Pelvic Examination Under Anesthesia

If a patient has symptoms that may be signs of bladder cancer—such as blood in the urine—then the first step is usually a medical history and physical examination performed at a primary care provider’s office.^1,2 This allows the healthcare provider to learn more about the patient’s overall health and specific symptoms, as well as any risk factors that can make a patient more likely to develop bladder cancer. During the physical exam, the healthcare provider may perform an internal exam in the rectum and/or vagina to feel for the presence of tumors on the bladder. Patients usually provide a urine sample for analysis in the laboratory as well.

Testing to diagnose or rule out bladder cancer

Based on the results of the medical history, physical exam, and urine laboratory tests, the healthcare provider may need to order further testing to help diagnose or rule out bladder cancer as the cause of the patient’s symptoms. One type of diagnostic test is an examination under anesthesia (sometimes called EUA or a bimanual examination under anesthesia). This procedure may be performed during the same visit as other types of procedures for which the patient may be under anesthesia, such as transurethral resection of bladder tumor (TURBT).

What happens during an examination under anesthesia?

The examination under anesthesia procedure is typically carried out by a urologist, which is a healthcare provider who specializes in bladder cancer and other health conditions related to the urinary tract.^2,3 The procedure allows urologists to feel the bladder from the inside of the patient’s body to check for signs of tumors. It also allows the urologist to carry out a more thorough physical exam of the outer surface of the bladder than is possible during a digital rectum exam or pelvic exam.

Why are patients under anesthesia?

Examination under anesthesia is often performed while the patient is under general anesthesia, and is completely unconscious during the entire procedure. This prevents the patient from feeling discomfort during the procedure. It also means that muscles in the area around the patient’s bladder are more relaxed, which makes it easier for the urologist to feel the bladder more precisely.

Doctors check for tumors by feeling the bladder from inside the body

Examination under anesthesia for bladder cancer allows the urologist to use both hands to feel the outer surface of the patient’s bladder very carefully. When men undergo the procedure, the urologist may feel the bladder by putting one hand on the patient’s abdomen and inserting a gloved finger of the other hand into the rectum. When women undergo the procedure, the urologist may place one hand on the patient’s abdomen, and two gloved fingers of the other hand into the vagina.

Checking for tumors by feeling the bladder

Examination under anesthesia is one of several diagnostic tests that help healthcare providers to make an initial diagnosis of bladder cancer.^1,2 If a patient has already been diagnosed, then the tests can also be used to “stage” the bladder cancer. Staging provides detailed information about the patient’s bladder cancer that is used to develop a treatment plan.

Next steps for diagnosis:

• Cystoscopy and fluorescence cystoscopy
• Transurethral resection of bladder tumor (TURBT)
• Imaging tests, including pyelogram, CT/CAT scan, MRI, x-rays, and ultrasound
• Biopsy