Diagnosis is the procedure whereby the disease or condition responsible for patient symptoms is determined.

For diagnosis, information obtained from a patient’s medical history and clinical examination is used.

In some cases further tests are required, such as laboratory tests and medical imaging.

Outlined below are the diagnostic algorithms for several urological conditions.


Renal cancer diagnosis

For the establishment of the diagnosis, the following are required:

  • History: it provides information on the type and symptom onset
  • Clinical examination: it can show a palpable mass in the kidney region
  • Urine tests
  • Blood tests: important to examine the renal function and check for anemia
  • Ultrasound: a simple, painless and harmless imaging study which can diagnose a renal tumor
  • CT scan
  • MRI scan

Kidney and ureter stones diagnosis

To diagnose the presence of a kidney stone in the urinary system, the following tests are required:

  • Blood tests: May reveal high levels of calcium or uric acid in the blood. Assist in the monitoring of renal health and can also assist in the diagnosis of pathological conditions related to kidney stones
  • Urine tests: A 24-hour urine collection and investigation helps measure the quantity of the excreted salts in the urine, as well as of substances which prevent the formation of kidney stones
  • Imaging tests: They can show stones present in the urinary tract. Several options are available:
    • simple X-ray of kidneys-ureter-bladder (KUB), which may, however, not show small stones
    • high-resolution CT scan, which can reveal even small stones
    • ultrasound examination
    • intravenous pyelogram (in a pyelogram, a contrast agent is administered and then images are obtained as the contrast agent travels from the kidneys to the bladder)
  • Stone analysis: It provides information to determine the cause of kidney stone formation and helps in the drawing up of the prevention and treatment plan

Cancer of the renal pelvis and ureter diagnosis

The investigation process should always include:

  • Lab tests
  • CT or MRI scan of the urinary tract
  • Cystoscopy (to rule out bladder cancer)
  • Urine cytology examination
  • In case of doubt or with a solitary kidney, flexible ureteroscopy and biopsy specimens are required

Pyelonephritis diagnosis

The diagnosis is delivered based on the history, clinical examination, and blood and urine test results.

It is important to assess the overall condition of the patient (blood pressure, pulse), and start the appropriate treatment immediately.

Imaging studies (ultrasound, CT scan) may be required to identify the causes of pyelonephritis and administer the appropriate treatment.

Bladder cancer diagnosis

The following are necessary:

  • Detailed history
  • Clinical examination
  • Urinalysis
  • Cystoscopy
  • Urine cytology examination (to detect any cancerous cells)
  • Upper and lower abdominal CT scan

Vesicoureteral reflux diagnosis

In recent years, due to the wide use of ultrasonography as part of prenatal screening, the possible existence of vesicoureteral reflux is also examined.

In other cases, the diagnosis is established after the investigation of the urinary tract due to urinary infection.

The following are needed for the diagnostic investigation of vesicoureteral reflux:

  • History and clinical examination
  • Urinalysis
  • Blood tests, including investigation of the renal function
  • Urinary tract ultrasound
  • Voiding cystourethrography

After the diagnostic investigation, the vesicoureteral reflux is classified into 5 grades according to its severity.

The appropriate treatment is determined according to this classification.

Prostate cancer diagnosis

The most useful test in the diagnosis of prostate cancer is the measurement of the Prostate Specific Antigen (PSA) in the blood.

At younger ages prostate cancer is rare, but all men aged 50 and over should regularly undergo the test.

PSA values, together with age, family history and rectal examination findings, are all considered to assess the likelihood of prostate cancer presence.

If the risk is high, a prostate biopsy may be ordered.

In prostate biopsy, under ultrasound guidance, prostate tissue specimens are obtained and analyzed by the pathologist for the establishment of both the diagnosis and treatment.

Early diagnosis is feasible.

However, it requires patient education and awareness on preventive exams (check-ups).

Check-ups are necessary because patients do not manifest any symptoms in the early stages of the disease, when cancer is treatable.

Benign prostatic hyperplasia diagnosis

The following are required:

  • Medical history
  • Clinical examination, incl. digital rectal exam (DRE), i.e. finger exam
  • Blood tests, including PSA
  • Urinalysis
  • Uroflowmetry
  • Urinary tract ultrasound
  • Post-void residual measurement

Prostatitis diagnosis

Diagnosis is made based on patient medical history and clinical examination findings.

Urinalysis may be useful in detecting the microorganism responsible for the infection.

In case of acute prostatitis, blood tests may be ordered to confirm the diagnosis.

In acute prostatitis, the establishment of the diagnosis is a more difficult process and is delivered based on the symptoms, and by excluding all other types of prostatitis.

Testicular cancer diagnosis

Palpation of the testicles is required to identify any possible induration (hardening).

The following tests are also needed:

  • Scrotal ultrasound: This test can determine whether the enlargement is due to a solid mass, like cancer, or fluid build-up between the layers of the testicle.
  • Tumor markers: (β-hCG, AFP, LDH)
  • To determine the extent of the disease, the following exams are needed: upper and lower abdomen CT scan, a retroperitoneal region CT scan and a chest CT scan.

Hydrocele diagnosis

Typically, the patient’s medical history and a clinical examination by the urologist are sufficient.

However, additional tests may be required, such as an ultrasound, to confirm the diagnosis and rule out other conditions resulting in the enlarged scrotum.

Varicocele diagnosis

Diagnosis is established through clinical examination and scrotal Doppler ultrasound.

Testicular torsion diagnosis

Usually, patient medical history and clinical examination are sufficient to establish the diagnosis.

To confirm the diagnosis and differentiate it from other conditions which exhibit similar symptoms, e.g. orchiepididymitis, a color Doppler ultrasound of the scrotum is required.

When the diagnosis is ambiguous, it is preferable that the testicle is surgically investigated and the possible torsion is restored.

Urinary tract infections diagnosis

The following are needed:

  • urinalysis: to detect any microbes or pyocytes in the urine
  • urine culture: it takes 48 hours for the results
  • antibiogram: to determine the antibiotic sensitivity of the microbes
  • additional tests may be required, such as an ultrasound