What to expect at a urology appointment

A urology examination begins with a conversation, and this is often the most revealing part. The urologist is interested in details patients like to skip: how much fluid you drink during the day, how many times you get up at night, how strong the stream is, at what time of day the problems are worst and when they started. This is followed by a clinical examination guided by what you have said.

Often a urine test, an ultrasound of the urinary tract or a urine flow measurement is also done. A full bladder is useful for the ultrasound and flow measurement, so if possible do not pass urine before the examination and drink a glass or two of water. If a test cannot be done the same day, the doctor orders it and invites you back for a follow-up with the results.

The digital rectal examination of the prostate is the part with the worst reputation. In practice it takes a few seconds and is done lying on your side or bending forward, with a glove and lubricant, and the urologist assesses the size, firmness and shape of the prostate. It is unpleasant but not painful, and it is not a compulsory part of every examination. The urologist explains in advance when it makes sense.

PSA is a protein produced by the prostate. Its level can rise for several reasons: an enlarged prostate, inflammation, a recent procedure, cycling or sexual activity before the blood test. A raised result is a reason for further assessment but not a diagnosis, and a normal value does not rule out all prostate diseases. The trend of the value over time says more than a single measurement, so bring old results too. You decide on further steps, which may include imaging or a biopsy, together with the doctor, after they have explained what each step involves.

The reason for putting it off is almost always the same. Symptoms develop slowly, a weaker stream and getting up at night seem part of ageing, and the visit is postponed indefinitely. Some people fear that the examination will mean a diagnosis, so they would rather not know. For a urologist these problems are an everyday part of clinic work and talking about them is routine. The details that seem most unpleasant to you are often exactly the ones that guide the diagnosis.

Urology is not just the prostate and not just for men. The clinic deals with the urinary tract in both sexes – the kidneys, ureters, bladder and urethra – as well as kidney stones, recurring urinary tract infections, urinary incontinence, kidney cysts and questions about erectile dysfunction and fertility. Treatment includes procedures such as vasectomy and circumcision, for which there is a consultation first.

Some conditions should not wait for an appointment. Blood in the urine, even once and painless, is always a reason for an examination. With sudden severe pain in the lower back with fever and chills, inability to pass urine, or heavy bleeding from the urinary tract, seek emergency medical help or call 112.

Urology treatment at Medicinski center Ljubljana is self-pay and you do not need a referral. The clinic is run by two providers, and booking is with the provider that runs the clinic. Bring the reports of previous tests, especially past lab results and PSA values, and a list of your medicines.