A urologist specializes in the urinary tract system for both men and women, and the male reproductive system. This includes conditions affecting the kidneys, ureters, bladder, urethra, prostate, testes, and penis. Men often seek a urologist for problems related to urination, sexual function, and fertility, or when a primary care physician identifies an issue requiring specialized care. Consulting a urologist is the appropriate step for symptoms involving the urinary or male reproductive systems.
Conditions Affecting Urination and Voiding
A frequent reason for men to visit a urologist involves lower urinary tract symptoms (LUTS), describing issues with storing or emptying urine. These symptoms include increased frequency of urination, a sudden, strong urge to urinate (urgency), and needing to wake up multiple times at night to void (nocturia). Voiding symptoms relate to the flow, such as difficulty starting a stream (hesitancy), a weak or intermittent flow, or the sensation of incomplete bladder emptying.
These symptoms can stem from various causes, including an overactive bladder, inflammation, or a urethral narrowing called a stricture. Urologists investigate these symptoms using tests like urinalysis, which checks for infection or blood, and sometimes urodynamics, which measures bladder function and pressure. The presence of blood in the urine (hematuria) always warrants a prompt urological evaluation to rule out serious underlying conditions. Urinary Tract Infections (UTIs) can occur in men, often presenting with painful urination (dysuria) and requiring antibiotic treatment.
Prostate Health and Screening
Many voiding symptoms in men over the age of 50 are caused by a non-cancerous enlargement of the prostate gland called Benign Prostatic Hyperplasia (BPH). The prostate naturally grows with age and surrounds the urethra; this enlargement can squeeze the urinary channel, creating an obstruction. This physical blockage forces the bladder to work harder, leading to the common symptoms of frequency, urgency, and a weak stream.
Urologists manage BPH using medications that either relax the muscle fibers in the prostate or shrink the gland’s size. If the symptoms are severe or unresponsive to medication, surgical options are available to remove or reduce the excess prostate tissue, such as transurethral resection of the prostate (TURP) or newer, minimally invasive procedures. Separately from BPH, urologists play a primary role in screening for and managing prostate cancer, which is often asymptomatic in its early stages.
Screening involves the Prostate-Specific Antigen (PSA) blood test, which measures a protein produced by the prostate, and a Digital Rectal Examination (DRE) to feel for abnormalities. An elevated PSA level or a suspicious DRE finding may lead a urologist to recommend a prostate biopsy to accurately diagnose prostate cancer. If cancer is detected, the urologist then discusses various treatment strategies, which can range from active surveillance for slow-growing, low-risk tumors to surgery (prostatectomy) or radiation therapy.
Addressing Sexual Function and Fertility Concerns
Urologists are specialists in male sexual health, with Erectile Dysfunction (ED) being a common issue they evaluate and treat. ED is the inability to achieve or maintain an erection sufficient for sexual activity and often indicates underlying health issues like cardiovascular disease or diabetes. Evaluation involves a detailed medical history, physical examination, and sometimes specific tests like a penile Doppler ultrasound to assess blood flow.
Treatment for ED typically begins with oral medications like phosphodiesterase inhibitors, which enhance blood flow to the penis. For men who do not respond to oral drugs, urologists offer other options, including injection therapy, vacuum erection devices, or the surgical placement of a penile implant. Urologists also manage conditions related to male fertility, performing procedures like vasectomy and vasectomy reversal. They investigate male infertility through semen analysis and hormonal tests, addressing issues such as low testosterone (hypogonadism) or structural problems like a varicocele.
Managing Pain and Kidney and Bladder Stones
Acute, severe pain is a common reason for an urgent urology consultation, most frequently due to kidney stones (nephrolithiasis). These hard deposits of minerals and salts form in the kidney, and the intense flank pain occurs as they travel down the narrow ureter toward the bladder. The pain is often described as colicky, meaning it comes in waves, and can radiate down to the groin or testicles due to shared nerve pathways.
Urologists diagnose stones using imaging studies like CT scans and manage the condition with medications to help small stones pass or with procedural interventions for larger stones. Procedures include extracorporeal shock wave lithotripsy (ESWL), which uses sound waves to break stones into smaller fragments, or ureteroscopy, where a scope is used for removal or fragmentation. Urologists also evaluate and treat chronic testicular pain (orchialgia), often caused by infections like epididymitis, or structural issues like a hydrocele or varicocele. They also manage conditions that can cause sudden, severe pain, such as testicular torsion, which is a medical emergency requiring immediate attention.