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Just as there are many types of incontinence, there are many types of tests to help doctors find out if you have incontinence, what type it is and what may be causing it.  Remember, incontinence is a symptom, not a disease unto it’s own!  Most of the tests for incontinence, while not always pleasant, are not painful or dangerous.  Understand that modesty goes out the window with a lot of the tests, but the results they can give a doctor can prove very useful in helping the doctor treat and even possibly cure your incontinence!  This list of tests is not necessarily in the order that they are given and as with the rest of the information on this site, they are for reference and may or may not apply in your specific situation.

The Voiding Diary:  While not really a “test”, the voiding diary can give your Urologist a LOT of information in regards to voiding patterns, volumes, times, etc...  The voiding diary is exactly what it sounds like.  Each time you urinate (whether accidentally or intentionally), you record the time, approximate length of time you urinated (counting seconds “one Mississippi, two Mississippi....), what you were doing when you urinated and generally how much you urinated (for example:  a little dampness, wet clothing/pad, completely emptied bladder).  In the diary, you will also keep track of what and how much you drank during that period, as different types and quantities of drinks can have an affect on when and how much you urinate.  Usually, you will keep this diary for 3 days to a week and return it to your Urologist.  He/She will be able to look at patterns, amounts, etc...for clues as to what may be causing your problem.  Whether the results are conclusive or inconclusive, your Urologist will probably order one or more of the following tests.

Abdominal and Renal Ultrasound:  In this test, a technician uses an instrument to take images of your kidneys, bladder and abdominal areas.  The ultrasound uses radio waves to take pictures and is NOT painful or dangerous in any way and most of the time you do not even have to get undressed.  The technician will have you lay on a table and will take the instrument (looks like a roll on deodorant attached to a machine by a cord) and will apply a gel to your skin down below your ribs and will “roll’ the instrument through the gel up and down each side and around to the front down in your bladder area.  The technician may or may not ask you to hold your breath for a couple of seconds and may ask if you voided/cathed recently.  This instrument will take detailed pictures that the doctor will look at to see if there are any obstructions, defects, damage or anything that could be contributing to or causing your incontinence or retention.  The ultrasound will also help the Urologist to determine if you have reflux (urine backing up into the kidneys), the size and shape of your bladder and the thickness of your bladder walls.  Using this information, the doctor can tell a lot about the health of your urinary system.  This test can take 20 to 30 minutes at the most, and carries no risks.

Bladder Biopsy:  In this test, a tissue sample is taken from the inside of the bladder so that a doctor can look at it under a microscope for signs of disease.  Usually the biopsy is used when cancer of the bladder is suspected.  This test is usually done as an outpatient procedure.  You will be given anesthesia and the Urologist will pass a cystoscope up your urethra into the bladder.  The doctor will then pass tools through the cystoscope to take a sample of your bladder tissue.  After the procedure, you may experience a little pain and maybe some blood in your urine and/or stinging when you urinate, but these symptoms are only temporary.  As with any time you are put under anesthesia, there can be risks associated with it, but they are minimal.

BPH Symptom Score:  This “test” is where you are given a symptom chart where you are asked to rate the various symptoms that may be related to benign prostatic hyperplasia (BPH) or “enlarged prostate”.  These symptoms range form frequency of the need to urinate, urgency of the need to urinate, weakness of urine stream, etc...  While this can not tell a doctor how severe your urinary obstruction is or how large your prostate is, it can give them a baseline of how bad your symptoms are to compare with your symptoms after treatment.

Bone Scan:  While a bone scan may not sound urologically related, it is sometimes used for staging of advanced bladder, kidney or prostate cancer.  It is similar to an x-ray and radiation exposure risk is quite low.  If there are abnormal findings, the doctor may order additional tests such as a MRI or CAT (CT) scan.

Cystoscopy:  In this test, an instrument called a cystoscope, which is a fiberoptic telescope with a light on it, is passed up the urethra into the bladder.  Usually a camera is passed through the cystoscope so the Urologist can look at the condition of your urinary system for abnormal things such as growths, obstructions, damage, etc...  Some of the reasons cystoscopy may be used to check are for frequent urinary tract infections, blood in the urine, incontinence or unexplained pain upon urination.  Usually before the test, an anesthetic is squeezed into your urethra from a tube so that you do not feel any pain during the procedure.  You may feel a little discomfort when the scope passes through your urinary sphincter but you should feel no serious pain.  You may feel a little burning when you urinate for couple hours after the anesthetic wears off or see a little blood in your urine.  There is a very low risk for urinary tract infection and you may be given a prophylactic antibiotic before the cystoscopy to help prevent any possible infection.  Overall risk with this test is very low.

Cytology:  This is a VERY detailed examination of a urine sample.  The Urologist looks for things such as abnormal blood cells, organisms and cancer cells in the sample.  The best urine sample to give for this test is the first time you urinate in the morning.  Since abnormal cells, organisms, etc... can form or originate anywhere in the urinary system, other tests will be needed to narrow down where the abnormality is coming from.

Intravenous Pyelogram (IVP) or Urogram (IVU):  This is a study of the upper urinary system such as the kidneys and ureters.  For this test, a dye is injected into a vein and a series of pictures is taken so kidneys and ureters can be studied as the dye travels through them.  This can help to detect defects or obstructions in the upper urinary tract.  The risk for this test is very low and the only real discomfort is from the needle inserted into the vein to administer the dye. 

Kidney-Ureter-Bladder (KUB):  This is simply an x-ray of the abdomen and pelvis.  Usually, this x-ray is used to follow the progress of kidney stones through the urinary system after you have been treated for them.  A MINOR risk of radiation exposure exists, as it does with any x-ray.

Prostate-Specific Antigen (PSA) Test:  This blood test measures PSA (or prostate-specific antigen) which is predominantly made in the prostate.  This test is used as a tool in the diagnosis of prostate cancer, along with other tests such as a digital rectal exam (examining the prostate using a gloved and lubricated finger inserted into the rectum) and a prostate biopsy which is discussed below.  PSA is not always a definitive indicator of the presence or absence of prostate cancer, which is why the other tests are used in the diagnosis.

Prostate Biopsy:  In this test to check for the possibility of prostate cancer, several samples of prostate tissue are taken through needles.  These needles are passed through the rectal wall to access the prostate gland.  An ultrasound rectal probe is used to guide the needle as it makes it’s way to the prostate.  Typically 10 to 12 tiny biopsy samples are taken by needle for evaluation.  A local anesthetic is used to guard against pain from the needle.  Before the test, you will be given prophylactic antibiotics and a Fleet Enema.  You should STOP aspirin or any other blood thinning medications at least a week before the biopsy.  After the biopsy, you may experience a little blood spotting and rectal discomfort but these symptoms should last only a short time.  You also may experience blood in the urine and semen which should clear up within 7 to 10 days.  This is an outpatient office procedure.  As with any invasive procedure, there is always risk of infection or other complication, but these risks are considered very low.  Results should be available in about a week from the biopsy from the lab that evaluates the samples.

Urodynamics:  Urodynamics refers to a series of tests that study the function of the bladder, sphincters that control urination and other structures.  During the test, the Urologist may insert a foley catheter so he/she can fill your bladder with sterile solution.  A rectal sensor is inserted into the rectum to take different measurements as well.  The test may also involve video to watch the bladder as it fills and then it’s reaction to being full and emptying (called video urodynamics).  Such things as voiding pressures, urine reflux into the kidneys, voiding function and residual urine (urine left in the bladder) are checked for during these tests.  These tests carry very minor radiation exposure risks (no more than an average x-ray), minor urinary tract infections risks, for which you may be given a prophylactic antibiotic before the test and may involve a bit of discomfort during catheter and sensor insertion and while the bladder is being filled.  Overall risk from these tests though is very low.

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