Many men feel uneasy before seeing a urologist for the first time. Sweaty palms, nervous thoughts and fear of the digital rectal exam (DRE) are common. Still, knowing when to go — and what will happen — can make the experience far less stressful.
When should men see a urologist?
According to Dr Axel Merseburger of the German Society for Urology, men should seek specialist care if they experience:
- Frequent or painful urination
- Blood in the urine
- Recurrent urinary tract infections
- Kidney stones
- Erectile dysfunction
- Testicular pain
- Unexplained lower abdominal pain
Visible inflammation or lumps in the genital area are also warning signs, says Dr Robert Frese of the Association of Urologists in Private Practice in Hamburg. Urologists can also advise on fertility issues, sexual problems and sexually transmitted infections. Even so, both experts recommend checking with a general practitioner first, who can direct patients to the right specialist.
The importance of cancer screening
“Prostate cancer is the most common cancer in men, just as breast cancer is in women,” Frese notes. More than a million cases were recorded worldwide in 2020. Routine screening is recommended from age 45, yet many men still avoid it, even when it is covered by insurance.
What happens at the first appointment?
A proper consultation begins with a detailed discussion of a patient’s medical history — including family cancer risk, existing illnesses, medications and sexual function. A physical exam usually follows. Depending on symptoms, the doctor may add a urine test or blood test.
What is included in prostate cancer screening?
Screening involves examining the penis and scrotum for abnormalities, checking lymph nodes and performing the DRE. The prostate is felt through the rectum to detect unusual hard or lumpy areas. Although the DRE cannot detect every early tumour, it remains an important tool.
Medical associations also recommend a PSA test, which measures prostate-specific antigen in the blood. Higher PSA levels can indicate cancer, but may also be caused by non-cancerous conditions. Merseburger advises men to discuss the benefits of combining both tests. Frese warns against skipping the DRE because it provides valuable information about the prostate and can even reveal signs of colon cancer.
Is the DRE as bad as many fear?
Most men find it uncomfortable but not painful. The procedure lasts only a few seconds. While lying on your side with bent knees, the doctor inserts a lubricated, gloved finger into the rectum to examine the prostate. “It’s a bit unpleasant, but a blood test is worse,” Frese says. Clear explanations — and sometimes a bit of humour — help ease embarrassment. Merseburger encourages patients to relax and breathe steadily.
Frese believes psychological barriers keep men away from screenings: “Many men see their body as a machine that only needs a mechanic when something breaks.”
Are urologists only for men?
No. About 40% of Frese’s patients are women, who also seek help with urinary tract problems and other urological issues.
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