15.08.2019 · 👁 1,911

I’m embarrassed to ask: 10 important questions for a urologist

Taking care of your health is a useful thing, but even in it there is a lot of room for embarrassment and harmful misconceptions. What problems should you go to a urologist for, and what, on the contrary, should you not be afraid of? Let's figure it out.

What symptoms should you go to a urologist for, and which ones should you not be afraid of?

One of the key signs for which you need to see a urologist is blood in the urine and blood in the ejaculate. This point cannot be ignored under any circumstances. Especially smokers, because smoking is a risk factor for lung cancer, bladder cancer, and, although to a lesser extent, prostate cancer.

Other signs are pain and discomfort in the testicles, pain in the perineum, unusual discharge from the urethra, pain in the lower back, especially if it appears on one side.

If the testicles or one of them changes in size, this is also a reason to see a doctor. But their different positions should not be alarming.

You need to monitor how urine is excreted - there should be no pain, and trips to the toilet should be an average of 6-8 times a day. If the stream is weak, urination is difficult, intermittent, incontinence appears, frequent night urges - all these are reasons to consult a doctor, although not all of them definitely mean that the person is sick.

Prostate adenoma is a death sentence and will it only get worse?

No, not at all. Most men, after 40–50 years of age, develop an adenoma to one degree or another, and by the age of 90, all of them do. But in only about a third of them it becomes a disease; for the rest it is, let’s say, a process of growing up. Adenoma is not a death sentence; most men do not even require treatment and observation is sufficient. For most people who do need to be treated, there are solutions for conservative treatment of this disease. And only 25-30% of this third may ultimately need surgery.

What common fears associated with urological diseases are unfounded?

Fear about the degeneration of an adenoma into cancer, for example, is unfounded - contrary to what unfair advertising sometimes tries to impose. “Have you been checked for hidden infections? Otherwise they will cause prostatitis, adenoma, and then cancer.” Not only is this not the case, this is precisely what becomes the cause of fear - a person decides not to go anywhere and not get checked, they say, what will happen will not be avoided, and this is precisely harmful to health.

Yes, it’s better not to get an STD, and yes, almost all men eventually develop an adenoma, but no, it does not turn into cancer. Men after 45–50 years of age do have a parallel risk of prostate cancer, but they are not related to each other, they even grow from different parts of the prostate gland.

There is also a fear of operations. All normal people are afraid of operations, this is a natural fear. But surgery is not always a scary, serious intervention and difficult recovery; sometimes a couple of days are enough for it. Here you always need to look for a middle ground, so as not to succumb to the provocations of doctors and not to do unnecessary manipulations, but also not to miss the moment, not to let the problem become difficult to solve or insoluble instead of performing a good, elegant operation, after which the person will forget about this problem. Now, for example, after surgery for an adenoma, a person spends one day in the hospital and returns to normal life.

Are there harmful myths associated with STDs?

Of course, for example, you can only become infected during sex. Some diseases can be contracted from a towel, from a toilet seat, and so on, that is, the sexual route cannot be called exclusive. Another thing is that the probability is, of course, lower, but it is there, especially if there are wounds, cracks, and so on. But there is no need to walk around and be afraid - basic hygiene, attentiveness and accuracy are enough.

There is another side to such myths - for example, that any contact is a 100% risk of getting sick. This is wrong. My favorite example is with gonorrhea: with a single unprotected contact with a sick woman, the probability of becoming infected is only 17%. This does not mean that it is worth the risk - it is always better to choose barrier methods of contraception if there is more than one partner.

Should you be afraid of prostate cancer and how often should you get checked?

We, urologists, oncologists and epidemiologists, constantly fight with each other on this issue. There is a blood test for PSA - this is a tumor marker for prostate cancer. Oncologists say that everyone shouldn’t do this all the time. They conducted research that you need to look at the results of 1000 people in order to detect cancer in one. It turns out that the rest of the people took the blood test in vain.

There is another side: there is clinically insignificant prostate cancer. For example, an 80-year-old person with strokes and heart attacks. We will find markers of slowly growing prostate cancer in him, which will only become a disease in about 15 years. And we will start “chasing” him through a blood test, then a prostate biopsy, then prescribe treatment - we will only harm him. This is a question of patient selection - who needs it and who doesn’t.

In Scandinavia, where rates of prostate cancer are highest, PSA screening has been proposed between 40–45 years of age in men. If the indicators are low, then you can forget about it for the next few years. If they are high, then the examination is done annually. I like this selective position; this way we avoid unnecessary diagnoses and do not miss significant diseases.

Is it normal to have a small penis?

Fear related to size is one of the most common. Recently, colleagues conducted a survey - according to its results, it turned out that the average size of the penis is 21 cm. When the participants were asked to try to measure again and were taught exactly how, it turned out that the average length is still 13 cm. These are the average statistical figures - 12?16 cm - and you need to measure not just “from the abdomen”, but from the pubic symphysis. Some people have fat there - if you don’t measure it, then you can count less. Many people are dissatisfied with their appearance, and dissatisfaction in this area is also common, but this does not mean that there is a real reason for alarm and any serious measures. I am not a supporter of penis enlargement without indications.

There are also pathological deviations - there is the concept of “micropenis”, there is a hidden penis. In the vast majority of situations, a person can be helped - modern medicine is not about despair at all. There is a whole subsection of genital surgery in urology, these specialists who perform complex operations on gender reassignment, reduction, extension, enlargement, compression. There is almost always a solution that allows a person to be sexually active, even if it seemed that there was no chance - for example, with a traumatic loss of the penis.

Male infertility - should you be afraid of it and what to do?

There is no need to be afraid of anything. First, you need to determine whether this is infertility or a state of subfertility, that is, reduced ability to conceive. There are statistics that it is worth starting to be examined in this area if a generally healthy couple does not conceive within a year with regular sexual activity - precisely with regular, and not occasionally. If the woman in the couple is over 35 years old, then this period is reduced to six months. This is due to the fact that many modern women have a reduced ovarian reserve (total number of eggs), this is due to interventions and other factors.

Whatever the cause of male infertility, this is not a death sentence. Even if we are talking about an extreme degree - azoospermia, in which there are no sperm in the ejaculate. Now there are methods that allow you to conceive a child, at least within the framework of IVF.

One of the common causes of difficulty conceiving is obstruction of the vas deferens, which in turn can occur as a result of many factors. Most often this is a chlamydial or myoplasma infection, complications after gonorrhea. There are genetic forms in which critically few sperm are produced. We successfully overcome all this with the help of microsurgical operations that allow us to obtain sperm directly from the testicle or epididymis.

In any case, there is absolutely no need to despair.

Is it possible to reduce the risk of kidney stones?

The easiest way is to drink a lot of water; this is the most common recommendation at appointments. This generally prevents many health problems. The kidneys excrete about 1.5-2 liters of urine per day, but at the same time they pass up to 100 liters of liquid through themselves, so the fear of “flooding the kidneys” is not entirely justified, this is also part of the realm of myths - the kidneys have a gigantic working reserve. Moreover, if a person has one kidney removed, the second will take on all the work and cope. We recommend drinking enough water so that your urine is light or almost clear.

How often should you visit a urologist and should women go to him?

There is a misconception that a urologist is a male doctor, but this is not true. It is better for women to contact a urologist rather than a gynecologist when it comes to urinary tract infections - cystitis, pyelonephritis. These, by the way, are the most common bacterial infections; they occur more often than intestinal and pulmonary ones.

Men should visit a urologist if they have alarming symptoms or discomfort.

There are no clear uniform recommendations for preventive visits, but I advise regular check-ups after 45–50 years and periodic ultrasound of the kidneys and other organs. At the same time, it is imperative to conduct a self-examination - a man should regularly palpate the scrotum for lumps and other changes. Testicular tumors, for example, are practically asymptomatic for a very long time - even when they grow large, they still do not hurt. In general, most urological cancers are slow-growing, but testicular cancer is an exception; it can develop quickly and most often occurs at the age of 20–40 years, so feeling yourself is not only pleasant, but also useful.

But here I would like to convey one important thing. Today, in terms of oncourology, we have moved very far forward. When I started practicing urology in 1994, it was mostly major mutilating surgeries. Now the majority of patients whom we operate and perform minimally invasive interventions are patients with a good prognosis; a complete cure can occur in 70–80% of them. After most oncological urological operations, a person’s quality of life does not change, and sometimes even improves. The main thing is not to delay and be afraid to go to the doctor with questions. Taking care of your health is generally a sign of intelligence.

For questions, you can contact us by phone +(998 78) 140-03-03, +(998 78) 140-01-60 and at the address Tashkent, Uchtepa district, 12th quarter, st. M. Shaikhzoda. Telegram channel: https://t.me/urologic_uz