Because of the unique training and expertise of our providers in all aspects of diagnosis and treatment of disorders of the female pelvic floor, we can provide a comprehensive approach to the diagnosis of gynecologic, urologic and bowel disorders. We use state-of-the-art technology and extensive experience and expertise for the complete evaluation of the bladder, lower urinary tract, and pelvic floor.
Where the Evaluation Begins
All evaluations at Mountain States Urogynecology begin with a consultation with one of our expert practitioners. This involves a review of your medical history, a one-on-one interview and a specialized exam. Completion of the Medical History Questionnaire and a Bladder Diary prior to your appointment are crucial to this comprehensive evaluation.
After the initial evaluation, other testing may be necessary to complete the diagnosis and to determine the most appropriate treatment. The most common additional tests are urodynamics (bladder testing) and cystoscopy.
Urodynamics is a test to see how well your bladder functions. Some (but not all) reasons this test may be needed include for the evaluation of incontinence, for people with bladder emptying problems, to look for incontinence prior to surgery for pelvic prolapse, and for patients who have a poor response to medicines for incontinence. The purpose of this test is to see how well your bladder empties, how well it holds fluid, if the bladder spasms, and how easy (if at all) leakage occurs with coughing and straining. Additionally, the test assesses how strong the urethra (outlet of bladder) is and if the bladder contracts and urethra relaxes during emptying (urinating). During the exam you will be sitting on a chair that is partially open on the base. Narrow catheters (the size of the inside cartridge of a Bic pen (?)) that measure pressure are connected to a computer that record everything that happens during the test. One catheter is placed through the urethra into the bladder to measure bladder pressure and to fill the bladder and another is placed in the vagina or rectum to measure pressure in the pelvis. Overall, urodynamics actually involves four separate tests performed sequentially: Uroflow, Cystometrogram, Urethral Pressure Profile, Pressure Voiding (Micturition) Study.
Cystoscopyis a direct visual evaluation of the bladder and urethra. Some common (but not all) reasons that your doctor may want to perform this test include: the evaluation of recurrent bladder infections, a failure to respond to medicines for overactive bladder, to look for possible bladder stones and evaluation of blood in your urine. It is performed by placing a lighted telescope (cystoscope) through the urethra to examine the bladder. The lighted cystoscope is connected to a camera, with the image of the inside of your bladder projected to a TV monitor. Your doctor will examine the bladder and urethra thoroughly to make sure there are no growths, bladder stones, or other abnormalities that can be treated. Your doctor will also look to see that the ureters (the tubes that carry urine from the kidney to the bladder) empty urine correctly into the bladder. During the test, the urethra is also examined for any abnormalities, such as a diverticulum (out-pouching) or fistula (abnormal communication). Sometimes a small instrument is used to take a small pinch of tissue through the telescope, in order to sample an area that may look abnormal. This is called a biopsy, and generally does not hurt as your doctor will numb the area first with an anesthetic.
Listed below are some other tests that are sometimes needed to complete the evaluation of pelvic floor problems.
- Pelvic Ultrasound
- Anal Sphincter Ultrasound
- Pudendal Nerve Testing
- Pelvic MRI