You've taken the first step and arranged an appointment with a urologist but what does this involve? It will help you to better understand any urology symptoms you're experiencing such as problems urinating, frequent urinary tract infections, prostate troubles, or male impotence. Try not to worry, it's normal to be concerned about these problems and what the outcome of your urology appointment may be.
To help give you some peace of mind, you can equip yourself with a better understanding of what to expect during your first visit. You can also gather useful information to help your urologist investigate your symptoms and give you an accurate diagnosis.
Somewhat reassuring, the British Association of Urological Surgeons states that approximately nine out of ten (90%) patients referred to a urologist do not need surgery, and can be managed medically¹. You may also be inspired and comforted by the innovation that urologists have shown in pioneering modern minimally invasive techniques. They were one of the first specialties to routinely use "keyhole" surgery and to use robotic assistance for complex surgery.
So, what do urologists do?
If you're seeing a urologist, it's helpful to understand what they do. Urologists are specialists who diagnose, manage and treat diseases, trauma, and congenital abnormalities of the urinary tract and parts of the male reproductive system.
Urology disorders can include stones, tumours, obstruction and strictures, infections, trauma, congenital disorders, incontinence, and difficulty passing urine.
You may be wondering what your urinary tract is and what is its function. The urinary tract creates, stores, and removes urine from your body. Urologists investigate symptoms, diagnose, medically manage, and surgically treat problems in any part of this system including:
- Kidneys - two bean-shaped organs that filter waste out of your blood to produce urine
- Ureters - tubes that urine flows through from your kidneys to your bladder
- Bladder - a muscular sac that stores urine and controls urination
- Urethra - a tube that carries urine from your bladder out of your body
- Adrenal glands - glands at the top of each kidney that release hormones.
Urologists treat bladder problems and incontinence, urinary tract infections (UTIs), kidney disease, kidney stones, and bladder and kidney cancer.
Men may also see a urologist for problems with their male reproductive system which is made up of the:
- Penis - an organ that releases urine and carries sperm out of the body
- Prostate - a gland underneath the bladder that produces fluid that is added to sperm to produce semen
- Testicles - two oval organs inside the scrotum that make testosterone hormone and produce sperm.
Male urology reproductive problems include erectile dysfunction (ED), an enlarged prostate gland, prostate cancer, and testicular cancer.
There is a misconception that urologists only see male patients. In fact, many women see a urologist for problems such as UTIs, pelvic organ prolapse, weakened pelvic floor muscles, and incontinence.
What happens on the first visit to a urologist?
On your first visit to a urologist, you can typically expect the following:
- Paperwork that may consist of questionnaires and a symptom diary.
- A medical review including a detailed medical history, any medications you are taking, and a complete assessment of all of your body systems.
- A discussion about why you made your urology appointment. Don’t be embarrassed. Urologists regularly see patients with the same problems you have. They are there to help. They want to find out about your urology condition and determine the best way to treat it.
- A urine sample (urinalysis) to examine the content of your urine and check for bacteria. A urine test helps to diagnose conditions such as a urinary tract infection, kidney disease, kidney stones, diabetes, or pregnancy.
- A physical exam of your entire urinary tract system including your kidneys, ureters, and bladder. Men who are having problems related to their penis or testicles will also have an examination that includes these. They are known as genital and digital rectal exams (DRE). For men, a DRE evaluates their prostate gland and looks for enlargement or irregularities.
- Blood tests including a Prostate-Specific Antigen (PSA) blood test to help determine the cause of an inflamed prostate, Creatinine and Blood Urea Nitrogen (BUN) blood tests to assess kidney function, and Testosterone blood tests to measure testosterone levels and evaluate male erectile dysfunction.
- Semen samples that are examined in a laboratory to measure a man’s sperm motility, quantity, and quality, called a semen analysis or a seminogram.
- Imaging tests may be performed at your consultation or ordered. They include ultrasound, X-ray, CT, and MRI scans that allow your urologist to see inside your urinary tract, prostate and testicles to help locate the problem. They might choose a minimally invasive procedure called a cystoscopy that uses a tiny telescope to look inside your bladder and urethra in real time.
How do I prepare for a urologist appointment?
The best way to prepare for a urologist appointment is to come equipped with all the information your urologist may need. This can help in making a diagnosis and developing a treatment plan.
Things to remember in preparation for your urologist appointment:
Come to your appointment with a full bladder
It is a standard practice to provide a urine sample at your urology appointment. The results from a urine analysis will give your urologist an inside look at your urinary system organs. If you find it difficult to hold urine in, bring a water bottle with you to drink before your appointment.
Be prepared for paperwork
You may be asked to fill out a questionnaire about your current condition and its symptoms as well as your medical history. A registration form may also need completing if you are a new patient. Come prepared with insurance details, information about the severity and timings of your symptoms, and a good understanding of your family's medical history. You may find that tracking your symptoms is a good way to be able to describe your symptoms. Some urologists ask you to complete a bladder diary beforehand. This is a log that keeps track of any leaks and when they happened, and your food and drink intake.
Make a list of questions
It's quite normal to have a lot of questions before your urology appointment. Write them down so that you don’t forget any. You can then use this as a checklist to ensure that all of your concerns have been discussed and to give you more peace of mind. Jot down any important information discussed during your consultation so that you can easily and accurately recall it.
Bring any medication information
Go through all of the prescription medications, over-the-counter drugs, vitamins, and supplements that you currently take and write them down. Bring this list with you to your appointment for your urologist to evaluate, gain insight into other conditions, and see if any could have an effect on your urinary system.
Check your Private Medical Insurance (PMI)
If you intend to pay for your healthcare with an insurance policy, you should check its terms before your consultation. Pay particular attention to the level and type of outpatient cover you have and any reimbursement limits on individual consultation fees. You will be responsible for any fees not covered by your insurer. Ramsay is recognised by all major private medical insurers.
Be ready for a physical examination
You should expect a physical exam. This is different for men and women and depends on your symptoms. Men may need a rectal exam and women may need a pelvic exam. Your urologist may also do blood tests, imaging scans, PSA tests, or other urological exams to better understand your condition.
What are common urology problems?
Your urinary system works hard to regulate and eliminate urine waste so it's not surprising that its components can have problems. These urology problems affect your urinary tract and in men, they can also affect your reproductive system. Common urinary problems include:
Urinary tract infection (UTI)
UTIs are the most common type of urology problem. In fact, the National Institute for Health Research (NIHR, 2016) reports that UTIs are among the most common types of infections with in excess of 92 million people affected worldwide². They occur much more frequently in women due to a shorter urethra in women³.
The main symptoms of a UTI are a burning sensation and changes to urination such as an urgent or more frequent need. They happen when an infection, usually bacteria-caused, enters your urinary tract.
Luckily, UTIs are easily treated with antibiotics. They should be treated as soon as possible to prevent further infection and the chance of complications. If you have recurring UTIs, you should seek medical advice.
Urinary incontinence
Another frequently occurring urology problem is urinary incontinence or a lack of bladder control. It is estimated that around 7 million people in the UK have urinary incontinence. That's 5 to 10% of the population. Furthermore, urinary may be significantly under-reported, as it is often thought of as an embarrassing problem.
Urinary incontinence occurs more in older people and there are different types.
Stress incontinence and pelvic floor dysfunction is a common type. It happens when urine leaks with the exertion of pressure on your bladder by coughing, sneezing, laughing, exercising, or heavy lifting. Often it is caused by pelvic floor or urethral sphincter muscle weakening or damage.
Another type is urge incontinence. This is when you have a sudden urge to urinate that is so strong that you don't get to the toilet in time. It can be caused by minor conditions such as infection, or more serious problems including neurological disorders or diabetes.
Lifestyle changes, pelvic floor exercises, and bladder training may help. Surgery may be required to treat urinary incontinence.
Overactive bladder (OAB)
OAB happens when your bladder cannot store urine properly. It is due to involuntary bladder muscle contractions even when you have a low amount of urine in your bladder. OAB can cause you to suffer from urge incontinence where you find it difficult to control sudden urges to urinate, frequent urination of eight or more times in 24 hours, and waking up more than twice in the night to urinate.
Behavioural therapies such as bladder training and muscle exercises and medications may help treat OAB. Surgery tends to be reserved for people with severe symptoms who haven’t responded to other treatments.
Kidney stones
Kidney stones are crystal-like waste chemicals that clump together. The stones can get blocked in your urinary tract system causing painful urination. Most stones are passed naturally but larger stones can cause severe pain and often require surgery or procedures such as using sound waves to break them up.
Prostate problems
Prostate problems are common, particularly in men over 50. A man’s prostate gland is similar in size and shape to a walnut. It tends to get bigger as you get older and can become swollen or enlarged by conditions such as:
- Benign Prostatic Hyperplasia (BPH) or prostate gland enlargement can cause urinary problems. Lifestyle changes and medicines tend to be used initially before the surgical removal of the inner part of the prostate.
- Prostatitis is when the prostate gland becomes inflamed. It can cause pain in the perineum, pelvis, genitals, lower back, and buttocks and when urinating and ejaculating as well as urination problems. Pain relief, medications, and antibiotics are used to treat prostatitis.
- Prostate cancer is the most common type of cancer in men. It can cause similar symptoms to prostate enlargement if the cancer grows large enough to put pressure on the urethra. Prostate cancer usually progresses slowly and may not need immediate treatment.
Erectile Dysfunction (ED)
ED is when a man has difficulty getting or maintaining an erection. This can cause stress, embarrassment, and strain on a relationship. Treatment often involves medication. Healthy lifestyle changes, psychological counselling, testosterone replacement, and surgery are other options.
Summary
If you are experiencing any symptoms that may be related to a urology problem you should book an appointment with your GP or a urology specialist. Ramsay works alongside highly experienced urologists throughout their network of UK hospitals.
Many people are embarrassed by urology symptoms and wait and hope that they will clear on their own. It’s advisable to seek advice from a medical expert sooner rather than later to prevent urology problems from developing which can lead to pain, discomfort, and more serious health issues.
Urology problems are common. They are often thought of as male problems due to urology also encompassing conditions that affect the male reproductive organs and often women being too uneasy discussing their urinary incontinence issues.
Urologists find it useful for their patients to come prepared for their first appointment. This includes bringing as much information about your urology condition and its symptoms as well as understanding that a urine sample, a physical test, and further tests may be required to help fully understand what is going on. You will benefit from a valuable consultation and advice and treatment recommendations to help alleviate your symptoms.
Ramsay offers convenient urology appointments without waiting with male and female specialists. You can get an early diagnosis and the latest treatments to help you to return to your normal daily life without pain or worry.