Tests and making the diagnosis

Once you have been referred to the hospital you will see a urologist either in a general clinic or, if you presented with blood in the urine, you will be seen in the "One Stop" haematuria clinic (see separate patient information sheet).  A number of tests will be performed:

Blood  and urine tests

We may send samples of your blood and urine to the laboratory for testing.

Cystoscopy

This is where a doctor uses a cystoscope (a thin tube with a camera and light on the end) to look at the inside of your bladder.

A cystoscopy is usually done under a local anaesthetic. A jelly that contains anaesthetic is squeezed into the opening of your urethra (the tip of the penis or just above the vagina).  The doctor will then gently pass the cystoscope into your urethra (water pipe) to show the lining of the urethra and bladder.

The whole test takes only a few minutes and you can usually go home after it is done. You may have some soreness or mild pain when you pass urine for the first time after the test. And, there may be some blood in your urine for the first couple of days. There are not usually any other after-effects.

If any abnormal areas that could be bladder cancer are seen you will be asked to come back to the hospital for a second cystoscopy when biopsies can be taken under a general anaesthetic. The tissue samples are sent to be examined by a pathologist (an expert who identifies diseases by looking at cells under a microscope).

Ultrasound scan

This test uses sound waves to build up a picture of the inside of the body. It can show abnormalities in your urinary system (the bladder, ureters and kidneys). You'll be asked to drink plenty of fluids before your test so that your bladder is full and can be seen clearly.

Once you're lying comfortably on your back, a gel is spread over the skin of your abdomen. A small device is passed over the area. It gives out sound waves and picks them up as they bounce back as echoes from the organs inside your body. The echoes are made into a picture by a computer. The scan is painless and takes about 15-20 minutes.

CT (computerised tomography) scan

A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of your body. Pictures are taken of the chest, abdomen and pelvis, and these pictures are fed into a computer to give a detailed picture. This picture will help your doctor look for any signs that the cancer has spread. The scan is painless and takes 10-30 minutes. CT scans use a small amount of radiation, which is very unlikely to harm you and won't harm anyone you come into contact with.

You may be given a drink or an injection of dye (contrast) before it. This helps the doctor see particular areas more clearly. Most people feel hot and flushed for a few minutes after having the injection. If you're allergic to iodine or have asthma, you could have a more serious reaction to the injection, so it's important to let your doctor know beforehand. You'll probably be able to go home as soon as the scan is over.

Once your tests are done you will be seen back in the clinic to discuss the results and the treatment plan.