To treat or investigate diseases such as urinary tract infections, infertility, sexual impotence, prostate cancer , premature ejaculation and other pathologies, you can request, perform or guide the patient through different tests and procedures.
Among the most common are prostate exam and vasectomy, in addition to performing surgical procedures, such as tumor removal.
To consult in this specialty, the patient can look in public hospitals (SUS), private clinics and also in specialized urology centers.
Urinary system and male reproductive system
Knowing what urology is and what the urologist does, it is interesting to understand a little about the urinary tract (male and female) and the male reproductive system:
The urinary system has a fundamental role in the human body, filtering and eliminating substances that the body no longer needs, being responsible for producing, storing and eliminating urine.
The following are part of the urinary tract:
- Kidneys : filter the blood to select useful substances (water, glucose and minerals) and return them to the bloodstream. They also separate the substances that will be eliminated, that is, a quantity of water, urea, ammonia, uric acid and residues, which form the urine;
- Ureters : are two channels (tubes) that transfer the urine produced in the kidneys to the bladder;
- Bladder : it is an elastic organ, as if it were a pouch, that stores the urine that reaches through the ureters;
- Urethra : is the channel through which urine is eliminated from the body.
The main difference between the female and male urinary systems is that the urethra of men is larger than that of women.
In general, the channel measures approximately 20 cm in them and 5 cm in them. Along with the proximity of the vagina to the anus, the shorter urethra are factors that favor the occurrence of urinary infections, because when infectious agents invade the region, the route to the bladder, for example, is much shorter.
As for the male reproductive system, which is also a specialty of the urologist, the organs that comprise it are:
- Penis : the organ that eliminates urine from the body and expels sperm;
- Testicles : are the sexual gonads (glands) of men, which have the function of producing the hormone testosterone and sperm;
- Prostate : it is a gland responsible for producing and storing a fluid that, together with sperm, forms semen.
What does the urologist take care of?
The urologist is the doctor who takes care of the diagnosis, prevention and treatment of any health condition linked to the urinary system of both sexes and the male reproductive system.
Thus, it is responsible for verifying the functionality of organs and other structures, such as the kidneys, urethra, bladder, prostate, penis, the duct that collects and stores sperm, adrenal glands and epididymis (tube responsible for bringing urine from the bladder to outside the body).
Read more: Vasectomy (surgery): what is it, price, reversion, by SUS, can it fail?
The conditions that the urologist treats can be divided according to the age and sex of the patient, as follows:
During childhood, the main conditions that the urologist treats are obstruction or blockage of the urinary tract, testicles that have not descended and urinary changes, such as urination at night (enuresis).
Read more: The penis grows up to what age? What is the average penis size?
In women, the urologist can help diagnose conditions such as low bladder (bladder prolapse), kidney stones, cystitis , overactive bladder, urinary incontinence and tumors in the bladder, kidneys or adrenal glands.
During menopause , pregnancy or with aging, consultations may be more frequent, due to the greater risk of problems in the urinary tract.
The urologist, with regard to men’s health, contributes in many ways, from the diagnosis of problems such as cancer of the prostate, kidney dysfunction, tumors, erectile dysfunction, premature ejaculation, infertility and urinary infections.
In adulthood and aging, men must maintain a regular routine of consultations like this specialist, in order to carry out preventive exams.
When to see a urologist?
Whenever there is a health problem related to the urinary tract in both sexes or the reproductive system of men, the urologist can be contacted. But, depending on the condition of the patient, treatment can be done by a specialist in another area or in conjunction with the urologist.
In cases of urinary infections, the patient can receive treatment and diagnosis through a general practitioner or, in the case of women, by a gynecologist.
In these cases, in the event of complications or persistence of the problem, the patient can be referred to the urologist, as this is the doctor who specializes in treatment.
Patients diagnosed with prostate cancer, for example, can be treated jointly by oncologists and urologists.
But, to get a sense of when to see the urologist, it is important to pay attention to some symptoms that are valid for men and women:
- Presence of blood in the urine;
- Change in the color of urine;
- Difficulty urinating;
- Excessive or urgent need to urinate;
- Pain or burning when urinating;
- Pain in the pelvis or back;
- Very weak urine flow.
Related to the male reproductive system, some indications that it is time to see a urologist are:
- Reduced libido;
- Lumps in the testicles;
- Difficulty in having or maintaining an erection;
- Premature ejaculation.
The list of diseases diagnosed and treated by the urologist is quite extensive, as it is a medical specialty that is present in the monitoring of patients at different stages of life, both for men and women.
Below, we list the main conditions that lead patients to this specialist’s office:
Urinary tract infection or Urinary Tract Infection (UTI) is an infectious process caused by bacteria that invade any of the structures of the urinary system, be it bladder, urethra, kidneys or ureters.
There are several factors that can cause a urinary infection, such as poor hygiene, low water intake, holding urine, staying for a long time with the absorbent and inappropriate use of products that affect vaginal pH (such as intimate soaps or medications).
Also called urethral stenosis, urological obstruction is characterized by a blockage in some part of the urinary system, making it difficult or preventing the patient from urinating.
The condition is much more common in men, although it can occur in women. In them, the condition is more frequent as a result of aging, due to hyperplasia of the prostate (which is a swelling of the region).
In addition to the difficulty in releasing urine, there may be severe pain, dilation of the bladder and greater ease in contracting infections due to the accumulation of urine in the bladder.
Phimosis is a condition in which the skin of the foreskin (skin that covers the penis) narrows, preventing the glans of the penis from being fully exposed during an erection.
Despite being more common during childhood and regressing according to the child’s growth, phimosis can also affect adults.
In such cases, it is possible that the patient has to use ointments or undergo surgery, as it is a condition that can cause pain, cracks and hinder hygiene.
Also known as kidney stones, this is a condition characterized by the formation of kidney stones. The biggest cause is the excessive absorption of minerals by the intestine, which ends up overloading the kidneys.
From this happens the formation of solid masses (pebbles) that are concentrated in the urine. Because it is difficult to pass these crystals through the urinary tract, the condition can cause a lot of pain in the patient, especially in the lateral region of the abdomen.
To help with treatment, it is important for the patient to drink plenty of water. In more severe cases, surgery may be necessary to remove the stones.
In this condition, the patient has no control over urination and ends up suffering involuntary leakage of urine. Incontinence is more common in pregnant women and menopause, however, it is not a disease exclusive to women.
Read more: Find out what menopause is and understand its stages
Men can also suffer from urinary dysfunction, being more common when they also have some alteration in the prostate. In the case of children, involuntary urination is more related to psychological factors or dysfunctions in the nerves that control the bladder.
Prostate cancer is caused by the presence of a tumor in the region. It is an often asymptomatic condition, so it needs more frequent monitoring for prevention.
Patients with this diagnosis may need radiotherapy, hormonal therapy, chemotherapy or undergo surgical procedures, which can be done with the monitoring of the oncology urologist.
Male sexual impotence
Sexual impotence in men, also called erectile dysfunction , is the condition in which it is difficult to maintain or have an erection, which ends up harming your sex life.
It can be caused by different factors, which can be a physical or even a psychological issue, such as low self-esteem , relationship problems and stress .
As it deals with the male reproductive system, the urologist is not the doctor responsible for caring for cases of impotence or low female libido, which are usually treated by the gynecologist.
The urologist also helps in the diagnosis and treatment of male infertility, which can be caused by low number of sperm, poor mobility, lack of production, vasectomy, difficulty having sex (impotence) or STDs.
The search for a urologist in relation to premature ejaculation should happen when it is frequent during sexual intercourse, not being a cause for concern when it occurs sporadically.
The cause of premature ejaculation, however, is still uncertain. But the associated factors point out that this is a condition linked to anxiety , erectile dysfunction, emotional problems and medication use.
The varicocele is an inflammation that occurs in the testes, characterized by enlargement of the veins in the scrotal area.
Usually, it has no noticeable symptoms, but it can interfere with the production of sperm or the quality of sperm. Thus, it interferes with male fertility.
How does the query work?
In the first consultation with the urologist, the doctor usually conducts an interview with the patient to better understand his problems and for an accurate diagnosis. This interview (anamnesis) helps the specialist to better understand the symptoms and to understand which tests are necessary to order.
Therefore, you can ask the patient about his sexual life, family history of diseases, comorbidities, use of medicines and drugs, and eating habits.
In addition, you should ask about urinary habits, such as how many times a day you feel the need to urinate or if you notice a variation in smell, color or pain during urination.
From the answers, the doctor can do a physical exam or order laboratory tests and images for diagnosis.
In order to act as a urologist, it is necessary to take a bachelor’s degree in medicine, in institutions that must be recognized by the Ministry of Education (MEC).
The course lasts for 6 years full-time and has a grid with subjects such as genetics, biochemistry, medical biophysics, immunology, medical clinic and surgery, for example.
After completing the course of medicine, you must undergo residency in general surgery, lasting 2 years, and only afterwards specializing in urology, lasting 3 years.
In the specialization, this professional will have contact with disciplines such as:
- Urogenital anatomy;
- Sexually Transmitted Diseases;
- Female urology;
- Clinical urology;
- Urological surgical practice.
Urologist doctor: what are the areas of expertise?
The urologist can choose between two areas of expertise within the field of work, namely clinical and hospital urology.
The urologist who works in a clinic may choose to have a private practice or to work together with other professionals in the field in a clinic, for example.
The focus is on consultations and assistance that, in general, do not characterize emergencies, accompanying the patient in the long term.
Both the private system (private or health plans) and the public (SUS) have specialist professionals, according to the availability of each location.
The hospital urologist, in general, provides care in a multidisciplinary way, involving specialists from different areas.
Although it is possible to carry out routine consultations, it is usually the emergency or emergency care cases that are most associated with hospital practices, always preserving the integrity and assistance to the patient.
Within urology, the urologist can choose between different specializations, contributing more specifically to treatments and diagnoses in the following sub-areas:
Also treated by uro-oncology, this subspecialty represents the area in which treatment, surgical procedures and monitoring of cases of tumors in the male or urinary genital region of both sexes are carried out.
The doctor who chooses this area of activity is usually responsible for screening different types of cancer, such as prostate, penis, bladder, testis and kidney.
It is the area of urology responsible for dealing with endoscopic procedures, made for the diagnosis of problems in the urinary tract, being a minimally invasive way to investigate possible complications.
It is done with the use of a thin device and with a camera together, which makes it possible to insert it into the orifices of the body for a better view of the bladder, prostate, ureter, urethra and interior of the kidneys, for example.
For having a easier recovery, less painful and with faster results, this procedure is widely used.
Usually, patients seek this type of specialist when they have a condition that is causing abnormal urination related to neurological diseases.
People who suffer from multiple sclerosis, Parkinson’s disease, who have suffered a stroke or spinal cord injury can develop urinary problems, such as incontinence, urinary retention and an overactive bladder.
Pediatric urology is the subspecialty responsible for treating diseases and conditions related to the urinary system of children and adolescents.
Usually, there are disorders such as nocturnal enuresis (excessive frequency of urine at night), ambiguous genitalia, hereditary abnormalities in the genitourinary tract and other dysfunctions.
Reconstructive urology is the subspecialty that deepens in the treatment of patients who have suffered some trauma that may require restoration of urinary and genital function or structure.
These reconstructions are possible through the use of knowledge of different techniques and specialties, such as urology itself, plastic surgery, gynecology and digestive surgery.
Patients who have suffered more serious accidents and who have had injuries in the region may need to consult with this specialist.
By returning functionality and aesthetics to the tissues and organs of the urinary or genital tract, this type of treatment helps to improve the quality of life of patients.
Female urology is the subspecialty that focuses on the treatment of urinary tract problems in women. The main assisted conditions are urinary tract infection, overactive bladder, low bladder and incontinence (most common in pregnancy and menopause).
It is also possible to find specialists in this area who call themselves urogynecologists. The union of these specialties arises from the interest of gynecologists and urologists to delve into the female urinary system, especially in the functioning of the pelvic floor.
However, it is not a specialty recognized by the Regional Council of Medicine, it is just an area that involves knowledge and performance within urology and gynecology.
Procedures and exams
There are several tests and urological procedures that can be performed, such as:
Vasectomy is one of the best known procedures performed by the urologist. It is a permanent sterilization technique for men who decide not to have children in the future.
The ligament made in the man’s different ducts, channels through which sperm pass, prevents them from moving to the outlet channel (urethra) and therefore there is no risk of pregnancy.
The digital rectal exam , or prostate exam , is a procedure done for the prevention and diagnosis of prostate cancer or benign prostatic hyperplasia (enlargement of the organ usually due to aging).
The doctor, to examine the region, inserts the index finger into the patient’s anus, using a new disposable glove, properly lubricated.
It is a simple, painless and quick exam, and can last from 15 seconds to 2 minutes. In that time, the urologist assesses the size, shape and density of the prostate, looking for lumps, soft or hard spots.
It is an examination done with a fine endoscopy device called a cystoscope. It allows visualization of the interior of the urethra and bladder to investigate possible diseases in the region. It is a procedure that does not require hospitalization, and can be done with the use of local or general anesthesia.
In order to better visualize the organs and tissues of the urinary tract, the urologist may request the performance of imaging tests such as magnetic resonance, ultrasound and computed tomography.
Postectomy is a surgery performed to remove the foreskin, excess skin that is on the penis glans (phimosis). It is usually recommended for men who experience pain during intercourse.
It is an examination done through the use of x-rays to analyze the urethra and the bladder. It is performed to assess changes in the function and anatomy of these structures that may cause some disease or symptom.
The patient must empty the bladder so that it can receive the contrast, a liquid that facilitates the performance of the cystography. Then, anesthesia is used (usually in the form of a gel applied to the examination site) and a catheter is inserted into the patient’s urethra.
During the examination, the doctor must insert a catheter via the urethra to inject the contrast fluid into the bladder. In men, a lead shield is placed to avoid risks of radiation to the testicles.
That done, the doctor performs a series of radiographs, requesting that the patient change his position (from the back, from the side, from the front) in order to be able to view the urinary system more completely. After emptying the bladder, a last X-ray without the contrast is performed for comparison.
After the exam, there is no special care that needs to be done, just the intake of more water to completely eliminate the contrast, avoiding infections.
There are two types of bladder catheterization, delay and relief. The relief is done to completely and immediately empty the bladder in cases of temporary urinary retention.
In the procedure, a sterile catheter is placed in the urethra up to the bladder so that it can be emptied. In sequence, it is removed from the patient and discarded.
The bladder catheterization of delay is used when the catheter stays in the patient for longer, to perform a continuous drainage, and can be used before surgery, to reduce the contact of urine with skin lesions or for bladder irrigation (washing of the bladder mucosa ), for example.
Usually, it is a procedure done for removal of kidney stones, also used for treatment and diagnosis of various problems in the urinary tract.
It is done without incisions or cuts, in which a thin endoscope is introduced through the urethra to access the urinary tract structures less aggressively, with local or general anesthesia.
It is a surgical procedure in which a cut is made on the bridle (balano-prepucial frenulum), a strip of mucous skin that connects the glans to the foreskin.
When this brake is short, during an erection, it can cause a ventral curvature of the glans, which can cause pain, injuries and bleeding during sexual intercourse.
These lesions, even when small, can still increase the chances of inflammation and sexually transmitted diseases, such as HIV and HPV .
Frenuloplasty is, therefore, a treatment for this problem. The cut helps to release more skin. Thus, tension during erection decreases, as well as pain and other complications.
Salary: how much does a urologist earn?
The salary of the urologist can vary widely depending on the way he works, whether in a public, private hospital or in his own clinic. On average, the salary can be between R $ 6 and R $ 12 thousand per month, also varying according to the region where the professional works and the experience in the area.
Brazilian Society of Urology
Like other specialties, urology also has a society that represents it nationally, the Brazilian Society of Urology (SBU).
This is an institution responsible for organizing events, congresses, disseminating research and new guidelines on urology. Doctors in this specialty can actively participate in the SBU as members, taking courses and participating in events.
SBU’s history began in 1926, with the first meeting of Brazilian urologists and surgeons for the foundation of the society, which officially took place on May 13 of the same year and counted on the participation and help of political figures such as the former president Getúlio Vargas and Juscelino Kubitschek.
In 2006, Kubitschek, who was also an oncologist, received the title of patron in honor of the SBU.
How often do I go to the urologist?
Ideally, patients in general (men and women of any age) make an appointment each year with the urologist to prevent diseases in the reproductive and urinary system. For people who are undergoing treatment or who have some condition or health change, this frequency may be higher, according to each situation.
In the case of women, who normally have a routine consultation with the gynecologist, it may be necessary only in specific cases, such as urinary tract diseases.
What is the value of an appointment with a urologist?
The cost of an appointment with a gynecologist can vary, on average, between R $ 80 to R $ 120 reais, but they can also be made by the Unified Health System (SUS), free of charge, or by the health plans that cover the specialty.
What is the difference between urologist and nephrologist?
The nephrologist is the doctor who takes care of kidney-related diseases, but especially attends to conditions that do not need surgical intervention. The urologist, on the other hand, for having resided in surgery, assists and conducts the treatment of patients with kidney diseases that need surgery.
When should a woman go to the urologist?
It is recommended that you always see a urologist when you have any symptoms involving the urinary tract, such as pain when urinating, pain in the kidneys , sexually transmitted diseases or pain during sexual intercourse.
They should also seek this specialist in cases of urinary incontinence and especially in cases of urinary tract infection, a condition quite common in women.
Thus, making consultations once a year with the urologist would be ideal to ensure the health and functioning of the urinary system.