Clinical Investigations

Urinalysis: a "dipstick" test will detect microscopic haematuria (not visible grossly) which can indicate bladder disease, or pick up other substances such as protein or sugar in the urine which may flag up bladder infection or an underlying medical condition such as diabetes mellitus.

Mid-Stream Sample of Urine culture (MSSU): will confirm the presence of bacterial infection.

Intravenous Urogram (IVU): of limited value in the diagnosis of bladder disease. Tumours may present as filling defects.

Cystoscopy and cytology/biopsy.

Cystography: occasionally indicated to demonstrate vesicocolic or vesicovaginal fistulae, to evaluate bladder diverticula or post-bladder surgery to look for an anastomotic leak.

Micturating Cystourethrography: assesses the pathophysiology of micturition as well as the lower urinary tract anatomy. In bladder disease, useful for evaluating neurogenic bladder, diver-ticula and vesicoureteral reflux.

Loopography: occasionally performed to examine reconstructed urinary reservoirs or conduits after resection of the native bladder, e.g., to look for obstruction in an ileal conduit.

USS: can be used to detect radiolucent bladder stones or diverticula or to confirm the presence of bladder tumour in suspicious filling defects on IVU. Endoluminal ultrasound (ELUS) is used to stage bladder cancer in some specialized centres.

CT/MRI: both modalities are used to stage bladder cancer, primarily in looking for metastatic disease in regional lymph nodes and other organs.

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