We offer general urology services for diagnosis and treatment of common urological problems.
This is a blood test to look at the level of Prostatic Specific Antigen (PSA) in the blood. The results of this test are used to help in the assessment of prostate health including BPH and prostate cancer.
An ultrasound probe is inserted into the rectum (back passage) and the prostate and associated ducts are imaged and measured.
Multiparametric MRI is an emerging technique that offers non-invasive evaluation of the prostate. This technique may allow men to avoid repeated biopsy in the detection of prostate cancer. It has been included in the recent NICE guidelines on prostate cancer.
This is a procedure to rule out the presence of cancer. It is typically performed if the prostate is suspicious on digital rectal exam and/or the serum PSA test is abnormal. An ultrasound probe is inserted into the rectum (back passage) and the prostate is imaged and measured. Then, under local anesthesia, typically 12 cores from different locations are taken and sent for analysis. Patients are given antibiotics before and after the procedure to reduce the risk of infection. Patients will experience some blood in the urine, from the rectum and in the ejaculate for up to six weeks following the procedure.
Alternatively, your urologist may offer you a transperineal biopsy under general or local anaesthetic. This involves approximately 24 biopsies taken through the skin just below your scrotum and has a lower risk of infection (less than 1 in 100) and potentially greater accuracy for targeting all areas of the prostate. There is however a slightly higher risk of urinary retention with a small number of men (approx. 1 in 50) requiring a catheter for two or three days after the procedure. Although the standard has been to perform this under general anaesthetic, Oxford was one of the first places in the UK to have the expertise to offer this under local anaesthetic using the “Precision Point” device so please discuss this with your urologist.
Mr Leslie and Mr Lamb are investigators on Oxford’s TRANSLATE Trial (https://translate.octru.ox.ac.uk/welcome-translate-trial) along with all their Oxford Urology colleagues, including Prof Richard Bryant (who runs the trial with Mr Lamb). This is a UK randomised trial comparing transperineal biopsy under local anaesthetic (LATP) to the traditional transrectal (TRUS) biopsy in detection of prostate cancer. It is an important trial which should have an impact internationally for men having investigations for prostate cancer.
Benign (non-cancerous) or malignant (cancerous) prostate pathology can cause problems with passing urine.
This is an outpatient test, which measures the strength and capacity of the urinary bladder and sphincters. It involves placement of probes into the bladder and rectum and a computer based analysis at various levels of bladder pressure and filling. It is helpful in ascertaining whether the patient’s problem is one of urinary obstruction bladder overactivity or bladder weakness. The test is performed with a specialist nurse and takes about an hour.
Blood in the urine is often not always a sign of a significant underlying problem. Studies have shown that between 5% and 15% of normal individuals can have some degree of haematuria. However, haematuria can be a sign of a serious underlying problem requiring treatment. These include urinary tract infection, bladder cancer, kidney cancer, urinary stone disease and prostate cancer.
Investigation includes a full history and physical examination, bedside urine test, blood tests to measure the kidney function (and PSA test if appropriate in men), imaging of the kidneys (ultrasound or CT scan) and a flexible cystoscopy to evaluate the bladder.
A cystoscope (fiberoptic camera) is inesrted into the urethra (waterpipe) and then into the bladder to visually inspect the lining of the bladder for abnormalities. This is usually performed under local anesthesia. Antibiotics are given prior to the procedure to lessen the possibility of infection. It is not uncommon to have some irritative urinary symptoms (urgency, frequency, hesitancy) for a few days following the procedure as well as some blood in the urine. Occasionally patients may get a urine infection and require more antibiotics.