Urologists: Who Are They and What Procedures Do They Offer?

Urology is the study of urine. A urologist is a medical doctor and surgical specialist who specializes in diseases and conditions of the urinary tract in men, women, and children and the male reproductive system.

What Is a Urologist? 

A urologist is a physician who has been specially trained to diagnose and treat any condition related to the urinary system and the male reproductive system.  

A urologist treats conditions related to the urinary system, which is made up of the:

• bladder
• urethra
• ureters
• kidneys
• adrenal glands

They also treat disorders related to the male reproductive system:

• epididymis
• penis
• prostate
• seminal vesicles
• testes

These conditions may include kidney stones, cancers, infections, incontinence, sexual dysfunction, and pelvic floor abnormalities.

What Does a Urologist Do?

A urologist is a trained surgeon. They use medical and surgical treatments to treat conditions that affect the urinary system or the male reproductive system. Some urologists sub-specialize and limit their practice to:

• Pediatric urology
• Female urology
• Urologic oncology (cancer treatment)
• Genitourinary reconstruction
• Minimally invasive surgery
• Kidney (renal) transplantation
• Male infertility
• Sexual medicine
• Neurourology

Urologist vs. Nephrologist 

Like a urologist, a nephrologist is a specialist. However, a nephrologist limits their practice to treating diseases and conditions that affect the kidney. Nephrology is a subspecialty of internal medicine, and therefore nephrologists are not trained to do surgical procedures. Instead, nephrologists use non-surgical treatment methods, such as dialysis, medications, regulating fluids, electrolytes, and blood pressure. Urologists are surgeons.

What Conditions Do Urologists Treat?

Urologists treat a wide range of medical and surgical conditions of the urinary and reproductive system, including:

Infectious Diseases

Urologists treat infections in the urinary and reproductive systems, including:

• Urinary tract infections: Infections develop when bacteria migrate from the digestive system or blood (rarely) into the urinary system. Symptoms of a urinary tract infection include pain with urination, urinary urgency and frequency, incontinence, nausea, fever, and chills. Urinary tract infections are more common in women due to their shorter urethras.
• Interstitial cystitis: Interstitial cystitis is a chronic inflammatory bladder condition.
• Sexually transmitted infections: A urologist may identify and treat sexually transmitted infections, such as chlamydia and gonorrhea.

Structural Disorders

Urologists treat conditions that are related to malfunctions, aging, or maldevelopment of the urinary or reproductive systems, including:

• Incontinence: A weakening of the pelvic floor with aging or after childbirth can lead to incontinence or the involuntary loss of bladder control.
• Male infertility: Male infertility can occur for many reasons. One common cause is varicoceles, an enlarged vein in the scrotum.
• Bladder prolapse: When the pelvic floor muscles can no longer support the bladder, it may drop below its usual position, increasing the risk of infection and incontinence.
• Enlarged prostate: Benign prostatic hypertrophy affects about a third of men over the age of 50. The prostate encircles the urethra. When the prostate gland enlarges, it presses on the urethra, causing symptoms such as increased urination, inability to empty the bladder completely, and nighttime urination.
• Erectile dysfunction: Erectile dysfunction is the inability to get and sustain an erection satisfactory for sexual intercourse. The most common cause of erectile dysfunction (ED) is damage to small blood vessels from high blood pressure, smoking, diabetes, obesity, or medications. Psychological and lifestyle factors can also increase the risk of ED, especially in men in their 20s and 30s. Injectable medications are very effective. Trimix for ED consists of three compounded drugs that work synergistically to treat ED symptoms.
• Peyronie’s disease: Peyronie’s disease is a curvature of the penis that develops when a layer of scar tissue forms beneath the skin covering the penis. Curvature of the penis can cause pain and difficulty with sexual intercourse.
• Undescended testicles: If one or both testes do not move from the abdomen of a fetus to the scrotum after birth, it can cause complications such as impaired sperm production.
• Urethral stricture: Scar tissue can cause narrowing of the urethra, blocking urine flow, increasing the risk of infection or inflammation.
• Congenital problems: Urologists treat children with bladder exstrophy, hypospadias, and epispadias.

Kidney Disease:

Urologists work with nephrologists to treat diseases and conditions that affect the kidney, such as:

• End-stage renal disease: End-stage renal disease occurs when the kidneys can no longer filter urine effectively. It causes swelling of the extremities and abdomen, shortness of breath, high blood pressure, and anemia, among other symptoms. Dialysis or a kidney transplant may be needed to replace the kidney function.
• Kidney and ureteral stones: Minerals and acid salts can settle out of the urine and form small, hard deposits in the kidneys that may get stuck in the urethra. The stones cause intense pain, nausea and vomiting, with blood in the urine.

Cancers:

Cancers can develop in both the urinary and reproductive systems. Common examples include:

• Prostate cancer: Prostate cancer is second only to skin cancer as the most common cancer in men. Prostate cancers can grow quickly or slowly and are almost all adenocarcinomas. Men over the age of 50 should discuss prostate screening tests with their urologist.
• Ureteral cancer: Cancers of the ureters, the tubes that drain the kidneys into the bladder, make up about one-fourth of all upper urinary tract cancers. Overall, cancers of the upper urinary tract are rare.
• Kidney cancer: The most common type of kidney cancer is renal cell carcinoma. Typically, kidney cancer has no signs or symptoms and is detected incidentally when undergoing scans for another reason.

Hormone Based Conditions:

Both the urinary and reproductive systems can be affected when testosterone hormone levels are abnormal, including:

• Male infertility: Decreased testosterone levels or hypogonadism can cause infertility as testosterone is needed for normal sperm production. Testosterone replacement therapy is an effective treatment for men with hypogonadism and its symptoms.
• Reduced sex drive: Decreased testosterone levels are associated with decreased libido. Decreased testosterone has many effects on the health of both men and women.

What Procedures Do Urologists Perform?

If the urologist suspects a structural cause for your symptoms, they may order imaging tests such as CT scans, MRI scans, or an ultrasound to help identify the problem.

A cystoscope is a tube with a camera on the end that can be used to see the inside of the urethra and bladder. It can also be used to take a small sample of the tissue, called a biopsy.

For urinary symptoms, urodynamic testing can check how fast and how completely urine leaves the body, how much remains in the bladder after urinating, and how much pressure there is in the bladder.

If a structural problem is identified, a urologist can perform surgery to relieve obstruction, biopsy tissue, or correct a malformation. Surgery can be:

• Open: In an open surgical procedure, the urologist makes an incision through the skin and connective tissue to reach the kidney or urinary tract organ.
• Laparoscopy: Sometimes called keyhole surgery, laparoscopic procedures use small incisions and cameras to pass tools through a device and operate on an organ or tissue.
• Laser therapy: Urologists can use laser therapy to treat benign prostatic hypertrophy (BPH), kidney stones, cancer, and other conditions.

When Would I See a Urologist?

You may choose to make an appointment with a urologist directly or be referred by your primary care physician. With a referral, a urologist will have access to the notes the referring physician has sent along with the results of any labs or tests.

The urologist will ask questions about your current symptoms, past medical history, medical conditions, family history, medication use, and lifestyle factors that may increase your risk of urinary or kidney disease. For example, if you consult with a urologist about erectile dysfunction, the urologist will ask questions that may provide clues about what is causing ED.

The next step may be to request a urine sample and hormone levels to evaluate for common causes of ED. For example, the standard male hormone test measures total testosterone levels, estrogen, prostate-specific antigen, and cardiovascular risk factors.

Once these lab results are available for your urologist to review, they will probably discuss lifestyle modifications you can make to decrease your risk of ED, such as

• Decreasing alcohol use
• Stop smoking
• Eat a healthy diet composed of whole foods
• Make lifestyle changes that naturally boost your testosterone levels

Your doctor will also tell you about the wide range of ED treatment options available. The American Urological Association encourages men to participate in the process of shared decision-making to choose the best ED treatment option for them, whether it is ED pills or injectables such as Trimix injection.

Treatment is not the final step. It is important to follow up with your urologist to discuss how the medication is working for you and to report any side effects you may be experiencing. There are many treatment options for ED and other conditions associated with the urinary and reproductive systems. It may require a process of trial and error to determine which is the best choice.