This document discusses various tests and procedures used to evaluate the function of the urinary system. It begins by describing common urine and blood tests, such as urine microscopy, urine culture and sensitivity tests, creatinine clearance tests, and blood tests including full blood count, C-reactive protein, and erythrocyte sedimentation rate. It then discusses imaging tests like urodynamics, bladder scans, cystograms, and various types of x-rays. Finally, it briefly outlines some surgical procedures that may be used like vesicostomy, cystoplasty, catheterization procedures, conduits, and urethroplasty. The purpose is to provide a thorough overview of options to diagnose and treat issues with the ur

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Tests and procedures used to check
function of the urinary system
There are many tests that can be done to check that the
urinary system is functioning as well as possible. The tests
vary from a simple blood test to more invasive procedures.
All tests performed are done with your consent and should be
fully explained to you beforehand. You may not necessarily
have all the tests and or procedures performed.
Investigations then tested to measure the amount
of creatinine in it. A blood sample is
Urine tests (also called urinalysis) taken at the same time to compare
levels. The creatinine levels are
Urine Microscopy – White and red raised if there is advanced renal
blood cells and bacteria in the urine (kidney) disease because creatinine
can indicate problems such as urine cannot be excreted (got rid of) by
infection and stones. the kidneys which are seriously
damaged.
Urine Culture and Sensitivity –
This is where a sample of urine is Blood tests
taken to see if there are any harmful
bacteria (germs) growing in it. TheBlood consists of plasma in which
same sample can be used to find the blood cells are suspended.
out what antibiotics will kill the bugs
The most numerous cells are the
(sensitivity). red blood cells which help carry
oxygen around your body. About a
Creatinine Clearance – Urine is hundredth of the cells are white cells:
collected for a period of 24 hours their main job is to fight infection.

2. Tests and procedures used to check
function of the urinary system
Blood is taken for the following by the kidneys. Urea rises if renal
tests:– function is impaired. Electrolytes
are a common name for the body’s
Full Blood Count (FBC) – This salt, such as sodium. If you are
measures your haemoglobin (found dehydrated, the sodium and urea
in your red blood cells) levels to may be raised.
make sure you are not anaemic;
the number size and shape of your Imaging tests
red cells, to make sure they work
properly, and the number of your Urodynamics – Urodynamics means
white cells. If there are more white the study of the pressure and flow
cells than normal, it may be a sign of urine in the lower renal tract, (the
of infection somewhere. bladder, and the tube through which
you pass urine, called the urethra).
C-Reactive Protein – The level A urodynamics study helps to
in the blood rises if there is an determine if your current treatment
infection, and drops again when the is working for you, or if changes
infection passes. CRP can be high need to be made. The objective
for other reasons, such as just after of a urodynamics study is to
an operation. reproduce the patient’s complaints
or symptoms. Video urodynamics
Erythrocyte Sedimentation Rate may provide additional information
(ESR) – This is another test that that helps to further understand the
can be used to look for infection. It problem. Urodynamics is used to
measures the rate at which red cells answer three questions:
settle out of suspension in blood
plasma. If they settle more quickly - At what pressure does the bladder
than “normal”, infection may be store urine?
present, though as with CRP it can
be raised for other reasons. - Are there any abnormal dynamics
such as overactivity or poor bladder
Urea and Electrolytes (U and E) compliance which can damage the
– Urea is the main end product of kidneys?
protein breakdown and is excreted

3. - How does the bladder empty? Afterwards, you will be asked to lie
on a table while fully clothed, and
Urodynamics are classified in two an ultrasound image of the bladder
different categories: non-invasive, will be performed. An ultrasound is
and invasive, and the procedure a diagnostic test that uses sound
often varies among hospitals. waves to get an image of the
bladder. It is used to measure the
Prior to starting urodynamics, a amount of urine remaining in the
detailed interview must be done bladder. An uItrasound is done by
by the healthcare team. The gently moving an instrument (which
interview is important because it looks like a microphone) over your
gives vital information about your lower tummy, which will be coated
medical history, home and school with a cool gel.
or work environment, attitude
toward the urologic condition, and This appointment usually takes
your willingness to cooperate with about half an hour, and when
treatments. children are undergoing the
procedure, parents usually stay
Non-invasive or simple in the room. No catheters are
urodynamics is done to evaluate required for this procedure. Based
urine flow. You will usually be asked on the results of the non-invasive
to go for the test with a full bladder study, the urologist will either be
if you can manage it. You will be able identify the treatment you
asked to pass urine into a machine require, or will need to perform
that looks like a toilet which can invasive urodynamics in order to
measure the rate at which your get additional information that is
urine flows and the amount you only available from more detailed
pass. At least two free voids (wees) assessment.
are necessary to understand the
flow pattern. Also, some hospitals Invasive Urodynamics requires the
stick patches on the outer thighs insertion of a catheter (into the
and buttocks to measure muscle bladder), usually in the suprapubic
contractions while you urinate. region. A suprapubic catheter is

4. Tests and procedures used to check
function of the urinary system
normally inserted under anaesthesia whether the bladder is large or
24 hours before the urodynamics small. It is a non-invasive procedure
study is done. For some people who which uses ultrasound waves. Gel
have no sensation in the urethra, is put on to your tummy and a small
a urinary catheter may be used smooth instrument is pressed over
instead of suprapubic. However, the skin.
that often produces anxiety and
causes error in measurement. The Cystogram – This is an x-ray
catheter is used to fill and empty examination where dye is put in the
the bladder, and also to measure bladder through a catheter. This can
pressure in the bladder and urethra. be done to detect reflux (backward
flow) of urine from the bladder up
Another catheter is passed into the ureters to the kidneys.
your rectum (back passage); this
measures abdominal pressure. The following tests are rarely used:
Sometimes, a gastrostomy tube
can be used instead; or for those Cystoscopy – An instrument
with an ACE, the catheter can be which looks like a small telescope
inserted into the ACE channel. When is passed into the bladder via the
the test is finished the catheters urethra (tube through which urine
are removed. The whole test takes leaves the bladder) to have a look
between half an hour to one hour. at the bladder.
Since invasive urodynamics can
cause anxiety, it is important to Diethylene Triamine Pentacetic
have a qualified and cohesive team Acid (DTPA) Scan – A radio nuclide
of professionals. They will show (DTPA) is injected into the body, and
you the testing environment before a special camera shows it flowing
the assessment is done, answer through the kidneys. This is a useful
any questions, and give detailed test to show if there any stones in
information about the test and what the kidneys. The DTPA scan is not
you can expect. used as much as a DMSA scan. A
DMSA (Dimercaptosuccinic Acid)
Bladder Scan –This measures the scan is similar to the DTPA scan.
bladder volume, and can indicate

5. Retrograde Pyelography – Under
general anaesthetic, fine catheters Surgical procedures
are passed through the bladder,
up the ureters into the pelvis of the Following the results of any tests
kidneys (on the bottom edge of the that you have done, your doctor
kidney). Dye is injected directly into may decide that one or more of the
the renal pelvis and x-ray pictures following procedures is necessary.
are taken. Once again, they will be carried out
with your consent and should be
Loopogram – This is an injection fully explained prior to the start of
of dye into the loop of a urostomy. the operation.
It can show reflux back into the
kidneys, how they empty, and if Vesicostomy – A small cut made
there is thinning of the tubes out of in the tummy and into the bladder.
the kidney. This allows urine to drain from the
bladder and relieves high pressure
Intravenous Pyelogram (IVP) – within the bladder.
A dye which shows up on x-rays
is injected into a vein. When the Cystoplasty – See “Bladder
dye has worked its way around the Augmentation” information sheet.
body, a succession of x-ray pictures
are taken of the urinary tract. The Supra pubic Catheterisation – A
IVP reveals details of the kidneys, catheter is passed into the bladder
ureters and bladder. It tests kidney via a small incision (cut) on the
function and reveals the presence of tummy. A leg bag is attached and
stones in the kidneys or ureters and urine drains out continuously.
other abnormalities of the urinary
tract. It can take 15 to 20 minutes Indwelling Catheterisation – A
for the injected dye to reach the catheter (tube) is passed into the
kidneys. After the test you may be bladder via the urethra to drain
asked to pass urine, and another urine. The catheter remains in the
x-ray taken to see if you have any bladder and a bag is attached to
urine left in your bladder. collect the urine. The bag is usually
strapped to the leg, and is hidden

6. by clothing. The catheter is usually Ileal Conduit – The ureter is
changed about every 3 months. implanted into a segment of bowel
which is then opened out on to the
Intermittent surface of the skin to form a stoma.
Self-Catheterisation – See The urine can then drain from the
“Intermittent Self Catheterisation” kidney to a collection appliance
information sheet. (“stoma bag”) fixed over the stoma.
This way the urine does not go into
The following are rarely used: the bladder at all.
Ureterostomy – Under general
anaesthetic, a ureter is brought out
on to the surface of the skin. Urine
drains directly from the kidney into
a suitable appliance, eg bag.
Urethroplasty – This is just another
way of saying a surgical repair of
the urethra.
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This information has been produced by Shine’s medical advisers and
approved by Shine’s Medical Advisory Committee of senior medical
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