You have just been told by your primary care doctor that you need to see a urologist, or perhaps you are experiencing symptoms that you think are related to your urinary tract and you have decided to make an appointment on your own. You may have some trepidation about your appointment and what to expect during your visit.
Prior to your visit, it may be helpful to better understand what a urologist is. They are physicians who have specialized in treating the disease of the genitourinary tract: the kidneys, the urinary bladder, the adrenal glands, the urethra, the male genital organs, and male infertility. Urologists are also trained in the surgical and medical treatment of the diseases that affect these organs.
Below are some of the typical steps to an urologist visit.
Inevitably, a urologist will request that you provide a urine specimen, so it is important not to go to the office visit with an empty bladder. Many conditions that you may have been referred for may prevent you from being able to hold your urine, so when you arrive at the office, let the office staff know that you are ready to provide a specimen.
All office visits start off with a pile of paper work. Some of this may include various questionnaires that are used to assess the severity of your disease. Symptom scores often will be utilized to assess the lower urinary tract symptoms that men may experience (International Prostate Symptom Score). A female incontinence questionnaire (Urogenital Distress Inventory) also may be used. A male sexual health inventory (SHIM) may be used to assess erectile function. Patients may be asked to complete a voiding diary that documents times and amounts of voids and when incontinent events occur.
A detailed medical history will then be obtained. Although this will be directed towards the genitourinary system and questions will be aimed at identifying what your underlying urologic problem actually is, a complete review of all body systems will be obtained. Many times diseases that exist in other systems can help diagnose urologic disease. Be prepared to give your urologist a complete list of all your medications, including any over-the-counter medications that you may be taking. If you are not comfortable providing this list, bring all your medications with you to the office visit.
A physical examination will then be done. Again, the exam will concentrate on the genitourinary system; however, other systems will be evaluated. A complete genital exam will be undertaken, which may include a pelvic exam for females depending on their symptoms. A digital rectal examination will be undertaken to assess the prostate in men.
After the completion of the examination, the urologist will discuss a treatment plan for you to determine what is happening. This will usually involve additional tests to be performed either at the time of the current visit or, more commonly, at a subsequent visit. These tests may include blood tests, such as blood counts, chemistries including an assessment of kidney function, a PSA evaluation, and, possibly, a testosterone level.
Urologists may commonly order imaging studies. These tests give us an insight as to what is happening in the organs of interest. Sonography of the kidneys, the bladder, and the prostate either by a transabdominal or transrectal approach or a transvaginal ultrasound may be ordered. A CT scan or an MRI may be recommended to visualize the kidneys, intrabdominal or pelvic organs.
The urologist also may recommend office-based procedures to be performed, such as a cystoscopy, which is a test that involves the placement of endoscopic instrument through the urethra to visualize the lining of the bladder and the urethra. Urodynamics, a test that assesses the functionality of the bladder, may be ordered and is commonly performed in patients who have incontinence. Biopsies of the bladder or the prostate also may be ordered.
With a focused, detailed office visit, your urologist should be able to determine the correct course of action that will be undertaken in order to treat your symptoms.