One way of assessing the severity of your symptoms is to use the International Prostate Symptom Score (IPSS). You may be asked to fill this in before your consultation. This involves answering 7 questions and only takes 1-2 minutes to complete. A high score indicates more severe symptoms. Men with high scores tend to respond with better outcomes to treatment. It is important to note that other conditions apart from obstruction can cause similar symptoms.
A simple ultrasound test of the kidneys, bladder and prostate can provide a lot of useful information regarding bladder and prostate problems. The size of the prostate will be measured, and its shape will be noted. Large prostates often cause a blockage but not always. Small prostates can cause a blockage, especially if they protrude into the opening of the bladder. Ultrasound also measures the volume of urine in bladder after voiding to determine how well you empty. An ultrasound examination will also sometimes pick up problems such as tumours or stones in the bladder that obviously need to be dealt with when detected. Various other parameters are measured that all add to the overall picture.
Another simple but very informative test is called a Flow study. This requires the patient to come to the office with a full bladder. The patient is required to pass urine into a special container called a Flow Meter that measures the speed at which the urine comes out. An ultrasound scan will then be performed over the bladder to see how well it has emptied. A slow flow rate associated with a large volume of residual urine is an indication of an obstruction to the flow of urine. It is important to have a full bladder prior to this test, but not overfull. Patients should empty their bladder a couple of hours prior to the test and then drink 4-6 glasses of water while making their way to Dr Ende’s office. The test should be performed when you feel a normal to strong desire to pass urine but it is not good to hold on too long as this can overstretch the bladder and impair its ability to empty normally. If you do not think you can hold on for too long, let my secretary know and we will try to get your test done when you arrive. If you are not ready to void when the nurse calls for you, you may wait and drink more water (or go for some coffee) until you feel ready.
Sometimes it is difficult to ascertain whether or not voiding symptoms are related to a blockage, or other bladder dysfunction. Urodynamics is a specific test designed to obtain accurate information about the functioning of your bladder. It will help your Urologist to determine if there is a blockage, usually related to an enlarged prostate, or if in fact your symptoms may be related to some other cause of bladder dysfunction. This will help the Urologist to decide whether or not you need specific surgery to relieve a blockage or other investigations to determine the cause of your symptoms.
Urodynamics is a test performed in the Doctor’s Office. Dr Ende’s Nurse will help set up the test and will often carry out part of the test. Following the test, on the same day, you will see Dr Ende to discuss the results and any further treatment that may be required.
The test itself involves passing a catheter (small tube) through the penis into the bladder. Another very small tube (2mm to 3mm diameter) is passed into your rectum and both of these tubes are then connected to pressure reading devices attached to the computer. During the test you will usually be standing or sitting next to the computer. Saline (salt water) will be slowly pumped into your bladder through the tube in your penis and as your bladder fills up, the pressure will be recorded. During the test the Doctor Ende will ask you how full your bladder feels and whether you have a weak or strong desire to pass urine.
When you feel that your bladder is full this part of the test will be terminated. At this point you will be asked to pass urine into a small collection device to measure your flow rate. Once you feel you have emptied your bladder, all remaining tubes will be removed and the test will have been completed.
Following the procedure you may have some discomfort when passing urine for a day or so. You may even see a small amount of blood in the urine but in almost all cases this will clear up without any complication. In certain circumstances your Doctor may have prescribed you some antibiotics to reduce the risk of infection but this is a very uncommon complication.
If you take medications to help with your flow, you should continue these prior to these tests as this is usually as good as your flow can get
Sometimes a telescope is used to visually inspect the urethra (water pipe), prostate and bladder to get a better idea of what may be causing your symptoms and what treatment would be optimal. This test is usually carried out in the operating theatre and can be performed with local anaesthetic while you are awake, or with sedation/general anaesthetic.