Urology

From erectile dysfunction to prostate cancer, millions of men suffer from urologic and sexual health issues every day. 

It is possible for most men to be treated and return to a full life if they recognize and understand the symptoms.

Urologic Procedures

Scope Exam

Scope exams are used to examine the urethra and the bladder lining. 

This test is often used to determine whether a person has hematuria (blood in the urine) or if there is difficulty urinating due to scar tissue or prostate enlargement.

Digital Rectal Exam

Rectal exam, or digital rectal exam, is a physical examination of the prostate. 

The health care provider asks the man to bend over a table or lie on his side with his knees close to his chest during the exam. 

In order to feel the part of the prostate located next to the rectum, the health care provider inserts a gloved, lubricated finger into the rectum. 

During the rectal exam, a man may feel slight discomfort. 

The rectal exam is most often performed during an office visit by a health care provider, and men do not need anesthesia. 

Health care providers can use this exam to determine if the prostate is enlarged or tender, or if there are any abnormalities that need further assessment.

Rectal exams are routinely performed during a physical exam for men age 40 and older, regardless of whether they have urinary problems.

Urinalysis

A urine sample is tested during a urine analysis. During a health care provider’s office visit or at a commercial facility, the patient collects a urine sample in a special container. 

The sample is tested by the health care provider during an office visit or is sent to a lab for analysis. 

The test is performed by placing a strip of chemically treated paper, called a dipstick, in the urine. 

Dipstick patches change color to indicate signs of infection in urine.

PSA Blood Test

In a commercial facility or during an office visit, a health care provider can draw blood for a PSA test and send the sample to a lab for analysis. 

PSA is a protein produced by prostate cells. PSA levels may be higher in men with prostate cancer. 

High PSA levels do not necessarily indicate prostate cancer. Often, high PSA levels are caused by benign prostatic hyperplasia, prostate infections, inflammation, aging, and normal fluctuations. 

There is still much to learn about how the PSA blood test should be interpreted, whether it can differentiate between cancer and prostate conditions, such as benign prostatic hyperplasia, and what to do if the PSA level is high.

Urodynamic Tests

In urodynamic tests, the bladder and urethra are evaluated according to how well they store and release urine. 

Typically, urodynamic tests are performed during an office visit or in an outpatient center or hospital. 

While some urodynamic tests do not require anesthesia, others may require local anesthesia. 

A urodynamic test measures the bladder’s ability to hold urine and empty it steadily and completely.

Cystoscopy

A cystoscopy is a procedure for inspecting the urethra and bladder with a tubelike instrument called a cystoscope. 

The cystoscope is inserted into the lower urinary tract through the opening of the penis by a urologist. 

Cystoscopy is done by a urologist either in an outpatient clinic or in a hospital.

Local anesthesia will be administered by the urologist; however, in some instances, sedation or regional anesthesia may be required. 

Cystoscopy can be used by urologists to detect blockage or stones in the urinary tract.

Transrectal Ultrasound

Transrectal ultrasound uses a transducer to bounce sound waves off organs to create a picture of their structure. 

Transducers can be moved to different angles so that different organs can be examined. 

The procedure is performed in a doctor’s office, an outpatient center, or a hospital by a certified technician, and the images are interpreted by a radiologist — a specialist in medical imaging — without the patient being anesthetized.

 To examine the prostate, most urologists use transrectal ultrasound. 

A transrectal ultrasound involves inserting a transducer slightly larger than a pen into a man’s rectum, next to the prostate. 

Ultrasound images show the size of the prostate and any abnormalities, such as tumors. 

Prostate cancer cannot be reliably diagnosed through transrectal ultrasound.

Biopsy

During a biopsy, a small piece of prostate tissue is taken and examined under a microscope. 

The biopsy is performed by a urologist at an outpatient center or a hospital. 

In most cases, a urologist will give the patient light sedation and local anesthetic; however, in some cases, the patient will need general anesthesia. 

To guide the biopsy needle into the prostate, urologists use imaging techniques such as ultrasound, computerized tomography, or magnetic resonance imaging. 

In a lab, a pathologist examines the prostate tissue to diagnose the disease. The test can identify prostate cancer.

Urologic Cancer Care

The male and female urinary systems, and the male reproductive system, are all affected by urologic cancers.

There are several types of urologic cancer, including those of the kidney, bladder, renal pelvis, penis, testicles, and urethra.

Urologic cancers can be caused by environmental, lifestyle, genetic and other factors. 

Detection and treatment methods for urologic cancers have improved over the years, and patients are now offered a wide range of options to meet their needs.

Bladder Cancer

Muscles in the pelvis store urine produced by the kidneys in the bladder. 

Nearly 75,000 Americans each year are diagnosed with bladder cancer, the fourth most common cancer in men and the eighth most common cancer in women. 

About two-thirds of bladder cancer patients are over the age of 65. 

Several layers of tissue make up the bladder, but most cancers begin in the urothelial cells on the inside of the bladder. 

Cancers that begin in the bladder are less common, but they can also occur.

Kidney Cancer

There are two kidneys on either side of the backbone. 

The kidneys remove impurities as well as excess minerals, salt, and water from the blood. 

The kidneys also produce hormones that are important in controlling blood pressure and producing red blood cells. There are several types of kidney cancer, but the most common is renal cell carcinoma. Patients with von Hippel-Lindau syndrome are also at risk for developing kidney cancer.

Prostate Cancer

In the U.S., prostate cancer is the second most common cancer in men (after skin cancer). Prostate cancer is more likely to occur in men with a family history of the disease, who eat a high-fat diet and/or are older. More than 70 percent of prostate cancer cases are diagnosed in men older than 65.

Urethra Cancer

The urethra is the tube that empties urine from the bladder during urination. In women, it is a short tube that opens in front of the vagina. In men, the urethra is about eight inches long and passes through the prostate gland and penis. Urethral cancer is comparatively rare but can spread quickly to nearby lymph nodes and tissue.

Penile Cancer

Penile cancer is very rare, accounting for less than one percent of cancers in men. It’s also related to older age, as well as to human papillomavirus (HPV) infection, lack of circumcision and poor genital hygiene.

The rate of testicular cancer—which usually develops in younger men, between the ages 15 and 35—is on the rise.  Although in most cases it’s not clear what causes testicular cancer, other medical conditions can be risk factors, such as polycystic kidney disease for kidney cancer and chronic inflammation for bladder cancer. A small percentage of these cancers are inherited.

Symptoms

Most of the time, symptoms don’t occur until the cancer has become more advanced. Then, they depend on the type of cancer. Blood in the urine (without pain) is a symptom of bladder, kidney and prostate cancer—at later stages, pelvic and back pain can also develop. Patients with prostate cancer may also have other changes in urination and sexual function. Those with testicular or penile cancer may notice a visible lesion on the skin, along with other skin changes or swelling. Any cancer patient can experience weight loss and fatigue.

Treatment

Treatment for urologic cancer depends on several factors, such as the tumor’s grade and stage (indicating how advanced the cancer has become) and the patient’s preference. Common options include surgery, chemotherapy and radiation therapy. Patients can also receive immunotherapy, which boosts the immune system to fight disease.

Urologic Diseases

Urinary Tract Infections (UTIs)

A urinary tract infection (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra. 

Most infections involve the lower urinary tract — the bladder and the urethra.

Women are at greater risk of developing a UTI than are men. 

Infection limited to your bladder can be painful and annoying. 

However, serious consequences can occur if a UTI spreads to your kidneys.

Doctors typically treat urinary tract infections with antibiotics. 

But you can take steps to reduce your chances of getting a UTI in the first place.

When treated promptly and properly, lower urinary tract infections rarely lead to complications. 

But left untreated, a urinary tract infection can have serious consequences.

Risk

Some people are at higher risk of getting a UTI. 

UTIs are more common in females because their urethras are shorter and closer to the rectum. 

This makes it easier for bacteria to enter the urinary tract.

Treatment

Bacteria cause UTIs and antibiotics treat them. 

However, any time you take antibiotics, they can cause side effects. 

Side effects can include rash, dizziness, nausea, diarrhea, and yeast infections. 

More serious side effects can include antibiotic-resistant infections or C. diff infection, which causes diarrhea that can lead to severe colon damage and death. 

Call your healthcare professional if you develop any side effects while taking your antibiotic.

Drink plenty of water or other fluids. 

Your healthcare professional might also recommend medicine to help lessen the pain or discomfort. 

Talk with your healthcare professional if you have any questions about your antibiotics.

People with frequent UTIs are occasionally given low-dose antibiotics for a period of time to prevent the infection from coming back. 

This cautious approach to treating frequent UTIs is because your body can develop a resistance to the antibiotic and you can get other types of infections, such as C. diff colitis. 

This practice is used very infrequently.

Urinary tract infections (UTIs) typically respond very well to treatment. 

A UTI can be uncomfortable before you start treatment, but once your healthcare provider identifies the type of bacteria and prescribes the right antibiotic medication, your symptoms should improve quickly. 

It’s important to keep taking your medication for the entire amount of time your healthcare provider prescribed. 

If you have frequent UTIs or if your symptoms aren’t improving, your provider may test to see if it’s an antibiotic-resistant infection. 

These are more complicated infections to treat and may require intravenous antibiotics (through an IV) or alternative treatments.

Sometimes other illnesses, such as sexually transmitted diseases, have symptoms similar to UTIs. 

Your healthcare professional can determine if a UTI or different illness is causing your symptoms and determine the best treatment.

If you get frequent urinary tract infections, your healthcare provider may do tests to check for other health problems — such as diabetes or an abnormal urinary system—that may be contributing to your infections. 

Not all urinary tract infections become bladder infections. 

Preventing the spread of the infection is one of the most important reasons to treat a UTI quickly when you have symptoms. 

The infection can spread not only to the bladder, but also into your kidneys, which is a more complicated type of infection than a UTI.

A urinary tract infection causes the lining of the urinary tract to become red and irritated (inflammation).

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia—also called BPH—is a condition in men in which the prostate gland is enlarged and not cancerous. 

Benign prostatic hyperplasia is also called benign prostatic hypertrophy or benign prostatic obstruction.

The prostate goes through two main growth periods as a man ages. 

The first occurs early in puberty, when the prostate doubles in size. 

The second phase of growth begins around age 25 and continues during most of a man’s life. 

Benign prostatic hyperplasia often occurs with the second growth phase.

As the prostate enlarges, the gland presses against and pinches the urethra. 

The bladder wall becomes thicker. 

Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. 

The narrowing of the urethra and urinary retention—the inability to empty the bladder completely—cause many of the problems associated with benign prostatic hyperplasia.

The size of the prostate does not always determine the severity of the blockage or symptoms. 

Some men with greatly enlarged prostates have little blockage and few symptoms, while other men who have minimally enlarged prostates have greater blockage and more symptoms. 

Less than half of all men with benign prostatic hyperplasia have lower urinary tract symptoms.

Sometimes men may not know they have a blockage until they cannot urinate. 

This condition, called acute urinary retention, can result from taking over-the-counter cold or allergy medications that contain decongestants, such as pseudoephedrine and oxymetazoline. 

A potential side effect of these medications may prevent the bladder neck from relaxing and releasing urine. 

Medications that contain antihistamines, such as diphenhydramine, can weaken the contraction of bladder muscles and cause urinary retention, difficulty urinating, and painful urination. 

When men have partial urethra blockage, urinary retention also can occur as a result of alcohol consumption, cold temperatures, or a long period of inactivity.

Most men with benign prostatic hyperplasia do not develop these complications. 

However, kidney damage in particular can be a serious health threat when it occurs.

A person may have urinary symptoms unrelated to benign prostatic hyperplasia that are caused by bladder problems, UTIs, or prostatitis—inflammation of the prostate. 

Symptoms of benign prostatic hyperplasia can also signal more serious conditions, including prostate cancer.

Urinary Incontinence

A person with urinary incontinence leaks urine by accident. 

Urinary incontinence may affect anyone, but it is most common in older women. 

The condition can usually be controlled or cured. 

Speak to your healthcare provider for more information.

Urine is stored in the bladder. 

Urination occurs when muscles in the bladder tighten to move urine into a tube called the urethra. 

The muscles around the urethra relax at the same time and allow the urine to exit the body. 

When the muscles in and around the bladder don’t work correctly, urine can leak. 

Incontinence usually occurs when the muscles relax suddenly.

Incontinence can occur for a variety of reasons. 

A urinary tract infection, vaginal infection or irritation, or constipation, are just a few examples. 

Some medicines can cause temporary problems with bladder control.

The first step to treating incontinence is to consult a doctor. 

Your doctor will examine you physically and ask about your medical history. 

Your doctor will ask about your symptoms and the medicines you take. 

You should tell him or her if you have recently been ill or undergone surgery. 

Your doctor may also order a number of tests.

You might also be asked to keep a daily diary of when you urinate and when you leak urine. 

You may also be referred to a urologist, a doctor who specializes in urinary tract problems.

Kidney Stones

Stones in the kidneys (also known as renal calculi, nephrolithiasis, or urolithiasis) are deposits made of minerals and salts.

Among the many causes of kidney stones are diet, excess body weight, medical conditions, and some supplements and medications. 

Any part of your urinary tract can be affected by kidney stones – from your kidneys to your bladder. 

Urine crystallizes when it becomes concentrated, allowing minerals to stick together and form stones.

Although passing kidney stones can be painful, the stones usually don’t cause permanent damage if they are recognized and treated in a timely manner.

In some cases, passing a kidney stone can be accomplished by taking pain medication and drinking lots of water.

Surgery may be necessary in other cases, such as when stones lodge in the urinary tract, are associated with an infection, or cause complications.

If you have an increased risk of recurrent kidney stones, your doctor may suggest a preventive treatment.

Urology Frequently Asked Questions

An urologist is a medical doctor who specializes in conditions that affect the urinary tract in men, women and children, as well as diseases that affect the reproductive system. 

They can treat a wide variety of problems, from too much or too little peeing to being unable to father a child.

Infections of the urinary tract, kidney stones, bladder control problems, and prostate problems are among the many urinary diseases and conditions. 

Some urologic diseases are short-lived, while others last for a long time.

The four most common sites where cancer occurs are the prostate, urinary bladder, kidney or renal pelvis, and testis. 

There are also sites in the penis, ureter, and urethra. 

The most common urologic cancer in men of all races and ethnicities is prostate cancer.

Cancer of the urinary tract and the male reproductive tract is caused by abnormal cell growth. 

An urologic cancer can affect the kidneys, ureter, bladder, urethra, and, in men, the penis, prostate, and testicles.

Urologists treat bladder problems, urinary tract infections (UTIs), bladder and kidney cancer, kidney blockages, and kidney stones. 

Men may also seek treatment for erectile dysfunction (ED).