Urology is the medical and surgical specialty focused on diagnosing and treating conditions of the urinary tracts in both men and women, as well as the male reproductive system. The urinary and reproductive organs are closely linked, leading to the joint term “genitourinary system” to describe the scope of this practice. A urological examination is a comprehensive evaluation designed to identify the source of symptoms, ranging from difficulties with urination to concerns about fertility or sexual function. Urologists utilize physical examination, laboratory analysis, and specialized imaging to assess function and pathology, providing medical management or surgical intervention where appropriate.
Checking the Shared Urinary Tract
A significant portion of a urologist’s practice involves the urinary tract structures common to all patients, including the kidneys, ureters, and bladder. One common condition evaluated is nephrolithiasis, or kidney stones, which are solid masses formed by the crystallization of minerals and salts in the urine. Urologists assess the stone’s size and location. For smaller stones, medical expulsive therapy using medications like alpha-blockers may be recommended to help them pass naturally. For larger stones, procedures such as ureteroscopy (using a scope to fragment or remove the stone) or extracorporeal shock wave lithotripsy (ESWL, using focused sound waves) are performed. Preventing recurrence involves 24-hour urine collection analysis to determine the metabolic cause, followed by dietary changes like increased fluid intake.
Recurrent or complicated urinary tract infections (UTIs) frequently require a urologist’s attention, as they may indicate an underlying structural or functional problem. Evaluation includes a thorough search for predisposing factors such as incomplete bladder emptying (high post-void residual volume) or anatomical abnormalities. Urologists use specialized urine cultures and sometimes imaging to identify the specific bacteria. They also rule out conditions like bladder stones or urethral strictures that can act as reservoirs for infection. If an anatomical cause is identified, surgical correction may be necessary to prevent future infections.
Issues concerning bladder function and control are routinely addressed, including urinary incontinence and chronic pain syndromes. Urinary incontinence is broadly categorized into types. Stress incontinence results from weakened pelvic floor support, causing leakage with physical strain. Urge incontinence is characterized by a sudden, intense need to urinate due to involuntary bladder muscle contractions. Overflow incontinence occurs when the bladder does not empty completely, leading to frequent leakage. Treatment is individualized, beginning with behavioral therapy and pelvic floor muscle exercises before progressing to medications or surgical options, such as mid-urethral slings.
For patients experiencing chronic bladder discomfort, urologists evaluate for conditions like interstitial cystitis, often referred to as bladder pain syndrome. This chronic condition is characterized by persistent pain and pressure that typically worsens as the bladder fills. Diagnosis involves ruling out other causes. Management focuses on a multimodal approach to ease symptoms, including dietary modifications to avoid irritants like acidic foods and caffeine. Other therapies include oral medications to help restore the protective lining of the bladder or nerve stimulation techniques.
Checking Male Reproductive and Prostate Health
The examination of male patients by a urologist extends to the reproductive organs, focusing significantly on prostate health. Benign Prostatic Hyperplasia (BPH) is the non-cancerous enlargement of the prostate gland, which surrounds the urethra. This growth can obstruct urine flow, causing symptoms such as a weak stream, hesitancy, and nocturia (the frequent need to wake up at night to void). Management ranges from medication that relaxes muscles or shrinks the prostate tissue, to minimally invasive surgical procedures that remove or ablate the obstructing tissue.
Prostate cancer screening involves a discussion between the patient and the provider regarding the balance of benefits and risks, typically beginning around age 50 for men at average risk. The primary screening tool is the Prostate-Specific Antigen (PSA) blood test, which measures a protein produced by the prostate gland. An elevated PSA level, which can also be caused by BPH or infection, may prompt further investigation. Men with a PSA level below 2.5 nanograms per milliliter may be re-screened every two years, while those with higher levels usually require annual monitoring.
A urologist performs a thorough assessment of testicular health, investigating masses, swelling, or pain. While pain can indicate an infection like epididymitis or a torsion requiring immediate surgical correction, a painless lump or swelling is the most common presentation for testicular cancer. Evaluation typically includes a physical examination and scrotal ultrasound to differentiate between a solid mass (suspicious for cancer) and a fluid-filled sac (usually benign). Blood tests are also performed to check for specific tumor markers, such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG), which aid in diagnosis and staging.
Male sexual health, specifically Erectile Dysfunction (ED), falls within the urologist’s expertise. Diagnosis begins with a detailed medical and sexual history, as the condition is often linked to underlying health issues like cardiovascular disease or diabetes. Specialized tests may include a penile Doppler ultrasound to evaluate blood flow into and out of the penis. Treatment options vary widely, starting with oral medications (phosphodiesterase type-5 inhibitors) to increase blood flow, and progressing to self-administered penile injections or, for refractory cases, the surgical placement of a penile implant.
A urologist evaluates male infertility, which is a factor in approximately 50% of couples struggling to conceive. The initial workup centers on semen analysis, which provides specific measurements of sperm concentration, motility, and morphology. If the sperm count is low, hormone blood tests measure levels of testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) to identify hormonal imbalances. Further evaluation may include a physical examination to check for a varicocele or a transrectal ultrasound to detect blockages in the ducts that transport sperm.
Essential Diagnostic Procedures
Physical examinations and laboratory studies form the foundation of the urological checkup, providing initial data on the patient’s condition. The digital rectal exam (DRE) is a brief physical assessment used to manually check the prostate gland for size, texture, and the presence of hard or nodular areas. This procedure allows the physician to feel the back wall of the prostate, a common site for cancerous growth. Standard laboratory work includes urinalysis to look for signs of infection, blood, or crystals that indicate stones, and blood tests like the PSA to monitor prostate health.
Imaging techniques provide non-invasive visualizations of the entire genitourinary system. Ultrasound uses high-frequency sound waves to create real-time images, useful for evaluating the kidneys for blockages or cysts, and the testicles for masses or fluid collections. Computed Tomography (CT) scans offer detailed cross-sectional images, frequently used to pinpoint the exact location and size of kidney stones or to stage cancers. Magnetic Resonance Imaging (MRI) is often utilized for highly detailed soft tissue imaging, particularly in the prostate, to better define suspicious areas before a biopsy.
For functional or structural problems in the lower urinary tract, urologists use specialized procedures. Cystoscopy involves inserting a thin, flexible tube (cystoscope) through the urethra into the bladder. This direct visualization allows the physician to examine the lining of the urethra and bladder for inflammation, tumors, stones, or structural narrowing, and can be used to perform small biopsies or minor treatments. Urodynamic testing measures how well the bladder, sphincter muscles, and urethra store and release urine. These tests involve measuring flow rate, bladder pressure during filling, and how completely the bladder empties to diagnose the cause of incontinence or difficulty voiding.