When to See a Urologist: Symptoms That Warrant a Referral

What does a urologist treat?

Urologists are surgeons who specialize in the urinary tract (kidneys, ureters, bladder, urethra) in both men and women, and the male reproductive system. They handle conditions ranging from kidney stones and bladder cancer to erectile dysfunction, prostate disease, and vasectomy.

Subspecialties within urology include: - Endourology (minimally invasive stone and tumor procedures) - Female pelvic medicine and reconstructive surgery (incontinence, prolapse) - Male infertility and sexual medicine - Pediatric urology - Urologic oncology

Urinary tract infections: primary care first or urologist?

Start with primary care for uncomplicated UTIs — a burning, urgent bladder infection in an otherwise healthy woman. A primary-care clinician can diagnose and treat these efficiently.

See a urologist if: - You have recurrent UTIs (three or more in a year, or two in six months) and standard prevention has not helped 1Ref 1Anger J, Lee U, Ackerman AL, et al. (2019).Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline.Supports recurrent UTI as indication for urology referral and specialist management - You have a UTI that did not clear with antibiotics - You are a man, child, or pregnant person with UTI symptoms (these are not considered uncomplicated) - Imaging or evaluation suggests a structural abnormality

The AUA Recurrent UTI Guideline identifies persistent recurrence despite behavioral interventions as an indication for further evaluation and urologic management 1Ref 1Anger J, Lee U, Ackerman AL, et al. (2019).Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline.Supports recurrent UTI as indication for urology referral and specialist management.

Kidney stones: primary care first or urologist?

Start with primary care or urgent care for an initial stone if it is small, pain is manageable, and there are no red flags (fever, single kidney, severe obstruction). A primary-care clinician can order labs, imaging, pain medication, and watchful waiting.

See a urologist for: - Stones larger than 10 mm (very unlikely to pass on their own) 2Ref 2Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TMT, White JR (2014).Medical Management of Kidney Stones: AUA Guideline.Supports stone size thresholds for urology referral and hematuria evaluation - Stones causing significant obstruction or signs of infection - Stones that have not passed after 4 to 6 weeks - Recurrent stone-formers who need metabolic evaluation and prevention planning 2Ref 2Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TMT, White JR (2014).Medical Management of Kidney Stones: AUA Guideline.Supports stone size thresholds for urology referral and hematuria evaluation

Prostate and lower urinary tract symptoms in men

Slow urinary stream, urgency, frequent nighttime urination, and incomplete bladder emptying are common symptoms of benign prostatic hyperplasia (BPH). These often start with a primary-care evaluation and may be managed with medication.

See a urologist if: - Symptoms are severe or significantly affect quality of life - Medical therapy has not helped - There are signs of retention, bladder damage, or concern for prostate cancer 3Ref 3Lerner LB, McVary KT, Barry MJ, et al. (2021).Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Part I — Initial Work-up and Medical Management.Supports primary-care to urology pathway for BPH and lower urinary tract symptoms in men - PSA (prostate-specific antigen) is elevated and further workup is needed

The AUA BPH Guideline outlines the primary-care to urology pathway for men with lower urinary tract symptoms 3Ref 3Lerner LB, McVary KT, Barry MJ, et al. (2021).Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Part I — Initial Work-up and Medical Management.Supports primary-care to urology pathway for BPH and lower urinary tract symptoms in men.

Erectile dysfunction and male sexual health

Erectile dysfunction (ED) is common and often starts with a primary-care assessment that evaluates cardiovascular risk factors, diabetes, hormones, and medications. Most men with ED can be managed in primary care with lifestyle counseling and, if appropriate, PDE5 inhibitor medications.

See a urologist (or a urologist specializing in sexual medicine) if: - There is a structural cause suspected (Peyronie's disease, vascular problem) - First-line medications have not worked - You are interested in penile prosthesis or other surgical options - There is a concern about testosterone deficiency alongside sexual dysfunction

Blood in the urine (hematuria)

Any visible blood in the urine in an adult should be evaluated promptly. A primary-care clinician can order initial urine tests, but visible (gross) hematuria or persistent microscopic hematuria that is not explained by an obvious cause (such as a recent UTI) generally warrants urology referral for cystoscopy to exclude bladder cancer and other structural causes 2Ref 2Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TMT, White JR (2014).Medical Management of Kidney Stones: AUA Guideline.Supports stone size thresholds for urology referral and hematuria evaluation.

Vasectomy and male contraception

Vasectomy is performed by a urologist. A primary-care clinician or Gale clinician can discuss contraception options, answer questions, and provide a referral — but the procedure itself belongs with a urologist trained in the technique 4Ref 4Sharlip ID, Belker AM, Honig S, et al. (2012).Vasectomy: AUA Guideline.Supports vasectomy as a urologist-performed procedure.

How can Gale help?

A Gale primary-care clinician can evaluate urinary symptoms, order relevant labs and imaging, treat uncomplicated UTIs, and refer you to a urologist when the situation warrants it. If you are unsure where to start, beginning with Gale primary care is a reasonable first step for most non-emergency urologic concerns.