Special Procedures

There are several special procedures that may have to be done to establish the cause of the bloody urine.  Some of these procedures are done in the urologist's office, and some require a trip to the operating room so anesthesia can be given to make the procedure painless.

Cystoscopy

Cystoscopy involves using a telescope to directly see the urethra and bladder of a man or woman.  The procedure can be performed with a soft, flexible telescope.  Pain medicine, in the form of an anesthetizing jelly that coats the urethra, thereby numbing it, makes the procedure pain-free and able to be performed in the office.  Cystoscopy can see bleeding from the prostate and bladder.  It can see blood coming down into the bladder from the kidneys.  Cystoscopy is the procedure that diagnoses bladder cancer as well as identifies stones within the bladder.

  Mass within the bladder later shown to be bladder cancer.

  Growth within bladder, later shown to be bladder cancer.  

Retrograde pyelogram    

Retrograde pyelogram is an x-ray of the ureters and kidneys using iodine.  As opposed to an intravenous pyelogram which is an x-ray of the urinary tract taken after iodine has filtered through the kidneys themselves, a retrograde pyelogram is an x-ray taken after iodine is injected directly up the ureter and kidney via a cystoscope.  The iodine never filters through the blood system or the kidneys themselves, but only fills out the middle of the kidneys where urine collects before it is transported down the ureters into the bladder.  Retrograde pyelogram is used when the kidneys and ureters are not visualized well enough on an intravenous pyelogram, when a patient is allergic to iodine and we do not wish it to filter through the blood, or when the patient's kidneys are not functioning well and would not be able to concentrate the iodine enough in the kidneys to produce an adequate picture.

  Large shadow in bladder (bladder cancer) causing blockage and fullness of left ureter.  

Ureteroscopy

Ureteroscopy involves using a special long, skinny telescope to actually directly see the ureters and the kineys themselves.  It is entered into the bladder just as a cystoscope is entered into the bladder, but the ureteroscope is then advanced up the ureter to the kidney.  This allows direct visualize of the inside of the ureters and kidneys, and is used to look for stones or tumors in these locations. 

  Stone within lumen of ureter.

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