Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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The diagnosis of bladder disease at Liv Hospital moves beyond basic testing to “Precision Diagnostics.” We aim not only to identify the disease but to characterize its molecular and functional subtypes. This allows us to tailor treatments specifically to the patient—whether that means selecting the right chemotherapy for a tumor or the right pacemaker setting for a neurogenic bladder. Our diagnostic pathway typically begins with non-invasive tests and escalates to advanced endoscopic and imaging procedures.
The foundation of bladder diagnostics is the examination of the urine itself.
For non-cancerous conditions, such as incontinence, retention, or neurogenic bladder, imaging provides little insight into function. For this, we perform a Urodynamic Study (UDS). This is an EKG for the bladder.
During UDS, small catheters are placed in the bladder and rectum (to measure abdominal pressure). The bladder is slowly filled with sterile water while a computer records the pressures.
When bladder cancer is diagnosed, or when explaining complex anatomy, imaging is required to “stage” the disease—checking if it has spread outside the bladder.
Cystoscopy is the direct visualization of the bladder interior. Under local anesthesia (gel) or sedation, a thin, flexible tube with a high-definition camera is inserted through the urethra into the bladder. This allows the urologist to inspect the entire mucosal surface.
Blue Light Cystoscopy (Photodynamic Diagnosis – PDD): Standard white-light cystoscopy can miss small, flat tumors (Carcinoma in Situ) that blend in with the bladder’s standard red lining. At Liv Hospital, we utilize Blue Light Cystoscopy (Cysview/Hexvix). Before the procedure, a contrast agent is instilled into the bladder, which is absorbed preferentially by cancer cells. When viewed under a blue light filter, normal tissue appears blue, while cancer cells fluoresce a bright pink/red. This technology significantly improves detection rates and reduces recurrence by ensuring all tumor tissue is seen and removed.
Narrow Band Imaging (NBI): Another optical enhancement technology available on our scopes. It uses specific wavelengths of light to highlight the vascular structure (blood vessels) of the mucosa. Since tumors have chaotic blood supplies, NBI makes them stand out clearly against the background.
If a mass is seen on cystoscopy, a biopsy is required. In the bladder, the biopsy is usually the treatment as well. TURBT is an endoscopic surgery where a rigid resectoscope is used to shave off the tumor from the bladder wall. Tissue chips are sent to pathology to determine the grade (aggressiveness) and stage (depth) of the cancer. At Liv Hospital, we often use “En-Bloc Resection,” removing the tumor in one piece to provide the pathologist with better architectural information.
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For men, it can be uncomfortable due to the length of the urethra, but it is generally not “painful.” We use plenty of numbing jelly (lidocaine). For women, the procedure is rapid and usually causes minimal discomfort. Flexible cystoscopes have made this procedure much more tolerable than the rigid instruments of the past.
A standard CT scan typically looks at the abdomen. A CT Urogram is a specialized protocol that involves acquiring images at specific time points after contrast injection to ensure the dye has traveled down the ureters and filled the bladder, providing a clear view of the urinary lining.
We need to be 100% sure of the type of incontinence. If you have “Urge Incontinence” (bladder spasms) but we perform surgery for “Stress Incontinence” (sling), the surgery will not work and could actually make your symptoms worse. Urodynamics provides the roadmap for the correct surgery.
Not yet. While MRI is excellent for detecting whether cancer has invaded the muscle wall, it cannot detect small, flat surface tumors or subtle inflammation, as the human eye can through a cystoscope. The two tests are complementary, not interchangeable.
This is a classic dilemma. It suggests that cancer cells are shedding from somewhere, but they aren’t visible in the bladder. They could be from Carcinoma in Situ (invisible flat cancer) or from the upper tract (ureters or kidney lining). In this case, we would perform Blue Light Cystoscopy and a CT Urogram to find the source.
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