Urology is a specialty in medicine that deals with diseases of the male and female urinary tract (kidneys, ureters, bladder and urethra). It also deals with the male organs (penis, testes, scrotum, prostate, male reproductive organs) as well as certain conditions in the female organs (incontinence, prolapse).
The important components of a Urological Assessment are:
A detailed history of your current problems, your current health situation, past history of all medical problems, family history of medical problems, your social habits (smoking, drinking, profession), all your current medications and if you suffer from any allergies.
A detailed history is very important for your doctor to determine your urological problem, and what is the best way to manage it. Your past problems and all investigations, even if it were done many years ago, will also prove to be very useful.
A focused physical examination of diseases related to urinary tract system – which included the kidneys, ureters, and bladder. If you are having problems related to the penis or testicles, the examination will also include an examination of your genitalia as well.
Digital Rectal Exam (DRE)
This is an important part of your urological examination if it is related to a prostate problem.
This examination is performed to evaluate the prostate gland and look for enlargement or irregularities. Digital rectal examinations are done by inserting a lubricated, gloved finger into the rectum and evaluating the prostate.
At the same time, your doctor will examine if there are any lesions in your rectum, as well as assess the anal tone as part of the focused neurological examination.
Focused neurological examination
A focused neurological examination would be necessary when there is lower urinary tract symptoms (LUTS), namely urinary frequency and poor flow urine, suspected to be caused by a neurological cause, either due to involvement of the nerve roots or the spine. It is also usually required before a urodynamic study when there is a suspicion of bladder involvement due to a neurological cause.
The focused neurological assessment will consist of evaluating your sensations, power and reflexes of your lower abdomen and lower limbs relating to any neurological lesions affecting these regions of interest in Urology.
Pelvic examination is done for females.
During a pelvic examination, your doctor performs a visual and physical examination of your reproductive organs. During the examination, your doctor inspects the vagina with a gloved finger and a speculum usually lasting for a few minutes.
Your doctor will inspect and examine the condition of your vagina (for any lesions, infection or atrophy / thinning of the vaginal wall), assess for any vaginal prolapse (the uterus or any of the vaginal contents falling downwards when you cough or strain) or any lesions nearby affecting your urinary symptoms (urethral caruncle, Bartholin’s cyst, etc).
Your doctor will then assess the strength of your pelvic floor muscles when your cough or strain.
He will then assess for any urine leakage during coughing or straining, and will also note whether there is any urethral hypermobility or not.
Investigations will only be focused on the presenting complaint and the required investigations that may accompany this.
Investigations may include a urine microscopy test, portable ultrasound of your kidneys and bladder, residual urine volume after you pass urine and uroflowmetry when indicated.
Further investigations would include blood tests and radiological imaging which may include CT scan and MRI.
Common urological symptoms
The common urological symptoms include:
- Obstructive symptoms (poor flow urine)
- Irritative symptoms (urinary frequency)
- Dysuria (burning pain or discomfort on passing urine)
- Nocturia (getting up at night to pass urine)
- Urinary incontinence (leaking of urine)
- Renal and ureteric colic (pain due to passage of stone)
- Hematuria (blood in the urine)
- Hemospermia (blood in the semen / sperm ejaculate)
The investigations that will be required will differ, and will depend on your presenting symptoms.