A urologist is a medical doctor specializing in conditions affecting the urinary system in both men and women, and the male reproductive system, addressing issues from urinary tract infections and kidney stones to male reproductive health concerns. They diagnose and treat these conditions, sometimes performing surgical procedures.
Initial Consultation and Medical History
Your first visit to a urologist begins with a thorough discussion of your medical background and current symptoms. You will likely be asked to provide a urine sample upon arrival for a urinalysis.
The urologist will ask detailed questions about your symptoms, including when they started, their severity, and any patterns you have noticed. Be prepared to discuss your complete medical history, including any previous diagnoses, surgeries, and all medications, supplements, and herbal remedies you are currently taking.
Common Physical Examinations
Following the initial discussion, a physical examination is performed, tailored to your specific symptoms and gender. This examination helps identify physical signs of conditions affecting the urinary and reproductive organs, such as tenderness, swelling, or unusual growths.
For male patients, the examination includes a genital assessment, checking the penis and testicles for any irregularities. A digital rectal exam (DRE) also evaluates the prostate gland. During a DRE, the urologist inserts a gloved, lubricated finger into the rectum to feel the prostate for its size, shape, and consistency, looking for any enlargement or suspicious areas.
For female patients, a pelvic exam is conducted to assess the health of the reproductive organs and the urinary tract. It involves a visual inspection of the vulva and vagina, followed by an internal examination using a speculum to view the vagina and cervix. The urologist also performs a manual examination to feel the uterus, ovaries, and bladder for any abnormalities.
Diagnostic Tests and Imaging
Beyond physical examinations, urologists order laboratory and imaging tests to gather more information. Urinalysis is a test that examines a urine sample for bacteria, blood cells, or other substances, which can indicate infections or kidney issues. A urine culture is also performed to identify specific bacteria causing an infection and determine effective antibiotics.
Blood tests are used to assess kidney function, checking levels of substances like creatinine and blood urea nitrogen (BUN). For male patients, a Prostate-Specific Antigen (PSA) blood test is ordered to screen for prostate inflammation or potential prostate conditions. These tests provide biochemical insights into organ health and function.
Imaging studies provide visual details of the internal organs. Ultrasound is a non-invasive technique that uses sound waves to create images of the kidneys, bladder, and prostate, detecting stones, cysts, or blockages. X-rays, such as a Kidney, Ureter, and Bladder (KUB) X-ray, assess the overall structure of the urinary system and identify causes of abdominal pain. For more detailed views, computed tomography (CT) scans or magnetic resonance imaging (MRI) are used to identify tumors or other structural anomalies.
Specialized Urological Procedures
When initial evaluations suggest a need for more direct investigation, urologists perform specialized procedures. Cystoscopy involves inserting a thin tube with a camera, called a cystoscope, through the urethra into the bladder, allowing visual examination of the lining for abnormalities such as stones, tumors, or inflammation. During a cystoscopy, small tissue samples are also collected for biopsy.
Urodynamic studies assess how the bladder and urethra function in storing and releasing urine. These tests measure bladder pressure, urine flow rate, and how completely the bladder empties, providing information about issues like incontinence or difficulty urinating. They can involve various measurements, sometimes combining them with imaging.
If prostate abnormalities are suspected, particularly after elevated PSA levels or an abnormal DRE, a prostate biopsy is performed. This procedure involves taking small tissue samples from the prostate gland, guided by ultrasound, to check for cancerous cells. Samples are taken through the rectum (transrectal biopsy) or the skin between the anus and scrotum (transperineal biopsy).