A urologist is a physician specializing in the genitourinary tract, including the kidneys, bladder, ureters, and urethra, and the male reproductive organs (testes, prostate, and penis). This surgical specialty addresses conditions affecting both systems, making the urologist the primary expert for a wide range of male health concerns. While a primary care physician (PCP) can manage initial symptoms, a referral is often necessary when symptoms persist, involve complex diagnoses, or require specialized procedural care. Seeking this specialized care is a proactive step in managing health, particularly as men age and issues related to the prostate or sexual function become more common.
Conditions Affecting Urinary Flow and Comfort
Problems related to the storage and passage of urine are frequently addressed by a urologist, often presenting as lower urinary tract symptoms (LUTS). These symptoms include increased frequency, a sudden urge to urinate, a weak or intermittent stream, or waking up multiple times at night (nocturia). Urinary incontinence, the involuntary loss of bladder control, is also a common condition under the urologist’s expertise.
Hematuria, the presence of blood in the urine, requires immediate urological evaluation, as it can signal conditions ranging from urinary tract infections to kidney or bladder cancer. A urologist performs diagnostic tests, such as cystoscopy or imaging studies, to determine the source of the bleeding.
Kidney stones (urolithiasis) represent a major reason for urgent consultation due to the severe flank pain they cause. These hard masses of minerals form in the kidneys and can become lodged in the ureter, causing intense pain and blockage. Treatment depends on the stone’s size and location, ranging from managing pain while the stone passes naturally to procedural intervention.
For stones that are too large or fail to pass, a urologist may use techniques like extracorporeal shock wave lithotripsy (ESWL), which uses sound waves to break the stone into smaller fragments. Alternatively, ureteroscopy involves passing a small scope through the urethra and bladder into the ureter, where a laser fragments the stone.
Prostate Health and Screening
The prostate gland is a central focus of male urology, particularly for men in their middle and later years. Benign Prostatic Hyperplasia (BPH) involves the non-cancerous enlargement of the prostate, which physically squeezes the urethra and obstructs urine flow. This obstruction is a primary cause of LUTS, and a urologist provides medical management or surgical options, such as Transurethral Resection of the Prostate (TURP), which removes the obstructing tissue.
Prostate cancer screening is a significant reason for a urology visit. The primary screening tool is the Prostate-Specific Antigen (PSA) blood test, which measures a substance produced by the prostate, with higher levels potentially indicating a problem. A digital rectal exam (DRE) may be used alongside the PSA test to feel for any physical abnormalities in the gland.
Current guidelines suggest offering screening to average-risk men starting at age 50, or earlier for those at higher risk (e.g., men of Black ancestry or those with a strong family history). If the PSA level is elevated, the urologist often repeats the test before recommending further steps, such as a biopsy to confirm cancer. Prostatitis, inflammation or infection of the prostate gland, is another condition requiring diagnosis and treatment, often causing pain in the groin or pelvis.
Male Sexual Function and Hormonal Issues
Urologists commonly address issues related to male sexual and reproductive health. Erectile Dysfunction (ED) is the consistent inability to achieve or maintain an erection firm enough for satisfactory sexual activity, often stemming from underlying vascular, neurological, or psychological factors. Treatment options for ED are varied, beginning with lifestyle modifications to improve cardiovascular health, and progressing to oral medications known as PDE-5 inhibitors (e.g., sildenafil).
For men with low testosterone, a condition called hypogonadism, the urologist can diagnose the deficiency based on symptoms like reduced libido, fatigue, and mood changes, confirmed by blood tests. Hypogonadism can be treated with hormone replacement therapy (HRT), administered through gels or injections, which aims to restore normal hormone levels and alleviate symptoms. However, the urologist monitors this therapy carefully, as testosterone replacement can interfere with male fertility and presents other risks.
Male infertility evaluation is also within the urologist’s scope, beginning with a semen analysis to assess sperm count and quality. The urologist investigates conditions like varicocele or obstruction and discusses treatment options for reproductive challenges. Urologists also perform sterilization procedures, notably vasectomy, and may perform vasectomy reversals for men who wish to restore fertility.
Physical Changes and Acute Symptoms
Consulting a urologist is warranted for physical changes or acute symptoms affecting the external genitalia. The discovery of any testicular mass or lump requires prompt evaluation, as it is the primary sign of testicular cancer, emphasizing the importance of regular self-examination.
Acute, severe testicular pain is a medical emergency, potentially indicating testicular torsion, where the testicle twists on the spermatic cord, cutting off its blood supply. This condition requires immediate surgical intervention, ideally within six hours, to prevent permanent damage or loss of the testicle. Chronic testicular pain, known as orchalgia, lasts three months or longer and can be caused by various factors, including infection, inflammation (epididymitis), or a varicocele (enlargement of the veins within the scrotum).
Physical changes to the penis are also managed by a urologist, including conditions like Peyronie’s disease. This condition involves scar tissue (plaque) forming under the skin, causing the penis to bend or curve during an erection. This curvature can lead to painful erections, loss of length, or difficulty with sexual intercourse. Other physical issues, such as hydrocele (fluid collection around the testes) or phimosis (a tight foreskin), are also diagnosed and treated.