Posts Tagged ‘cystoscopy’

How Often Do You Need To See Me?

September 1, 2012

You may wonder how the decision is made to making the next appointment for a patient. Is there a book, or now a website with guidelines, that guide physicians on when to make the patients’ next appointments? No, there is not. It is not something we learn in medical school but is something that is part of the art of medicine. Some patients really need to be seen in a few days or a few weeks such as the patient with a urinary tract infection where the urine has to be checked to be sure the infection has cleared even after the symptoms have subsided. Then there is the asymptomatic patient who is on no medications and probably needs to be seen only for a screening annual or even a biannual exam. Then there is the majority that fall somewhere in the middle of those two extremes.

What if you had diabetes, coronary disease, hypertension, high cholesterol, and sleep apnea, but no symptoms to indicate any acute problems? You’d probably see your primary doctor fairly routinely (mostly for management of diabetes) and maybe your cardiologist every six months or so.

Here’s the big question: When you’re coasting along pretty well with no actively changing symptoms but with chronic medical problems, how often do you need to see your doctors? Let’s take the example above: with those particular problems, should you see your cardiologist yearly, biannually, quarterly, monthly, or what? In the non-hypothetical world a patient’s follow-up is likely to be dictated by the doctor and set at the end of each appointment. “Okay, Mrs. X, it looks like you’re doing well. Let’s plan to see you again in 6 months.”

How does the doctor know when to see you next? There are a few ground rules to take into consideration. The pharmaceutical industry doesn’t allow us to write prescriptions with refills that extend past 12 months, and many clinics have a policy of not providing new prescriptions after the 12-month mark unless they’ve at least laid eyes on the patient (apparently to make sure the patient is indeed alive), and so most people with chronic problems will likely have to be seen at least once a year. It is amazing how many men using erectile dysfunction drugs will keep that annual appointment in order to obtain a refill of their medications! The other ground rule is common sense.

So, routine follow-up will most likely fall somewhere between “less often than weekly” and “at least once yearly or more frequently.” But within those limits, as a doctor I’m pretty much free to choose whatever I like.

I don’t know how other doctors do it, but I like to burden healthy patients with as few doctor visits as possible, so I mostly try to set my return appointments for a year. This works well for most people, but there are clearly exceptions. I see a lot of men with prostate cancer. Many of them are on medications to decrease the testosterone level and receive injections every 3-6 months. If it is possible, I try to convert these men to injections that can be given once a year. Most of the men with prostate cancer like the idea of getting a yearly injection and coming in every six months for a blood test, a PSA level. However, there are some men that want that more often and I allow them to make appointments to be seen more frequently. This, again, is where the art of medicine is used to guide how often a patient returns for an appointment.

There are patients with certain conditions like bladder cancer that should have a cystoscopy or look into their bladder with a lighted tube every 3 months. This guideline is written in all urologic textbooks and is good medicine to see these patients on a frequent basis.

I commonly ask certain patients to see me more frequently. Any patient who is on medications that is having side effects is asked to come back more frequently until I can get the dosage or the medication straightened out that provides them with the beneficial effect and with manageable side effects.

Bottom Line: How often should you be seeing your doctor? I have no clue. Between you and your doctor you’ll come up with some type of balance that works. Just understand that none of this is written in stone….i.e., a kidney stone!

This blog was inspired and modified from a blog by Dr. Eric Van de Graaf, which appeared in Patient on January 17, 2011.

Bladder Testing-Urodynamics

May 3, 2010

Urodynamics are simply a combination of several useful tests which provide information about your lower urinary tract. This information is obtained much in the same way that an electrocardiogram (EKG) proxies information about your heart. Urodynamics “draws a picture” for your doctor and helps to determine the diagnosis and what will be the appropriate treatment of your urinary problem(s).

Urodynamics testing is done at the office and usually takes 30-45 minutes.

During the test you will be catherized at least once. Your bladder will be filled one or more times with carbon dioxide gas or water or both. You may have a very small tube placed in the rectum. The nurse will tell you beforehand whether you are to have this done. Muscle activity in your pelvis will be recorded during the tests by small electrodes which are placed on the skin near the rectum. These electrodes are very similar to those used for an EKG.

Preparation for Urodynamics

It is important to have a full bladder when you arrive for the studies; please be ready to urinate! There are no other special preparations or food restrictions for this test. If you wear padding, external catheters, etc., you may wish to bring extra supplies for replacement after the test. You can help to make the test easier by remaining relaxed. Each step of the evaluation will be explained to you throughout the test by the experienced nurse who performs the studies. Every effort will be made to make you as comfortable as possible during the procedure. A urodynamics evaluation usually includes the following tests:

CystometrogramlElectromyogram (CMG\EMG)

This test involves filling your bladder through a catheter with sterile gas or water. The nurse will ask you when you feel the urge to urinate, and when your bladder feels completely full. Pelvic muscle activity will be recorded as already described.

Flow Rate

A flow rate is done simply by asking you to void into a special toilet which records the pattern of your urine stream on a graph and the amount of urine you void. Muscle activity in your pelvis will usually be recorded while you void via the electrodes already described. The amount of urine left in your bladder after you void (the residual urine) will also be measured at this time.


Cystoscopy is a test that allows your doctor to look at the interior lining of the bladder and the urethra. The cystoscope is a thin, lighted viewing instrument that is inserted into the urethra and advanced into the bladder.

The cystoscope is inserted into your urethra and slowly advanced into the bladder while your doctor looks through the scope to examine the inside of the urethra. Your doctor then examines the inside of your bladder for stones, tumors, bleeding, and infection. Cystoscopy allows your doctor to look at areas of your bladder and urethra that usually do not show up well on X-rays. Tiny surgical instruments can be advanced through the cystoscope that allow your doctor to remove samples of tissue (biopsy) or samples of urine from each kidney.

Cystoscopy can also be used to treat some bladder problems. Small bladder stones and some small growths can be removed by using tiny surgical instruments that slide through the cystoscope. This may eliminate the need for more extensive surgery.

After Urodynamics:

After urodynamics, you may experience some burning on urination or some increased frequency of urination for a short time. If you drink plenty of fluids afterwards, it will help to alleviate this sensation. You may also have some blood in your urine for a short while, which should be minimal. To decrease the risk of urinary tract infection, you will be given a few days of antibiotics to take by mouth.

You should notify your doctor if you experience fever, chills, severe bleeding or severe discomfort after your urodynamic study.