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Diagnostic Testing
When you come for your first visit, Dr. Hall will carefully review your medical history and do a detailed, comprehensive pelvic exam. This exam will entail having you bear down or stand to assess the degree
of prolapse. She will also perform a cough stress test to assess urine leakage and mobility of the urethra. The office will collect a urine sample for urinalysis and perform both a uroflow and a bladder scan
to make sure you are voiding completely. In a patient with pelvic pain or pain with sexual activity, a targeted exam to pinpoint the cause of pain will be performed. Dr. Hall will also assess the strength of the pelvic floor musculature and a woman’s ability to contract these muscles.
The findings of the evaluation will be discussed at length with you and when possible, a preliminary diagnosis and treatment plan can be made. If the diagnosis is not completely clear, or if you are considering surgery for your condition, additional testing may be necessary.
The office uses the most up-to-date diagnostic equipment to arrive at an individualized diagnosis and treatment plan. These may include:
In addition, appropriate outside tests may be ordered such as anal manometry (which studies the pressures in the rectum), pudendal nerve testing, anal ultrasound to examine the external anal sphincter, and defecography, which is a special X-ray to determine the anatomy of the rectum, small bowel, and sigmoid colon.
A bladder scan is a non-invasive targeted ultrasound to determine the amount of urine left in your bladder after voiding. Often people are not aware they are emptying poorly and this can lead to recurrent urine infections or kidney dysfunction if severe. Poor voiding can also make the treatment of urinary incontinence more complicated.
Complex uroflowmetry is a procedure that measures the amount of urine voided and its flow rate. Decreased urine flow might be the result of inadequate bladder muscle contraction or prolapse (when the bladder drops from its usual position) which can kink the urethra. An increased rate of flow may indicate stress urinary incontinence or sphincter dysfunction.
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| Urodynamic testing is a painless office procedure to better understand bladder and urethral function and often helps guide treatment. |
Urodynamic testing is a tool measuring bladder pressures to get an idea of bladder function and the cause of incontinence. This test is done in the office and involves placement of two catheters, one into the bladder to measure bladder and urethral pressures, and one in the rectum or vagina to subtract out the abdominal pressure for more accurate measurement. The bladder catheter also is attached to a pump to instill sterile water into the bladder during testing. The test takes about 30 minutes (plan on being here 1 hour to set up the test) and is mildly uncomfortable but not painful. Once the report is generated and reviewed, Dr. Hall will discuss the findings and together you will formulate a comprehensive treatment plan. Urodynamic testing includes cystometry, urethral pressure profile, leak point pressure testing, and pressure-voiding studies. Urodynamic testing is used to diagnose detrusor instability (uncontrolled bladder contractions which can result in frequency or incontinence), voiding dysfunction and also quantifies stress incontinence so that you can be offered treatment that is tailored to you as an individual.
Cystometry or a cystometrogram measures the bladder pressure while filling the bladder and performing certain maneuvers. Cystometry can help diagnose conditions such as overactive bladder, decreased bladder compliance, sensory urgency causing urinary frequency and decreased sensation of filling.
Pressure-flow voiding studies are used to determine the ability of the bladder to contract and properly expel urine. With a bladder catheter in place, the patient urinates into a flow meter while the strength and resistance to pressure of the muscles in the bladder and urethra are determined.
Urethral pressure profilometry is a procedure used to determine the urethral pressures which will sometimes guide surgical treatment.
The valsalva leak point pressure is the minimum intra-abdominal pressure sufficient to cause urinary leakage. It can help guide surgical treatment in patients with stress incontinence.
Cystoscopy or cysto-urethroscopy is a procedure used to examine visually the inside of the bladder and urethra. After receiving a local anesthetic, a cystoscope (a telescope with a small camera) is inserted through the urethra and into the bladder. Cysto-urethroscopy is used to diagnose and evaluate urinary tract disorders, such as infections, the presence of kidney or bladder stones, tumors in the bladder and more.
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