Treatments

Dr. Mulcahy is a Urological Surgeon who uses the latest medical technology within a state of the art medical facility to ensure his patients have the best possible outcome. Click on the tabs below for further information about the treatments and investigations Dr. Mulcahy offers. 

Treatments

Transrectal Ultrasound Guided (TRUSS) Biopsy

The prostate is a small, walnut-shaped gland present in men. It provides nutrition to sperm and assists in its transport. Certain conditions can enlarge the prostate, interfering with the flow of urine. When your doctor suspects prostate disease, a prostate biopsy is usually performed to remove a small sample of suspicious tissue from the prostate for further examination. Transrectal ultrasound (TRUSS) is a type of prostate biopsy that involves inserting an ultrasound probe through the rectum to guide a biopsy needle to collect a tissue sample for examination.

What is a Transrectal Ultrasonography Scan Biopsy?

A Transrectal Ultrasonography Scan Biopsy is performed with an ultrasound probe that is inserted in to the anal canal that allows imaging of the prostate gland to be seen. Local anaesthetic is used on the prostate gland to ease any local pain when obtaining the biopsies. A TRUSS biopsy may be indicated to evaluate the prostate for abnormalities such as enlargement, cancer or male infertility.

There is no need to fast. It is essential that you remain hydrated and eat/drink as per usual. Please ensure you drink at least 600mls of water prior to the procedure.

Before the Procedure

If you are taking Aspirin, any other blood thinners or anti-inflammatory medications, you will need to cease taking these two weeks prior to the procedure.

You will be given a prescription for anti-biotics. Start taking these the day before your procedure - twice per day (one in the morning, one in the evening) and another in the morning of the procedure. After the procedure, continue taking your anti-biotics until you have finished the entire course (7 days total).

You are also advised to take 1g of paracetamol approximately one hour prior to the procedure.

Please ensure you have someone accompany you to the procedure, as they will need to drive you home.

The Procedure

You will lie on the procedure room bed on your left side with your knees and bottom slightly over the edge of the bed.

The area is cleansed and a lubricant is applied to enable smooth insertion of the ultrasound probe into the rectum. Local anaesthetic is administered on both sides of the prostate to reduce discomfort while the biopsies are taken. Images are generated with the help of transrectal ultrasonography to assist the doctor in guiding the biopsy needle to the prostate. After proper positioning of the biopsy device, thin cylindrical sections of tissue are obtained with a hollow spring-propelled needle. This may cause an unpleasant sensation for a short period of time while the samples are being taken.

Usually, 16 biopsies are taken, however it is not unusual for one or two extra samples to be collected from an area of interest.

After the Procedure

When the procedure is finished, Dr. Mulcahy will check both the end of your penis and anal canal for any bleeding. A small amount of blood from both areas is normal.

When you leave the surgery you should plan on having a quiet week to recover from the procedure. This means NO heavy lifting, physical activity or sexual intercourse.

You also need to drink plenty of water and stay hydrated over the next few days. This is to dilute your blood, ensure clots do not form and ensure your antibiotics are adequately dispersed throughout your body.

Please ensure you take the entire course of antibiotics following the procedure (7 days)

Important Information

  • A small amount of bleeding is normal, however increased bleeding from either the anus or penis needs to be brought to medical attention. If this occurs, you need to present to your nearest Hospital Emergency Department.
  • If the flow of your urine stops completely, you must present to The Canberra Hospital Emergency Department.
  • If you feel generally unwell with hot flushes, you need to present to The Canberra Hospital Emergency Department as you may have an infection.
  • If any of the above occurs and you present to The Canberra Hospital, please advise them of the procedure you had and the date of procedure and Dr. Mulcahy’s team will contact him.

Ureteroscopy

Ureteroscopy is a procedure that involves the use of a thin, long tube called a ureteroscope, to examine, diagnose and treat urinary tract problems. The ureteroscope is most commonly used for the diagnosis and treatment of kidney stones but is also indicated for the treatment of various conditions such as frequent urinary tract infections, urinary blockage, haematuria (blood in the urine), unusual cell growth or tumour in the ureters (urine tubes). Ureteroscope may be flexible, or rigid and firm.

Ureteroscopy is an outpatient procedure, performed under spinal or general anaesthesia. Your doctor inserts the tip of the ureteroscope through the urethral opening (opening of the urinary bladder to the outside) and advances it up the urinary bladder and into the ureter (kidney tubes that empty urine into the bladder). No incisions are made. A sterile liquid is passed through the ureteroscope to fill and stretch the bladder. This helps your doctor to clearly view the bladder wall, locate the stone and diagnose any abnormalities.

To remove the stone, your doctor may insert a thin wire with a tiny basket attached to its end through the ureteroscope. The basket grabs and removes the kidney stone. Your doctor may sometimes break a large stone with the help of laser emitted through a flexible fibre passed through the ureteroscope.

The complete procedure takes about 15 to 30 minutes. After the procedure, you may feel a mild burning sensation during urination. You will be advised to drink plenty of water to relieve post-operative discomfort. Your doctor may prescribe antibiotics for a few days to prevent infection.

Like most therapeutic procedures, ureteroscopy may be associated with certain risks such as:

  • Abdominal pain
  • Bleeding
  • Injury in the ureter
  • Urinary tract infection

Pyeloscopy

Urinary stones are stones that form in any part of the urinary tract including the kidneys, ureters, or bladder. Kidney stones are one of the most painful urological disorders. With the advent of minimally invasive surgical treatments for kidney stones, open surgery is now rarely required. Most cases of kidney stones can be managed with no-scalpel surgery.

Laser stone surgery using flexible pyeloscopy is a minimally invasive procedure used to treat kidney stones without the need for an incision. In this procedure, the urethra is used as an entry point for the flexible ureteroscope (pyeloscope). The procedure has a high success rate and can be performed as day surgery. Moreover, it is relatively safe and has only a small risk of infection, mild bleeding or damage to the ureter. It is used to treat kidney stones up to 2 cm in size.

Procedure

The procedure is performed under general anaesthesia and usually takes about 60 to 90 minutes. It involves inserting a flexible scope (pyeloscope) less than 3 mm in diameter into the kidney from the bladder via the urethra. The flexible nature of the scope allows visualisation of the entire kidney drainage which helps to locate the stone. The pyeloscope also has a small instrument port through which a laser fibre (0.3 mm diameter) is introduced. Once the stone is located within the kidney, the laser is used to fragment the kidney stone. Micro baskets (less than 1 mm wide) are then used to remove the fragmented stones. Sometimes, a temporary urinary stent is left in place for a short period to ensure that stone fragments are drained from the kidney and ureter without the risk of blockage.

After the procedure

If urinary stent is left in place, care should be taken so as not to accidently dislodge the stent. After the procedure patients often feel the need to urinate and some people may notice blood in their urine. Oral antibiotics and simple analgesics are usually prescribed to prevent infection and reduce pain. Occasionally, a stronger analgesic may be required. As general anaesthesia is used for the procedure, driving should be avoided for at least 24 hours after the procedure.

Shockwave lithotripsy

Kidney stones are small, hard deposits that can develop in the kidneys. Lithotripsy, often referred to as Extracorporeal shock wave lithotripsy (ESWL), is the most common procedure for the management of kidney stones (renal lithiasis). It uses shock waves to break up stones that form in the kidney, bladder, or ureter to enable easy passage of the fragments out of the body within the urine. Most kidney stones are quite small and can be passed in urine. However larger stones are unable to pass through the ureters and can cause bleeding, kidney damage or urinary tract infections and may require more invasive treatment.

Indications

Lithotripsy is indicated in people with large kidney stones causing pain, urinary tract infection, bleeding, and renal damage.

Diagnosis

Your doctor usually arrives at a diagnosis of kidney stones based on your symptoms and medical history. Blood tests, urine tests, and other investigations may be ordered to confirm the diagnosis. Several diagnostic techniques such as X-ray, ultrasound, CT and intravenous urogram may also be used to identify the location of the kidney stones.

Intravenous urography is a test that involves injecting dye into a vein in your arm and taking X-rays, as the dye travels through your kidneys, to identify the presence of any stones.

Before the procedure

Prior to undergoing lithotripsy, inform your doctor about any medications or supplements you are taking. Your physician may advise you to stop taking blood- thinning medications for a specified period of time. You will be instructed not to eat or drink anything for several hours before the procedure as well as what medications need to be taken on the day of the procedure. You may take your prescribed medications with a small sip of water.

Procedure

Prior to the procedure a mild sedative and pain medications are given. General anaesthesia is often used to keep you asleep and free of pain during the procedure. To prevent infection, your doctor will also prescribe you antibiotics.

Lithotripsy takes about 45 to 60 minutes to complete. During the procedure you will lie on a water-filled cushion. High-energy sound waves that are created outside of the body travel through the body until they hit the kidney stones and break them into tiny pieces. You may feel a tapping sensation on your skin as the shockwaves enter the body.

A tube is inserted through your bladder or your back into your kidney to help drain urine from your kidneys until all the tiny fragments of stone pass out of your body. The tube may be inserted before or after the procedure.

After the procedure

You will be taken to the recovery room to be monitored for a couple hours after your procedure. Lithotripsy is usually an outpatient procedure where you are able to go home on the same day. You can usually resume regular activities within a day or two. You may experience pain when the stone fragments pass which occurs soon after treatment and may last for 4 to 8 weeks. Oral pain medications are prescribed to relieve pain. You will also be instructed to drink plenty of water to help clear the stone fragments out of your urinary system.

Risks and Complications

Lithotripsy is considered to be a relatively safe procedure but as with any medical procedure there are risks involved. Some risks associated with lithotripsy include:

  • Bleeding in or around the kidney
  • Kidney infection
  • Failure to remove the stones requiring additional treatments
  • Pain if a stone fragment blocks the flow of urine
  • Kidney damage or a decrease in kidney function
  • Ulcers may develop in your stomach or intestine

Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy is a procedure to remove large stones from the kidneys or ureters. It is performed under general or spinal anaesthesia and involves making an incision in your back and inserting a hollow tube through the kidney to reach the stone. Smaller instruments are then introduced through the tube to remove the stone.

The procedure is indicated for stones resistant to shockwave lithotripsy (non-invasive method that uses sound waves), large stones (more than 2 cm) that occur as a result of kidney infections which require complete removal, and stones that are high up in the ureter near the kidney.

A 2-3-day hospital stay is required after the procedure and you may return to your regular activities in a week. Risks of the procedure include kidney damage, bleeding, injury to surrounding structures such as colon or bladder, and loss of kidney function.

Laparoscopy and Stone Removal

Pyelolithotomy is a surgery performed to remove stones from the ureter or the renal pelvic region (the funnel shaped part of the kidney in which urine is collected). This surgery is performed only in cases where the stone causes complications and blockages and cannot be removed using less invasive techniques.

Pyelolithotomy is performed under general anaesthesia and takes about 2 to 4 hours. The area of incision (side of your body) will be shaved and cleaned before the incision is made. Once the incision is made your ureter and renal pelvis is exposed and your surgeon locates the stone manually or using X-ray imaging techniques. The stone is removed, and the incision is stitched close. A ureteric stent (thin soft tube) is placed within the ureter to drain out urine and any left-over fragments of the stones and also helps to heal the surgical incisions faster. A flexible drainage tube called a catheter is placed into your urethra to help urination. After the surgery your vitals will be checked, and you will be monitored for 2 to 3 days after the surgery in the hospital before discharge to home.

As with all surgeries pyelolithotomy also involves risks such as bleeding and infections. In addition, when a stone is lodged firmly in the ureter it can cause scars to form in the ureter making the canal narrower.

TURP

The prostate gland is an organ found in men, surrounding the neck of the urinary bladder. The gland grows with age, but if it grows too big, it can exert pressure on the urethra (tube that drains urine) and may obstruct the flow of urine. This condition is called benign prostatic hypertrophy (BPH) and causes urinary problems, such as difficulty in emptying the bladder and frequent urinary infections.

Transurethral resection of the prostate (TURP) is a procedure that involves the surgical removal of a section of an enlarged prostate gland. TURP uses a surgical instrument called a resectoscope (thin metal tube with light source, camera and cutting tool) to excise the enlarged region of the prostate and improve the flow of urine. It is performed through the penis without any external incision. There are two types of TURP: monopolar TURP and bipolar TURP.

TURP is performed under general or spinal anaesthesia. Your surgeon inserts the resectoscope into the penis and advances it through the urethra (the tube that carries urine from the bladder out of the body). The cutting tool is guided through the resectoscope and is heated with the help of an electric current. The heated wire is used to cut and remove the excess tissue. At the end of the procedure, the blood vessels are sealed back carefully, and the bladder is irrigated to flush out pieces of the tissue. The complete surgery takes about 1 hour, and you may have to stay in hospital for 1 to 3 days after the procedure. You can resume your normal activities within a week.

As with all surgical procedures, TURP may be associated with certain complications including:

  • Retrograde ejaculation (semen does not ejaculate from the penis, but instead flows into the bladder)
  • Urinary incontinence (loss of bladder control)
  • Narrowing of the urethra
  • Infection
  • Painful urination
  • Bleeding
  • TURP syndrome (rare disorder associated with fluid build-up in blood)

Circumcision

Circumcision is the surgical removal of a hood of skin called the foreskin which covers the tip of the penis. It is a procedure usually performed on a newborn before he gets discharged from the hospital. It can also be done in older boys and adults. Circumcision is generally done as a cultural or religious custom.

Anatomy

The foreskin is a portion of skin that covers the head of the penis. It protects the delicate tip of the penis from cold and rubbing against undergarments, and keeps the tip lubricated. It should be kept clean to prevent bacterial infection.

In babies, the foreskin is attached tightly to the penis, but can be pulled back by age 2 during urination or erection.

Indications

Circumcision is most often performed for religious reasons. Some also undergo this procedure for personal hygiene, or to prevent penile cancer, urinary tract infections and sexually transmitted diseases. It can also be conducted as a treatment for phimosis, when a man cannot pull back the foreskin completely, or for balanitis, when the penis tip gets infected.

Contraindications

Circumcision may not be advised if you or your son is suffering from certain blood-clotting disorders or in premature babies who are under medical care.

Procedure

Circumcision is usually performed 1 to 10 days after birth. Your child will be restrained during the procedure. Local anaesthesia will be given to numb the region. A clamp or plastic ring is placed and tightened to minimise bleeding. The foreskin is then cut below the clamp.

The procedure in older children and adults is the same but may require general anaesthesia and suturing to prevent bleeding.

Postoperative care

Your child will most likely be discharged on the same day of the surgery. You may notice that the skin of the penis is red and swollen or forms a yellow crust on the tip. You will be instructed to keep the operated area clean and dry by changing your child’s diaper more frequently and keeping it loosely fastened. With each diaper change, you will also have to change the bandage and apply petroleum jelly on the tip of penis so that it does not rub against the diaper. If a plastic clamp is used, it will fall off when the area heals.

Adults who have undergone circumcision should avoid rigorous exercises and any sexual activity for four to six weeks.

Recovery

Circumcision is generally considered a safe procedure in newborns and children. The operated area heals in about 1 week in newborns and up to 3 weeks in older boys.

Risks

As with any surgery, circumcision may be associated with certain risks such as bleeding and infection. Although rare, foreskin problems can occur if the foreskin is trimmed too short or too long, the incision does not heal properly, or the leftover foreskin reattaches to the tip of the penis requiring surgical correction.

Complications

You will be instructed to contact your doctor if your son does not urinate within 12 hours following the procedure, bleeding or redness persists, foul-smelling drainage occurs, or the plastic ring remains in place even after 2 weeks.

Hormone Therapy

Erectile dysfunction is the inability to achieve or maintain an erection long enough to have sexual intercourse. The condition can occur at any age but is more common after the age of 65 years. About 70% of cases of erectile dysfunction are due to physical causes, 10-20% due to emotional causes, and 10-20% due to a combination of physical and emotional causes.

Erectile dysfunction may occur due to several reasons such as reduced levels of the male sex hormone - testosterone, diabetes, high blood pressure, smoking, high cholesterol, drugs, nerve damage, and kidney or liver disease.

The only accurate way to confirm that hormone deficiency is causing erectile dysfunction is to perform a blood test to measure the amount of testosterone in your blood. If a low testosterone level has been identified as the underlying cause for erectile dysfunction, hormone replacement therapy can be provided using several delivery systems. These include:

  • Testosterone Injections: This method involves the administration of testosterone injections approximately every two weeks to maintain an effective level of testosterone. A drawback of this method is that the level of testosterone may become low towards the end of the second week.
  • Skin Patches and Gels: The skin patches are placed on the skin and the gel is rubbed into the skin every day. They deliver a constant dose to prevent fluctuations in hormone levels. A possible side effect is irritation of the skin or rashes may occur at the site of application.
  • Pellets: These are a long-acting form of testosterone treatment. The pellets are placed just under the skin by performing a minor surgery under local anaesthesia. An advantage of this method is the pellets need to be placed only once every 4-6 months.
  • Oral Pills: Testosterone tablets or pills are the least effective form of testosterone replacement and have a small risk of causing liver problems.

When on testosterone replacement therapy, you must be compliant with follow-ups to your physician to evaluate your progress on the treatment, monitor for side effects, and make any alterations or dose adjustments as needed.

Nephroureterectomy

Laparoscopic nephroureterectomy is a surgical technique that involves the removal of a kidney and ureter. It is indicated for the treatment of transitional cell carcinoma (cancer occurring in the tissue lining these organs). Laparoscopic nephroureterectomy is performed under general anaesthesia. Your surgeon makes 3 to 4 small keyhole incisions on the abdomen. A laparoscope (tube with a light and a miniature camera) is inserted to view the abdominal cavity and kidney. The camera is fixed to a video screen which allows your surgeon to have a magnified view of the operating field. Other surgical instruments are inserted through the incisions to access the kidney. The kidney and ureter are freed from the surrounding tissues and dissected. The dissected kidney and ureter are placed in a bag and removed by widening one of the incisions. A catheter may be placed to drain the urine from the bladder.

Like all surgical procedures, laparoscopic nephroureterectomy may be associated with certain complications, which include:

  • Injury to surrounding tissues or organs
  • Bleeding
  • Infection
  • Pain or hernia
  • Injury to the nearby organs
  • Recurrence of disease

The advantages of laparoscopic nephroureterectomy when compared to open nephroureterectomy include:

  • Faster recovery
  • Less post-operative pain
  • Smaller incisions and less scarring
  • Reduced hospital stays

Pyeloplasty

Pyeloplasty is a surgery which helps in the removal of blockages in the ureter. The urinary system consists of the kidneys, ureters and urinary bladder. The kidneys purify blood to form urine which passes through the ureters into the bladder and is excreted from the body through the urethra. Sometimes, a ureter may be blocked obstructing the flow of urine into the bladder. The block may be present at birth or may appear later in life due to a blood vessel blocking the ureter or from an area of scar tissue. If left untreated it can cause damage to the kidneys.

Pyeloplasty is performed under general anaesthesia and takes about 1 ½ to 2 1/2 hours. During the surgery an incision is made either in the back, side or on your abdomen. Your doctor locates the blockage in the ureter, removes the affected area and re-joins the ends of the ureter with sutures. A stent is inserted so that the ureter remains open and stable during the healing process and will be removed later. The incision is then closed with the help of sutures. You will be able to eat or drink soon after the surgery; however, you will be asked to stay in the hospital for about 2 days following the surgery for monitoring.

Like most surgical procedures pyeloplasty also has certain risks such as bleeding and infection at the site of the surgery, pain, injury to nearby organs and failure of the surgery due to recurrent scarring.

Vasectomy

Vasectomy is a minor surgical procedure in which the vas deferens, a thin tube that stores and transports sperm is cut and then tied or sealed so that the sperm can no longer get into the semen. It is a permanent method of birth control in men. It prevents the release of sperm when a man ejaculates.

Vasectomy can be performed by various surgical techniques and they include:

  • Conventional vasectomy: The testicles and scrotum are cleaned with an antiseptic solution. The procedure takes 20 to 30 minutes and may be done by a urologist or a general surgeon. Oral or intravenous (IV) anti-anxiety medications are given to relax and reduce anxiety. A vasectomy is usually done under local anaesthesia to numb the area. Two small punctures or holes are made on the scrotum and a part of vas deferens is removed through the opening. The cut ends of the vas deferens are then tied off with a synthetic thread or a clip. In some cases, electrocautery may be used to seal the ends with the heat. The skin is closed with absorbable sutures.
  • No-scalpel technique: It is a technique that uses a small clamp rather than a scalpel to puncture the scrotum. The clamp is poked through the skin of the scrotum and then opened. This technique reduces bleeding, infection and pain and no stitches are needed.
  • Vas clip implant procedure: This technique does not require cutting and suturing the vas deferens, but rather uses a clip known as vas clip to lock and close the vas deferens. This method is not as effective as other methods of sealing off the vas deferens.

Swelling and minor pain may be felt in the scrotum area for several days after vasectomy. Complications that might occur after a vasectomy include bleeding under the skin, infection at the site of incision, sperm leaking from a vas deferens and forming a small lump called sperm granuloma and inflammation of the tubes that carry sperms from the testicles. In rare circumstances, the vas deferens can regrow or recanalize, and if it occurs, it could cause pregnancy.

Instructions to follow after surgery may include:

  • Avoid heavy lifting for a week
  • Apply cold packs to the area
  • Wearing snug underwear to support the scrotum
  • Get plenty of rest

After vasectomy, it usually takes several months for all remaining sperm to ejaculate or reabsorb. Alternative methods of birth control must be used, until a semen sample test shows a zero-sperm count.

Flexible Cystoscopy

What is a Flexible Cystoscopy?

A flexible cystoscopy is a procedure in which a telescope is used to visualise the urethra, prostatic urethra, bladder neck, and bladder under strict aseptic conditions. It is performed after a local anaesthetic gel is introduced into the urethra. Flexible cystoscopy also allows the doctor to remove ureteral stents, take bladder biopsies and dilate the urethra if necessary.

A flexible cystoscopy will often be recommended to you if you have the following:

  • Haematuria (blood in the urine)
  • Suspected bladder cancer
  • Abnormal urine cytology results
  • Bladder outlet obstruction
  • Recurrent urinary tract infections
  • Symptoms of burning, stinging, frequency or leakage during or after urination
  • Bladder stone formation
  • Stricture

Before the Procedure

There is no specific preparation required for the procedure, however you may wish to take a pain killer prior to ease any local discomfort. Aspirin or Nurofen (Ibuprofen) based analgesia should not be taken due to their ability to prolong bleeding.

Please provide Dr. Mulcahy with a list of all your current medications, as certain drugs need to be ceased prior to the procedure.

There is no need to fast. Please remain hydrated and eat/drink as per usual.

You may wish to have someone accompany you to drive you home, however it is not a necessity.

What to Expect After the Procedure

Following the procedure, you are advised to rest for the remainder of the day. Most patients will find they are able to return to normal daily activities the following day.

You are encouraged to drink plenty of fluids (especially water) and try to pass large volumes of urine for a few days.

It is normal to experience irritative urinary symptoms after the procedure. These can include: urinary frequency, urgency, or a stinging sensation when passing urine. You may also see blood or debris in your urine for a few days. This is quite normal and will only need to be reported to the doctor if bleeding becomes more profuse or if pain becomes an issue. You may find that you have a constant urge to pass urine. This is also normal immediately after the procedure due to local irritation from the cystoscope and will subside over 24 hours.

If you experience any problems following the procedure, please contact your General Practitioner or attend The Canberra Hospital Emergency Department and advise them that you have recently had a Cystoscopy under local anaesthetic with Dr. Mulcahy.

Risks Associated with the Procedure

  • Cardiac, respiratory, Cerebro-vascular
  • Pulmonary Embolus, DVT (Deep Vein Thrombosis)
  • Heavy Bleeding – may require catheterisation or admission
  • Infection – Urine or Blood
  • Ongoing irritative voiding (urgency, frequency)
  • Urine retention
  • Bladder, bowel or ureteric injury
  • Urethral injury or stricture
  • Testicular infection

Urethral Dilatation

Urethral dilatation can be performed with or without the aid of a cystoscopy. Metal sounds, or other flexible rods are passed in to the urethra, across the scar tissue stricture. This allows it to be stretched and opened. Once the scar tissue is widened, a urinary catheter may be required for 48 to 72 hours to allow urethral regeneration and healing before it is removed. Urethral strictures can occur from trauma, catheters, congenital, urinary infections, STDs, or previous surgery.

Flow Rate Ultrasound Residual Test

What is a flow rate ultrasound residual test?

A flow rate ultrasound residual test is an investigation in which you void urine in to a special machine that measures the flow and volume of urine. Afterwards, an ultrasound is taken of the abdomen to see if there is any residual urine in the bladder. 

The Procedure

Generally, there is no delay and the test can be completed immediately so please arrive ready to pass urine. You will need to have a full bladder for the test to be completed accurately. Unfortunately, if the voided volume is less than 150mls, the test will need to be repeated. Please complete the following prior to arriving.

  1. Approximately two to three hours before your appointment, empty your bladder.
  2. Immediately consume 600mls of water and continue to drink additional fluids. Do not empty your bladder until your appointment.

When you have a full bladder, you will be asked to void urine in to a machine that will measure the volume and flow.

Afterwards, Dr. Mulcahy’s nurse will perform an ultrasound exam of your lower abdomen to determine the emptying capacity of the bladder. The procedure takes less than 15 minutes.

An appointment will be made for the following week and Dr. Mulcahy will discuss the results with you then.

Urodynamics

Indication for Procedure

If you are experiencing issues of urine leakage or blocked urine flow, your doctor may recommend urodynamic testing. Urodynamic testing provides information about how well your bladder and sphincter muscles work and can explain symptoms such as:

  • Incontinence
  • Urinary frequency
  • Sudden, strong urges to urinate
  • Urinary hesitancy
  • Painful urination
  • Inability to empty the bladder entirely
  • Recurrent urinary tract infections

Cystometry (Measurement of Bladder Pressure)

A Cystometrogram (CMG) measures the volume of urine your bladder can hold, the amount of pressure that builds inside your bladder as it stores urine, and the capacity of urine within the bladder when you first feel the urge to urinate. We will ask you to empty your bladder prior to commencing the urodynamics. A small urinary catheter will be placed in to the bladder via the urethra. This catheter has a pressure-measuring device called a manometer. Another catheter will be placed in to the rectum. Your bladder will slowly be filled with water and you will be asked to cough or strain occasionally. These actions will help the doctor to evaluate your sphincter muscles. You will also be asked to notify the doctor when you first feel an urge to urinate.

Measurement of Leak Point Pressure

While your bladder is being filled for the CMG, it may suddenly contract and release some water without warning. The manometer will record the pressure at the point when the leakage occurs. This reading may provide information about the particular bladder problem you have.

Pressure Flow Study

After the CMG, you will be asked to empty your bladder. The catheter will measure the bladder pressure required to urinate and the flow rate while pressure generates. This pressure flow study aims to identify bladder outlet obstruction that can occur in men from an enlarged prostate. Bladder outlet obstruction is less common in women, however can occur with a fallen bladder, or rarely after a surgical procedure for urinary incontinence. Most catheters can be used for both CMG and pressure flow studies.

Uroflowmetry

A uroflowmeter measures the amount of urine and the flow rate. This equipment creates a graph showing changes in the flow rate each second.

After the Procedure

You may experience mild discomfort for a few hours upon urination, however drinking water will alleviate this discomfort. If you have any symptoms of infection such as pain, chills, or fever – you should contact your doctor immediately. Minor haematuria (blood in the urine) is not unusual. Taking paracetamol can alleviate any mild pain you may experience.

What are the possible risks associated with this procedure?

  • Urethral trauma or stricture
  • Infection – in the urine or blood
  • Bleeding
  • Bladder injury
  • Failed procedure

Receiving the results

Dr. Mulcahy will discuss any findings with you after the procedure and you will have the opportunity to ask questions and discuss possible treatments.

Prostatectomy

Coming soon

If you wish to be advised on the most appropriate treatment, please phone reception on (02) 6281 0222 to schedule an appointment or click here to request an appointment online.