Until a few years ago, 27-year-old Valerie*, a third-grade teacher from New York, had never thought about her urologic health. "I didn't see urology as something that affected me," she said. "Then suddenly, it became a huge part of my life."
Valerie* was one month into her first year of teaching when she started feeling strong bursts of pelvic pain. In addition to the pain, she felt a strong "gotta go" feeling. She felt this urge to urinate all the time. "It was terrible," she remembered. "The pain was too much to handle. I had an urge to urinate all the time, even right after I left the bathroom. That's very hard to deal with if you're a third-grade teacher. You're with the kids almost all day long; going to the bathroom all the time is not an option," Valerie explained. "Not to mention dealing with the pain while trying to keep up with the kids. Third-graders are pretty active, so that's not easy to do."
The pain, pressure and urinary frequency became so bad that Valerie had to stay home from work. She went to her primary care doctor, who told her she had a urinary tract infection (UTI). A UTI is a bacterial infection in the urinary tract. UTIs are fairly common, affecting about 40 percent of women and 12 percent of men.
"I was amazed!" said Valerie. "I thought urologists only treated men. Then I found out that, not only do urologists treat men, women and children, but some urologists focus on treating women specifically."
Her primary care doctor prescribed antibiotics, the standard treatment for a UTI. "At first it seemed to help, but soon the pain and frequency came back," explained Valerie. "I went to my primary care doctor a few more times. Each time he gave me another prescription for antibiotics," she said. "But then it did not seem to be working. I started to think that this was not just a UTI."
By that point, it was time for Valerie's yearly gynecologist visit. Since she was feeling pelvic pain, she hoped her gynecologist would be able to help. "I figured gynecologists just treated everything in that area," she admitted. What Valerie's gynecologist said during Valerie's office visit surprised her. "He told me he could prescribe antibiotics to treat a UTI just like my primary care doctor did," she explained. "But he said if I really wanted to get to the root of the problem and find out why I kept feeling these symptoms, it was best to see a urologist."
Valerie's gynecologist referred her to a urologist named Dr. Goldberg. She specializes in what's known as "female urology," mainly treating women with bladder prolapse, painful bladder, UTIs, overactive bladder and stress urinary incontinence. "I was amazed!" said Valerie. "I thought urologists only treated men. Then I found out that, not only do urologists treat men, women and children, but some urologists focus on treating women specifically."
Dr. Goldberg tested Valerie's urine and performed an exam. She also looked inside Valerie's bladder with a tool urologists use called a cystoscope. "When my tests came back, Dr. Goldberg told me that I did not have a UTI," Valerie said. Inside Valerie's bladder, Dr. Goldberg saw inflammation (swelling) and ulcers in the bladder wall. Her urologist diagnosed Valerie with a condition called interstitial cystitis (IC), also known as painful bladder.
IC is often mistaken for a UTI because the symptoms are similar but usually more severe. While a UTI can be treated with antibiotics, IC is a chronic condition that is treated differently. Treatment for IC involves trying different ways to reduce inflammation in the bladder. Some drugs may help, as well as avoiding certain "bladder-irritating" foods, including spicy foods, chocolate, alcohol and caffeine. Different foods may make IC worse for different people. "Dr. Goldberg helped me figure out what worked best for me," said Valerie. "She taught me to remove all of these foods from my diet, and then slowly add them back in, one by one. I learned I could still have chocolate!" Valerie exclaimed. "I was pretty happy about that. And I'm glad working with Dr. Goldberg has helped me keep my symptoms under control, finally! I [have come] a long way since I first went to see my primary care doctor about my symptoms. I only wish I had gone to a urologist sooner!"
Like Valerie, many people are surprised to find that urology covers a wide range of conditions. Urologists treat diseases and conditions in the kidneys, bladder, urinary tract and male reproductive system. Urology impacts men and women in all stages of life, from infancy to old age. Dr. Robert Weiss, AUA member and urology program director at Robert Wood Johnson Medical School, said that was exactly why he became a urologist:
"Urology is very interesting because we cover such a variety of topics. We treat cancers like bladder, kidney and prostate cancers; bladder conditions like interstitial cystitis, bladder prolapse (fallen bladder); issues of urine leakage such as stress urinary incontinence and overactive bladder; kidney stones; bedwetting and abnormalities in children's urinary tracts; erectile dysfunction; and much more. And we are surgeons. We enjoy the challenge of surgery. But we can also get to know our patients in a clinical setting. You don't just do the surgery and then never see the patient again. We get to develop relationships with our patients. It's really a unique field."
When should I see a urologist instead of a primary care doctor or other specialist?
Urologists are best trained to treat any condition involving the urinary tract and the male reproductive system. Other healthcare professionals may be involved in your care-a urologist may work with an oncologist to treat prostate cancer, or with a gynecologist to treat pelvic pain in women. However, if you have a urologic condition, the urologist will be at the head of your medical team.
Sometimes a patient will be referred to a urologist by another health care professional, as Valerie was. But often people go straight to a urologist for treatment. Your primary care doctor may be able to treat some minor urologic issues. However, if your symptoms do not go away-like in Valerie's case-it is best to see a urologist and get to the root of the problem. If you know your symptoms or condition involve the urinary tract or male reproductive system, you may choose to see a urologist as your first step. To find a urologist in your area and even narrow your search by type of urologic condition, visit UrologyHealth.org/FindAUrologist.
What should I expect when visiting the urologist?
Urology offers patients a wide range of treatment choices, letting patients work with their urologists to find the best solution for them. Surgery may be the best choice for some people. Drugs or behavioral therapy (such as bladder re-training) may work better for others. Some people may improve most using a mix of two or three treatments. You and your urologist can work together as a team to address your own needs. As AUA member urologist and the Urology Care Foundation's Overactive Bladder Expert Panel member Dr. Lisa Hawes explained, "the wealth of choice in urology allows us to truly personalize treatment for each patient.
What training does my urologist have?
As with all doctors, urologists must complete an undergraduate degree and four years of medical school. But did you know the training doesn't stop there? After medical school, a urologist will have five or six more years of training called residency. Residency programs may include one or two years of surgical training. After that, there may be three or four years of clinical training in urology. (In clinical training, residents follow a patient from their first visit to the urologist through to the end of their treatment). All urologists will have both surgical and clinical training. Next, some urologists may choose to do one or two more years of training called a fellowship. Fellowships allow doctors to focus on a specific branch of urology, such as urologic oncology (cancer), female urology, pediatric urology, male infertility, sexual health and erectile dysfunction, or kidney stones. Urologists must also pass a licensing exam, and be board-certified by the American Board of Urology.
Even licensed and board-certified urologists are constantly learning and improving their skills. To keep their licenses and stay up to date in the latest knowledge, urologists are required to take education courses each year. "We are always learning," Dr. Weiss explained. "Throughout my career we have seen many improvements in diagnosis, treatment and technique. So our success rates get better and better. We keep advancing and every day there's something new!"