A urologist is a physician who specializes in diseases of the urinary tract and the male reproductive system.
Patients may be referred to a urologist if their physician suspects they may need treatment for a condition relating to bladder, urethra, ureters, kidneys, and adrenal glands.
In men, urologists treat disorders related to the epididymis, penis, prostate, seminal vesicles, and the testes.
A patient may be referred to a urologist for treatment of a range of conditions:
Urinary tract infections (UTIs): These often arise when bacteria migrate from the digestive tract to the urethra. Symptoms include abnormal urination, pain, incontinence, nausea, vomiting, fevers, and chills. It mostly affects women.
Incontinence: A malfunction in the urinary system can lead to involuntary loss of bladder control. In women, this may result from a weakening of the pelvic floor muscles during pregnancy.
Male infertility: This can result from damage to the male reproductive tract and a variety of sperm disorders. One common cause is varicoceles, an enlarged vein in the sac beneath the penis. Surgery can sometimes help.
Kidney disease: Damage to the kidneys can lead to swelling in the hands and ankles, high blood pressure, and other symptoms. If the kidneys no longer work effectively, this is kidney failure. Ultimately, it can be fatal.
Renal transplantation: A person may require kidney transplants following kidney failure.
Bladder prolapse: when the tissues and muscles of the pelvic floor are no longer able to support the organs in the pelvis, the organs can drop from their usual position.
Cancers: the bladder, kidneys, prostate gland, testicles, and any other cancer that affects the urinary system or, in men, the reproductive system.
Enlarged prostate: Benign prostatic hyperplasia (BPH) affects around 1 in 3 men over the age of 50 years. An overgrowth of cells in the prostate gland causes the urethra to constrict, leading to problems with urination.
Erectile dysfunction: The penis is unable to attain sufficient rigidity to fully participate in sexual intercourse. This is often a symptom of an underlying condition.
Peyronie’s disease: A fibrous layer of scar tissue develops beneath the skin of the penis. This can lead to bending or curving in the penis (phimosis) during an erection that can cause pain and lead to difficulties with sexual intercourse.
Interstitial cystitis or painful bladder syndrome: A chronic inflammatory bladder condition can produce discomfort ranging from mild to severe.
Kidney and ureteral stones: Small, hard deposits made from mineral and acid salts form in the kidneys but can pass through into the ureters. They can affect urination and cause pain, nausea and vomiting.
Prostatitis: Infection or inflammation of the prostate can cause painful urination or ejaculation. It can be acute or chronic.
Undescended testes, or cryptorchidism: Normally, the testicles form inside the abdomen of a fetus and descend into the scrotum before birth. If one or both does not descend, sperm production can be impaired, and there is a risk of complications.
Urethral stricture: scarring of the urethra can narrow or block the path of urine flowing from the bladder. Causes include infection, inflammation or injury. Symptoms include painful urination and reduced output. It can lead to complications such as prostatitis and urinary tract infections.
Pediatric urology: This includes the treatment of urological problems in children that are too complex for non-specialized pediatricians.
The urologist will normally have notes from the referring doctor, but they will ask questions about the patient’s medical history and carry out a physical examination.
They may also order some tests.
- Imaging tests, such as CT scans, MRI scans, or ultrasound can help the doctor locate the problem.
- A cystoscope is a long, thin probe with a camera on that can be used to see inside the urinary tract, and, sometimes, to take a sample of tissue for testing.
- A urine test can check for bacteria or other signs of disease.
- A biopsy can check for cancer and other disorders.
Urodynamic testing can check how fast the urine leaves the body, how much urine remains in the bladder after urinating, and how much pressure there is in the bladder.
Following diagnosis, the treatment will depend on the condition. Both medical management and surgery are options.
Treatment will vary according to the diagnosis. It includes the use of medications and surgery.
Types of medication include:
- antibiotics for infections
- hormone treatment for prostate cancer
- phosphodiesterase 5 (PDE5) inhibitors for erectile dysfunction, such as Cialis, or tadalafil
- drugs that act on the smooth muscle of the bladder to reduce urinary incontinence
- chemotherapy drugs for cancer
Surgery can be:
- open surgery
- laparoscopic, or minimally invasive “keyhole” surgery
- laser therapy to treat BPH, cancer, and kidney stones, among others
A urologist might perform surgery to:
- remove a tumor or the entire bladder, prostate, or other parts, in cases of cancer
- carry out repairs after a trauma
- relieve strictures in the urethra, caused by scar tissue, known as urethral dilation
- relieve stress incontinence, for example, with a sling procedure
- break up or remove kidney stones
- remove part of a kidney
- transplant of a kidney
Urologists also perform circumcisions. This procedure is done to remove the skin from the tip of the penis, for cultural, religious, or medical reasons.
A vasectomy, a permanent form of male contraception, is also carried out by a urologist.
As with any medical professional, it is essential to find a urologist who is qualified and accredited.
You should also find someone is easy for you to communicate with, especially if treatment will be ongoing.
In the United States (U.S.), urologists must graduate from an approved medical school and complete a urology residency program.
Checking with the American Board of Medical Specialties (ABMS) or the American Board of Urology (ABU) will enable you to verify that the urologist is accredited.
It is also important to check that your insurance provider will cover the cost of visiting the urologist of your choice, and of the treatment you may need.