Why Do You Need to See a Urologist?

Most people do not decide to see a urologist. They are sent — by a GP, after a test result they did not expect, or a scan done for something else entirely.

‍ So the question I am actually asked is rarely "should I see a urologist". It is "is this worth bothering about". People arrive apologetic, half-convinced they are wasting my time.

‍Some of them are, in the sense that nothing is wrong and they can be reassured and sent home. That is a good outcome, not a wasted appointment. What concerns me more is the opposite: the man who noticed blood in his urine eight months ago, decided it was nothing because it did not happen again, and is only sitting in front of me now because it came back.

‍Urological symptoms are easy to explain away. They are private, they are often intermittent, and they are very easy to attribute to getting older. That combination is why urological cancers are still diagnosed later than they need to be.

‍This article is about which things warrant a look, and which can reasonably wait.

What I actually treat

Urology is a surgical specialty covering the urinary tract in men and women, and the male reproductive system. It is broad, and no urologist covers all of it.

‍My practice is focused on urological cancer surgery — prostate, kidney and bladder — along with kidney stones, benign prostate conditions and the investigation of blood in the urine. Most of my operating is robotic.

That focus matters when you are deciding who to see. A urologist who mainly does stones is not the right person for a complex renal mass, and the reverse is equally true. If your GP is unsure who to refer to, they are welcome to ring the rooms and ask.

The things I would not leave

‍Blood in the urine. This is the one I want people to take seriously. Visible blood in the urine is never normal, and it does not become normal because it happened only once, because it was painless, or because it cleared up on its own. Painless bleeding that stops by itself is a classic presentation of bladder cancer, and the fact that it settles is exactly what convinces people to ignore it.

‍Most people with blood in their urine do not have cancer. Infection and stones are far more common. But haematuria needs to be investigated rather than assumed, and that investigation is straightforward. What blood in the urine means and how it is worked up covers what to expect.

Blood detected only on a dipstick, with nothing visible, is a softer signal — but it still deserves a considered look rather than a repeat test and a shrug.

‍A mass found on a scan. Kidney masses are increasingly found by accident, on imaging ordered for back pain or abdominal symptoms. Any mass that enhances with contrast on CT needs urological review. This is not a wait-and-see finding, even when you feel completely well — and feeling completely well is the norm.

‍A PSA result that has changed. A single PSA figure means less than most people assume, and less than the internet suggests. What matters is the pattern, your age, your family history, and whether you take medication that affects the number. I have written about how to read a PSA result in detail, because it is the test that causes the most unnecessary alarm and the most misplaced reassurance.

‍If your GP has referred you after a PSA result, that is the right call. It does not mean anyone thinks you have cancer.

The things worth raising, without alarm

‍A weaker stream, hesitancy, getting up at night, a sense of not emptying properly. These are common as men get older and they are usually caused by benign prostate enlargement rather than anything sinister.

They are still worth mentioning, for two reasons. The first is that they are treatable, and a lot of men tolerate years of broken sleep and constant planning around toilets when they did not need to. The second is that the assessment sorts out whether it is the prostate at all.

‍Recurrent urinary infections in men are a different matter, and always warrant investigation. Repeated infection in a man is unusual enough that the question is what is causing it.

‍Severe one-sided pain from the flank around to the groin, often with nausea, is the classic presentation of a kidney stone. That usually announces itself in an emergency department rather than a clinic — but if you have had one, the conversation worth having is about preventing the next.

When it is already about cancer

‍ If you have been told a biopsy is positive, or a scan has shown something that needs surgery, you are in a different situation from everything above. The question is no longer whether to be seen but how quickly, and by whom.

‍Referral pathways for prostate, kidney and bladder cancer can be arranged urgently. If you or your GP are waiting on an appointment that feels too far away, ring the rooms — timeframes can usually be moved.

How referral works

In Australia you need a referral from a GP or another specialist to see a urologist and claim a Medicare rebate. A GP referral lasts twelve months; a specialist referral lasts three.

If you are unsure whether your symptom warrants a referral, ask your GP rather than deciding on your own. The threshold for asking is much lower than most people think, and GPs are welcome to discuss a case with me before referring if the picture is unclear. Details are on the referral page.

What happens once you are here

Knowing you should come is one thing. Knowing what the appointment involves is another, and it is the part people are quietly anxious about — particularly around examinations.

I have set out what a first appointment actually involves, including what is and is not examined and why, in what happens when you see a urologist.

The short version: most of a first appointment is conversation. Not every symptom leads to a test, and not every test leads to treatment. A good deal of urology is deciding what does not need doing.

About the author:

Dr Deanne Soares is a Melbourne urologist specialising in robotic prostate, kidney and bladder cancer surgery.