Important Questions To Ask Your Urologist
Most of us use the bathroom multiple times a day and think nothing of it. After all, when you gotta go, you gotta go. But for some people, a range of disruptions to the system and organs involved with excreting fluid waste from the body may send them in search of a specialist doctor, called a urologist, to help fix the problem.
Urologists are “physicians and surgeons who are specially trained for the diagnosis and treatment of genitourinary and adrenal gland diseases in patients of any age and of either sex,” as the American Urological Association puts it. This system includes organs such as the kidneys and bladder as well the prostate, penis and testicles. Urologists also address problems and diseases in other important structures such as the ureters – tubes that run from the kidneys to the bladder – and the urethra – the duct that drains urine from the bladder and out of the body. Sometimes things go wrong in this complicated web of bodily plumbing, and the urologist is the specialist who can take care of problems within this system.
While it’s true that men are more likely to seek the assistance of a urologist, these specialist doctors can treat a range of diseases that affect patients of both sexes, of all ages with surgery, medications and other treatments. “One of the most common misconceptions is we only see men, but the reality is we see women as well because women have kidneys and bladders and ureters, and we’re the surgeons that take care of problems that happen to women as well,” says Dr. Jamin V. Brahmbhatt, a urologist with Orlando Health. “We do tend to see more men than women, but we see both sexes and all age ranges,” from newborns up to elderly patients.
Some of the most common conditions a urologist sees in daily practice can range from sexual dysfunction, problems voiding, overactive bladder, urinary tract infections, kidney and bladder stones, even cancer. The number and range of problems are many, so when you look to make an appointment with a new doctor, you should first “do some homework,” Brahmbhatt says. “Research the condition you’re having, but don’t freak out if you read the word cancer. Just make sure you know a little about what you’re getting yourself into,” such as what condition might be causing the symptoms you’re having and whether a general urologist or a subspecialist might be a better fit. This can help guide you in finding the right doctor.
“Sometimes when you go see a specialist, it might be a long wait to get into the office,” Brahmbhatt notes, which in some cases might be a big problem. “Your problem may be the worst thing for you right now, but to the office everything is triage.” If the specialist you want to see can’t fit you in right away, Brahmbhatt recommends asking the appointment scheduler if there’s a way to get in sooner. “It’s always good to ask if there’s a waitlist or cancellations or the possibility to see a physician extender such as a nurse practitioner or physician assistant. We all work together as a team, and while there might be a wait for a specific doctor, if you want to get in sooner, it’s always OK to ask if you can see someone else sooner,” he says.
Once you’ve gotten into the room with the provider, consider asking the following questions to be sure your concerns are being appropriately addressed:
1. What level of experience do you have with this particular issue?
Like many other specialists, urologists may focus their training and practice in a subspecialty area. The American Board of Urology offers certification in two subspecialties – pediatric urology (disorders in children) and female pelvic medicine and reconstructive surgery (disorders in women), but many doctors focus their practice on treating specific diseases or disorders. For example, Dr. Behfar Ehdaie, attending surgeon at Memorial Sloan Kettering Cancer Center in New York in the department of surgery and urology service, specializes in treating urological cancers. Much of his practice is in prostate cancer because it’s “the second most common cancer among men,” and a top reason men seek appointments with a urologist.
For people who live in areas “in which there might be a higher concentration of urologists, the key would be to find a specialist within the field of urology that’s specific to your condition,” Ehdaie says. “So if your diagnosis is prostate cancer or you’re concerned about prostate cancer, if you live in an area with a high concentration of urologists,” you may do well seeking help from a subspecialist who’s a urologic oncologist. “Even more importantly, someone who sees many prostate cancer patients specifically would yield the most important characteristics to look for.”
This might not be an option for patients in all areas of the country, especially in more rural regions. In those instances, a general urologist will likely be able to help or get you coordinated with the care you need. Ehdaie suggests “seeking care at academic medical centers,” which may provide access to more specialists in urology.
For all other urological concerns, you should also ask how equipped the doctor is to treat the problem. Brahmbhatt says patients often ask him how many of a certain procedure he’s done, and he’ll be honest with patients about his experience and confidence level in treating the problem. Still, he says getting a second opinion is always an option he encourages patients to explore.
2. Do you have enough information about me?
It’s always smart to come prepared to any doctor’s appointment with your complete medical history, all your medications and as much information as you can about your own health and any procedures you’ve had. It’s also important to be proactive about getting all the information pulled together, Bhrambhatt says. “Don’t assume we’re going to get your records from the other doctor’s office. It’s always good to keep a copy of your records,” and he says “the best patients are the ones who have spreadsheets,” or walk in with a whole packet of information and a list of questions they want to ask the doctor. He recommends giving this all to the person who checks you in so that the doctor can review it before he even gets into the room with you. Often, he says he can address the questions most patients have during the initial discussion. “It makes it a much more meaningful visit for you because we’re not just data mining, and it makes it easy for us to have access to that beforehand,” he says.
On a related issue, Bhrambhatt notes that sometimes patients aren’t always completely honest about why they’re making an appointment to see a urologist. But this only hinders a doctor’s ability to help you with the real issue you’re facing. “First and foremost, the patient has to be honest about what they’re coming to see their doctor for. Urologists are experts on men’s health and there’s certain things that could be happening down there that men particularly may be embarrassed to talk about like erectile dysfunction or a wart or a lump in the testicle.” He says sometimes patients schedule the appointment to see the doctor citing a different, less embarrassing issue and “they go through the whole process and paperwork. I get into the room with them and only then do they say, ‘I want to talk about erectile dysfunction.’ I can understand the hesitation about talking about some of these sensitive topics. But if you’re honest from the get-go it helps prepare you and our entire team.” In some cases, advance lab work or imaging might go a long way toward making the visit more productive, or you may need to see a different doctor in the practice. He urges patients to “just be honest about why you want to see us.”
3. What’s my risk of prostate cancer? (Or how will we treat my prostate cancer?)
Because one of the most common reasons to see a urologist is screening or treatment for prostate cancer, asking about your risk of developing the disease and when and whether you should begin screening are important aspects of your relationship with a urologist. If you haven’t been diagnosed with cancer but are concerned about your risk for the disease, ask questions about whether it’s time to start screening and how often you should be screened. “The questions there are more focused on [the patients’] preferences and their thresholds for risk,” Ehdaie says.
For patients who do have prostate cancer, Ehdaie recommends you ask your urologic oncologist specific questions about treatment options. “When we see patients with cancer specifically it’s important to discuss and focus in on the cancer and impact on survival. However, I think a critical component of that discussion should also be focused on quality of life.” Ask about the common side effects of different treatment options and discuss with your doctor what your risk tolerance is and how you’d be most comfortable moving forward with treatment.
Along similar lines, Ehdaie also points out that it’s important to seek a doctor who has access to a variety of treatment modalities. In these instances, “the focus can be on what’s the best treatment for my quality of life that can also provide me the best outcomes with regard to survival.”
Bhrambhatt also recommends asking whether there are non-surgical interventions that might be a good option as well. “Is there anything else we can do from an observation standpoint for this? Is there any new technology out there or new surgeries or procedures that will reduce side effects?” Particularly for patients with enlarged prostates, he encourages you to have a discussion with your doctor about all your options because treatment advances in that specific field have changed the way some cases are handled.
This blog was originally published on U.S. News & World Report.