Jim, a 48 year old cop, went to his primary care doctor because he saw blood in his urine after a vigorous work-out. At the time of his visit his primary care doctor saw no blood in his urine on the dipstick and so told him “don’t worry, it’s probably from the exercise.” His doctor was not concerned and said that some men just have blood in their urine, probably from their prostate and it shouldn’t be a problem because there’s no signs of infection.
Two years later, Jim was talking to a new doctor when he mentioned that he had intermittent blood in his urine. Concerned, the doctor insisted that he see a urologist, a specialist in disorders of the male and female urinary tract as well as the male reproductive system. The urologist discovered that Jim had a fairly large and aggressive bladder cancer.
The lesson is that some health problems require care that is beyond the scope and training of primary care physicians – sometimes it takes a specialist to recognize a problem. But how do you know when you need to take the step of seeing a urologist?
Here are just a few of the most common symptoms or conditions that should prompt you to make an appointment:
If you have testicular pain or mass, you should have a urologist check you out to be sure it is not torsion (severe pain from twisting that must be surgically fixed immediately) or even a tumor. Sure, it might be just inflammation or an infection, but torsion or a cancer is not something you want to miss as they both require immediate action. Sadly, many men with testicular cancer go undiagnosed for months before they are referred to a urologist.
Blood in the urine, called hematuria, is another reason to see a urologist – yes, even if the blood is only seen once and never seen again. Hematuria can be blood that you see (gross hematuria) or even blood only seen in lab tests (microscopic hematuria). You should never assume that blood is nothing to worry about. Even though it may be nothing serious, it might be the only early warning sign of an underlying bladder or kidney cancer, where early detection can make the difference between an easy curative treatment or much more aggressive surgery if the cancer has time to grow unchecked.
See a urologist if you have an elevated PSA or abnormal prostate exam (neither of these is a definitive indication that you have prostate cancer – only that you might have it). A PSA that is climbing is even more worrisome. Though there is much debate by government officials, there is no debate among urologists that early detection and treatment of an aggressive prostate cancer can save your life. The old idea of “let’s just watch this and see what happens” can have serious consequences.
If a man has prostate cancer, then urologists are the only specialty trained to oversee and recommend a variety of possible treatments, to include observation, radiation, chemotherapy, as well as provide hormone therapy or curative surgery.
If someone is unable to urinate, called urinary retention, then he must have a urologic evaluation to find out if this is a long-standing problem that needs correction or if this will get better with a week or two with a drainage catheter to let the bladder heal and medications to relax the prostate.
Kidney stones are another reason to see a urologist. Though many doctors can treat the pain of the stone as it passes, only urologists are trained in the advanced techniques to nonsurgically pulverize or remove stones, whether in the kidney, the ureter or the urinary bladder.
Kidney masses or tumors should always be evaluated by a urologist. In the old days, it was common for a doctor to find a mass on a patient’s kidney and have a radiologist simply biopsy the lesion. This can miss the cancer and even cause the cancer cells to spread. Today, urologists can often identify what the mass is by a variety of non-invasive tests and then if needed, remove the lesion or kidney. Advances in laparoscopic and robotic surgery have revolutionized kidney cancer care.
Male infertility requires a comprehensive exam and testing, again by a urologist. Oftentimes there are other underlying problems and so the infertility is correctable when the problem is treated. Other times, more advanced techniques are needed to correct the problem such as a varicocele, which is a collection of veins in the scrotum. For the most challenging issues, microsurgical reconstruction of the vas or sperm retrieval may be required.
