examination: 10 minutes.

Prostate biopsy
In this examination, a thin hollow needle punches tiny pieces of tissue out of the prostate gland. These tissue samples will be examined under the microscope.
Two weeks before the examination, you must stop taking blood-thinning medication like Ascal, Plavix, Persantin or dipyridamole. If you are taking Marcoumar or Sintromitis, special arrangements will be made in consultation with your urologist.
To prevent fever after biopsies as much as possible, it is essential that, for 3 days, 1 antibiotic tablet per day is taken. You start doing this 1 day before the biopsy day. On the day of the biopsy, you must take the antibiotic tablet 1 hour before the arranged appointment. The third tablet, therefore, should be taken on the day after the biopsy.
The biopsies will be taken from the prostate using a hollow needle under ultrasound guidance. For an ultrasound-guided biopsy, you lie on your left side with your lower body unclothed and knees drawn up to your abdomen. The insertion of the probe can give a feeling of pressure but is not painful. The biopsies themselves can sometimes be sensitive. A total of 8 biopsies will be removed from the prostate gland. More extractions may be required if the prostate is very enlarged; this will be explained to you beforehand. After the examination, there may be a temporary showing of blood in the stools, in the urine and/or the sperm.
The examination takes 10 minutes.

After the examination
Despite the prescribed antibiotics, 6% of cases can develop a high fever sometimes accompanied by cold shivering. If this is so, you should contact the Urology Outpatients’ Cllinic (till 16.00 hours). After 16.00 hours, you can contact the Accident and Emergency Department (Spoedeisende Hulp) on Telephone number: +31 - (0)70 - 312 44 55.

Extra information
You are advised not to drive a car yourself following the urodynamic examination, the cystoscopy and the removal of biopsies. You are also strongly advised not to ride a bicycle for 24 hours after the prostate biopsy.

If you still have any questions after reading this information, please contact the Urology Outpatients’ Clinic, tel. no.: +31 - (0)70 - 312 41 44 (from 08:00 - 13:00 hours).

Edition: September 2009/261