What is and does a urologist do?

What is a urologist?

In urology, doctors work who have specialized in medicine on diseases, functional disorders, malformations and injuries of the male genital tract and the urinary tract . The area of ​​the urinary organs includes in particular diseases of the kidneys, the urinary bladder, the ureter and the urethra. In the area of ​​the sex organs, the urologist is only responsible for the male sex – i.e. for the testicles, epididymis, vas deferens, seminal vesicles, as well as the penis and prostate.

Within these two central areas of responsibility, a specialist in urology can specialize in certain patient groups or diseases. Examples of these specializations are oncology (urological cancer diseases), andrology (hormonal diseases and impotence in men) or female urology (focus on diseases of the lower urinary tract and bladder).

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Who goes to the urologist?

Many think that the urologist is to men in medicine what the gynecologist is to women. To a certain extent, that is also correct. The urologist specializes in the male genital organs¹ . Diseases of the testicles and epididymis, the vas deferens, the seminal vesicles, the penis and the prostate fall under this jurisdiction. In addition, the urologist is the contact person for problems with sexual intercourse and fertility, such as erectile dysfunction, orgasm problems or impotence. One of the most important urological examinations for men is the check-up of the prostate, which is used for the early detection of cancer and should therefore be carried out regularly from a certain age.

Although the urologist specializes in the male sex organs, he is not just a “male doctor”. The specialist in urology is also responsible for diseases of the urinary tract and kidneys, which is why not only men, but also women and children visit him.

The main reason why women ² consult a urologist is cystitis. Women suffer particularly often from such urinary tract infections. There are anatomical reasons for this: a woman’s urethra is only a few centimeters long, which means that bacteria can get into the bladder more easily than it is in men. Another urological ailment in women is incontinence: one in three women is at risk of developing so-called stress incontinence. Other possible urological diseases in women are uterine prolapse, urinary stones and tumors in the kidneys or bladder.

In addition to men and women, children³ should also be examined and treated by a urologist for certain diseases. There are specialized pediatric urologists for this. The most common pediatric urological diseases include narrowing or adhesions of the foreskin, undescended testicles and urinary tract infections. Frequent bedwetting at night is also treated by the urologist. Another area of ​​responsibility of the urologist is the HPV vaccination of boys.

Preventive medical check-up: when and how often should men go to the urologist?

If you notice symptoms of the urogenital tract, you should definitely consult a urologist – regardless of your age. However, it is a big misconception that you can save yourself a visit to the urologist if you don’t have any problems with your erection, bladder and the like.

Preventive examinations by a urologist can be life-saving, especially in the area of ​​early detection of prostate cancer. Prostate cancer (prostate carcinoma) is a malignant tumor of the prostate gland in men and is the third leading cause of death from cancer in men⁴.

With the help of a screening examination by a urologist, prostate cancer and cancer of the external genitalia can be detected at the earliest possible stage and treated accordingly. This increases the chance of healing. During the screening examination, the external genitals and the prostate are examined and palpated. The “finger in the buttocks” that many men fear during a prostate examination does not cause any pain and is out again in less than a minute. Shame and fear from the examination are therefore completely unfounded.

In the UK, it is recommended for men over the age of 45 to have an annual check -up with a specialist in urology. This annual screening examination is covered by statutory health insurance.

But not only the urologist is responsible for the early detection of cancer. Here you can see which check-ups are offered to men as part of the statutory cancer screening⁵.

When should men and women go to the urologist?

The urogenital tract is a complex system and produces a multitude of different clinical pictures. The task of the urologist is to diagnose these clinical pictures and to treat them accordingly.

Unfortunately, even today, urology is still fraught with numerous prejudices. Feelings of shame about the diseases and fear of the urological examination are an obstacle for many patients to consult a urologist. However, this false shame is not only unfounded, it is also dangerous: even harmless-looking urological diseases such as cystitis can have serious consequences for the patient if left untreated have the health of the patients.

Diseases and symptoms for which you should start looking for a urologist are, for example:

➜ Urinary tract infections, urinary changes, painful urination, urethral discharge

➜ Urinary incontinence, bladder emptying disorders, nocturnal urine leakage

➜ Renal insufficiency, kidney stones

➜ Erectile dysfunction or erectile dysfunction

➜ Changes in the male sex organs, changes in the ejaculate

➜ Inflammation of the prostate

➜ STDs

➜ Andropause (menopause in men)

➜ Infertility (fertility test, spermiogram)

➜ Cancer prevention

Which examination and treatment methods does a urologist use?

According to the large number of possible clinical pictures, the urologist has a wide variety of examination and treatment methods at hand.

• The ultrasound examination is a non-invasive, imaging procedure in which, for example, kidney or bladder stones, tumors or malformations can be made visible.
• Urography is an X -ray examination of the kidneys, ureters and bladder. The urinary system is visualized using contrast media so that bladder or kidney stones, tumor diseases or malformations can be detected.
• During cystoscopy or cystoscopy, the urethra, bladder and prostate are examined with a thin special camera. In addition, small bladder stones can be removed, tissue samples taken and minor bleeding stopped.
• In a prostate biopsy, tissue samples are taken from the prostate using an endorectal probe inserted through the rectum, which are then analyzed and facilitate the search for prostate cancer.
• During the puncture , a cannula is inserted into a cavity in the kidney area in order to remove kidney tissue. This method is useful, for example, in the search for kidney cancer.
• The urine test looks for substances such as blood, sugar, protein or pathogens in the urine. Diseases such as urinary tract infections or even diabetes can be diagnosed.
• Cystometry measures the pressure and capacity of the bladder. For this purpose, the emptied bladder is filled with saline solution using a catheter. 
• In the spermiogram , the man’s semen is examined macroscopically and microscopically. The results provide indications of the man’s fertility.

What does the urologist do for bladder infections

Typical symptoms of a bladder infection are burning when urinating and a frequent urge to urinate. As unpleasant as it is – in most cases a bladder infection is harmless and quickly cured. However, if it persists for a longer period of time, a doctor, preferably a urologist, must be consulted. Otherwise the inflammation can rise and lead to a kidney pelvis infection.

In young, healthy women, the medical history is usually enough for the urologist to make the diagnosis. In severe cases or in patients at risk (young men, pregnant women, diabetics), midstream urine is also taken and examined microscopically for bacteria and blood using a test strip. In the case of a bladder infection caused by bacteria, antibiotics are then usually prescribed. But the patients are also given simple home remedies such as bladder and kidney teas, cranberry juice or essential oils.

In the case of recurring urinary tract infections , the bladder can also be examined using ultrasound, urography or cystoscopy. Special diseases, eg urinary stones, malformations or functional disorders can be detected or ruled out. In special cases, swabs from the urethra, blood tests, a urinary flow measurement or an X-ray of the bladder function with the help of contrast media can also provide information about the causes of the recurring urinary tract infections and determine further treatment.⁶

What does the urologist do for kidney pain?

A delayed urinary tract infection or an inflammation of the renal pelvis usually hides behind kidney pain. In addition to pain in both hips, this also manifests itself in pain when urinating, as well as fever and chills. Inflammation of the renal pelvis is always a reason to see a doctor – preferably a urologist.

In the case of kidney pain, the urologist examines the blood for inflammation values ​​and checks whether there is an increase in bacteria and white blood cells in the urine. In severe cases, the urologist can also perform an ultrasound examination or a computer tomography of the kidney and remove kidney tissue via a puncture. As with urinary tract infections, possible diseases or injuries to the kidneys can be ruled out.

In the case of an uncomplicated inflammation of the renal pelvis, the urologist usually initiates antibiotic treatment for 7-14 days. The treatment can usually be carried out on an outpatient basis. In the case of severe kidney inflammation, the urologist usually uses infusion interventions with antibiotics that last several days and are sometimes inpatient. If there is accumulation of pus in the kidney, surgical treatment must be considered. In the case of urinary obstruction in the kidneys, the placement of a ureteral splint can also be helpful.

Course of the first urological examination

Many patients are reluctant to visit a urologist because they fear unpleasant questions and examinations. Feelings of shame have no place here, however: Specialists in urology specialize in clinical pictures of sexual medicine and routinely carry out urological examinations. Nothing should be uncomfortable or embarrassing for you in front of these specialists. Here we explain what you can expect during your first visit to a urologist.

➀ Anamnesis survey (usually based on a questionnaire) with:

• Questions about the psychosocial and cultural environment (e.g. family, job, origin)
• questions about sexuality
• Questions about previous illnesses (e.g. diabetes mellitus, sexually transmitted diseases), operations, medication intake, etc.
• Questions about current complaints, especially in the urological area, eg with the bladder, urine, genitals or sexuality

➁ Submission of a urine sample, which is examined using a urine strip test

➂ Anamnesis discussion with the urologist (including discussion of the questionnaires)

➃ Blood collection:

• control of sex hormones
• Search for changes in so-called tumor markers
• Control of laboratory parameters such as thyroid values, blood sugar values, blood lipid values

➄ Carrying out urological examinations:

• Palpation of the abdominal and genital region
• Palpation of the penis and testicles in men
• Palpation of the prostate via the rectum in men
• Examination for changes in the skin (e.g. redness), swelling in the area of ​​the scrotum and discharge from the urethra
• Percussion on the kidneys

➅ Ultrasound examination of the prostate, bladder, testicles and penis

➆ If necessary, further examinations (e.g. tissue removal) 

➇ Discussion of the results and depending on the treatment plan or therapy

Guideline for diagnostics and therapy in urology

The guideline of the German Society for Urology contains recommendations regarding the diagnosis and treatment of urological diseases. The guideline is aimed in particular at specialists in urology and is intended to guarantee appropriate treatment and care for patients. The guideline summarizes the latest medical findings and the pros and cons of specific examinations and treatments. It differs from a guideline in that the guideline is not binding.

How much does a visit to the urologist cost?

Normally, if there are acute or chronic symptoms, a urological examination, treatment and therapy is paid for by the statutory health insurance. In addition, the health insurance company takes over the prostate cancer check-up for men over 45. Unfortunately, this is only done by 15% of men.

Not all urological services are paid for by health insurance companies. Accordingly, it is definitely advisable to find out about the catalog of benefits from the health insurance company before treatment and therapy. Such urological services, which are usually paid for privately, include, for example, special tests for the early detection of prostate cancer (e.g. the PSA test) that deviate from screening, sterilization of the man on request or therapy for erectile dysfunction.

On the other hand, some services, such as the fertility or semen test if infertility is suspected, are only covered to a limited extent, in this case an average of 1 x per quarter.