Q&A: What does a urologist actually do?

Interview with Dr Phillip Katelaris, urologist.

As a urologist for almost 30 years, I’ve realised that until someone actually needs one, most people don’t know exactly what we do. It’s the same I suppose for a majority of other specialist roles, such as an ophthalmologist (not to be confused with an optometrist!) or an endocrinologist (a physician who specialises in treating disorders of the endocrine system).

To quell any doubt, in this article I’ll go into detail about what a qualified urologist, like me, can actually help you with.

What is a urologist?

Simply put, we are surgical specialists who treat people for problems and diseases of the urinary tract and male reproductive system. Some of the organs we look after include the kidney, prostate, bladder, urethra, testes, penis and associated glands.

If you are having any issues related to the above areas then a urologist can help by discussing the problem, examining you, investigating and reaching an accurate diagnosis. Although there is a common misconception that we only treat men, urologists actually treat men, women and children.

Our main responsibilities include planning and undertaking surgery, using various methodologies to treat problems and prescribing medications.

To become a urologist, we first have to become a qualified doctor before specialising. This means that as well as in-depth skills and knowledge in urology, we also have broad, general medical knowledge.

Some urologists treat general diseases of the urinary tract while others specialise in the following areas:

• Male infertility – focusing on problems that prevent a man from conceiving children.
• Female urology – focusing on conditions of a woman’s reproductive and urinary tract.
• Neurourology – focusing on urinary problems caused by conditions of the nervous system.
• Urologic oncology – focusing on cancers of the urinary tract, including kidneys, bladder, prostate and testicles.
• Paediatric urology – focusing on urinary problems in children.

Conditions we treat

We have expertise in the medical and surgical management of conditions such as kidney, bladder and prostate cancer, kidney stones, incontinence, infection, pelvic floor problems, sexual dysfunction and traumatic injury to the urinary tract. We can also perform vasectomies and kidney transplants.

In children, urologists treat the following conditions:

• Undescended testes – where one or both of the testes have not descended into the scrotum at birth;
• Bladder exstrophy – where the skin over the bottom part of the stomach doesn’t form properly leaving the bladder open and exposed;
• Hypospadias – where the meatus, which is where urine exits from the urethra, is located on the underside of the penis instead of the tip;
• Epispadias – where the urethra and bladder do not form normally and the pelvic bones don’t sit together.

Signs or symptoms that must be seen by a urologist

A urologist can offer comprehensive consultative, diagnostic and treatment services in a range of areas but below are some examples of symptoms that must be seen by a urologist.

Male fertility

Any aspect of male fertility should be referred to a urologist as a small percentage of male infertility is caused by testicular cancer. Testicular cancer can be life-threatening but early diagnosis significantly increases the chance of survival and the signs can often be missed by primary care and fertility doctors.

Blood in urine

The presence of blood in urine can be caused by a number of different conditions, and while some are not serious and often resolve themselves, blood in urine can be a symptom of a urinary tract infection or more a more serious disorder such as kidney disease or cancer. As a result, this should never be ignored and should be checked out by a urologist.

Bladder control problems or pain

Another name for this is urinary incontinence and it is a common problem among women. A urologist can work out treatment options, including exercises to strengthen the pelvic muscles, medication, implanted devices and surgery.

If you are finding it painful to urinate, it could be a sign there is an infection in the urinary tract caused by bacteria. Urologists can determine the cause of the infection and recommend treatment options.

Erectile dysfunction

Erectile dysfunction, where the penis is unable to reach sufficient rigidity to participate in sexual intercourse, can be a symptom of an underlying condition and bigger health issue. Men can sometimes avoid coming to see us if they perceive a health issue to be embarrassing, but it is important to remember that we’re friendly, approachable professionals who you can trust.

What to expect during your visit

To see a urologist you will need a referral from your GP to ensure that we are the appropriate person for your condition, so if you have any urinary tract or male reproductive issues ask your GP about how to book an appointment.

We will have been given notes from the doctor who referred you, but we will still ask questions about your symptoms and medical history.

Depending on your symptoms and what we think is necessary for your individual situation, we may perform the following tests and examinations:

• CT or MRI scan;
• Ultrasound;
• Cystoscopy – which is a long thin probe with a camera on it that allows us to see inside the urinary tract;
• Urine specimen;
• Biopsy;
• Physical examination;
• X-ray;
• Urodynamic test – which is a study to assess how the bladder and urethra are performing their job.

This will allow us to diagnose your issue and then we will be able to suggest treatment options. Again, treatments will depend on your individual condition but could include:

• Antibiotics;
• Hormone treatment;
• Active surveillance;
• Chemotherapy;
• Surgery.

Urologists will discuss these specific procedures with you to help you visualise the results and explain any risks.

Urinary tract and male reproductive health are sensitive issues and as urologists, we know this. We’re compassionate and we understand the embarrassment that may come with a visit to our office. So don’t hesitate to get help from your urologist and always seek professional medical advice for all urology-related issues. The sooner you come and see us, the sooner we can help get your life back to normal.

About Dr Phillip Katelaris

Dr Phillip Katelaris is a urologist in Sydney with over 25 years’ experience in urological practice and surgery.