A urologist specializes in the urinary tract, including the kidneys, ureters, bladder, and urethra, for both men and women. For women, urology addresses conditions such as urinary incontinence, recurrent urinary tract infections (UTIs), interstitial cystitis, and pelvic organ prolapse. These issues often involve the pelvic floor muscles due to the close anatomical relationship between the urinary and reproductive systems. The examination is systematic, moving from a detailed conversation about symptoms to a physical assessment and specialized testing.
Gathering Patient History and Symptoms
The initial appointment involves a comprehensive review of the patient’s medical background, known as history taking. The urologist asks detailed questions about current symptoms, including the frequency, urgency, pain, burning, and involuntary urine leakage. This discussion covers the onset, duration, and severity of the patient’s specific complaints.
The doctor also gathers information about past surgical procedures, chronic health conditions, and current medications, as these factors influence urinary function. To obtain objective data, the urologist may ask the patient to complete symptom questionnaires or keep a voiding diary before the appointment. This diary records fluid intake, the timing and volume of each void, and any episodes of leakage, helping to characterize the pattern of dysfunction. This history is foundational for narrowing diagnoses and tailoring the physical examination.
Components of the Physical Assessment
Following the conversation, the urologist conducts a focused physical examination adapted to the patient’s symptoms. The examination typically begins with an abdominal assessment, where the doctor gently palpates the lower abdomen. This checks for bladder distention, tenderness, or masses that might indicate an obstruction or abnormality in the urinary system.
A crucial component for women with urinary symptoms is the pelvic examination, which differs from a standard gynecological check-up. This focused exam evaluates the structures supporting the bladder and urethra. The doctor inspects the external genitalia and vaginal walls for signs of atrophy, inflammation, or infection.
The urologist also assesses for pelvic organ prolapse, which is the descent of organs like the bladder or uterus due to weakened support muscles. The patient may be asked to cough or strain during the exam to demonstrate stress incontinence or the degree of prolapse. A neurological assessment is often integrated, focusing on the lower limbs and perineum to evaluate nerve function relevant to bladder control, including testing reflexes and sensation.
Specialized Diagnostic Tests
After the history and physical exam, the urologist may order specific laboratory or imaging tests to confirm a diagnosis. The most common initial test is a urinalysis, which analyzes a urine sample for blood, protein, glucose, or signs of infection. If infection is suspected, a urine culture identifies the specific bacteria and determines the most effective antibiotic treatment.
Another simple, non-invasive procedure is the Post-Void Residual (PVR) check, which measures the amount of urine remaining in the bladder after the patient voids. This is typically done using a portable ultrasound device on the lower abdomen. A high PVR indicates a bladder emptying problem, potentially due to obstruction or a weakened bladder muscle.
Imaging studies, such as a basic kidney and bladder ultrasound, visualize the structure of the urinary tract. This helps detect stones, tumors, or structural abnormalities. For complex cases, the urologist might recommend advanced procedures like urodynamic testing, which evaluates how the bladder stores and releases urine, or cystoscopy, which uses a thin scope to look directly inside the bladder and urethra.