From the Guidelines
Urologists should utilize a combination of diagnostic tests, including history and physical examination, cystoscopic evaluation, urine cytology, blood work, upper urinary tract imaging, and metastatic work-up, to evaluate urinary tract and reproductive system conditions, as recommended by the most recent guidelines 1. When evaluating patients with suspected bladder cancer, urologists should prioritize cystoscopic evaluation, including biopsy or TURBT with bimanual examination, as it has been shown to be a crucial diagnostic tool 1. Some key diagnostic tests for urologists include:
- History and physical examination to assess overall health and identify potential symptoms
- Cystoscopic evaluation, including biopsy or TURBT with bimanual examination, to directly visualize the bladder and urethra
- Urine cytology to detect abnormal cells in the urine
- Blood work, including haematology and biochemistry, to assess kidney function and overall health
- Upper urinary tract imaging, such as CT urogram, to visualize the ureters and kidneys
- Metastatic work-up, including CT chest, abdomen, and pelvis, and liver function tests, to detect potential metastases in high-risk patients According to a recent systematic review, cystoscopy has been shown to have high sensitivity and specificity for detecting bladder cancer in adults presenting with haematuria, with studies reporting sensitivities ranging from 87-100% and specificities ranging from 94-100% 1. The choice of diagnostic tests may vary depending on the specific clinical scenario and patient presentation, but a comprehensive diagnostic work-up, including cystoscopy and imaging studies, is essential for accurate diagnosis and effective treatment planning 1.
From the Research
Diagnostic Tests for Urologists
- The diagnostic tests for urologists include a range of procedures to determine the probability of an underlying condition, such as hematuria, prostate-specific antigen (PSA) test interpretation, phimosis and paraphimosis, acute scrotal pain and masses in the child and adult, urinary tract infection, renal colic, and castration-treatment-induced bone loss 2.
- Common diagnostic tests in urology include urinalysis, prostate-specific antigen (PSA) test, postvoid urine residual, and peak urine flow rate 3.
- The quality of evidence supporting the use of common diagnostic tests in urology is an important dimension of the decision-making process and appropriate interpretation of these tests 4.
- A strong understanding of the pathologic features of urologic malignancies, such as prostate cancer, bladder cancer, and kidney cancer, is essential to prognosticate and counsel patients and to determine the most effective course of treatment 5.
- The goal of work-up of lower urinary tract symptoms is to establish the severity and cause of lower urinary tract symptoms and to predict with certainty which patients will respond to which treatments, using a combination of medical history, physical examination, urinalysis, and other diagnostic tests 3.