Many patients put off seeing a urologist for months – out of worry, embarrassment or because they do not know what to expect. The examination itself, however, is short, painless and predictable, and a little preparation on your part makes it much more useful.
Dr Penev sees patients at his private practice at 5 Anri Barbyus St, Plovdiv, and at Vita Med Medical Centre in Karlovo, and he operates at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv. Appointments must be booked in advance, and you will find the prices (€50 for an initial consultation and €30 for a follow-up consultation) on the consultation prices page. Dr Penev works with the NHIF (Bulgaria’s National Health Insurance Fund) – if you have a referral from your GP, mention it when you book.
Describe your symptoms in advance
The urologist works first and foremost with your account, so being precise saves time and unnecessary tests. Before the appointment, think through the answers to these questions and, if it helps, write them down:
- when your symptoms started and how they have changed;
- exactly where you feel pain or discomfort and what makes it worse or better;
- how many times you pass urine during the day and how many times you get up at night;
- whether there has been blood in your urine, a temperature or leaking of urine;
- changes in erections, pain during sex, discharge from the urethra.
If you pass urine often or with difficulty, a two-day diary is very helpful: the time of each visit to the toilet and the approximate amount of fluid you drink. Also write down the questions you want to ask – they are easy to forget in the consulting room.
Gather your documents and test results
Bring everything that is related to the problem: results of urine and blood tests (including PSA, if it has been tested), hospital discharge summaries, images and discs from ultrasound, X-ray or CT scans, and reports from other specialists. Even older results are valuable – they show how the condition has developed and save repeat procedures. Documents in English or German are no problem – Dr Penev consults in both languages.
Make a list of your medicines
Write down all the medicines you take regularly, with their doses – including supplements, herbal remedies and over-the-counter medicines. It is especially important for the urologist to know about blood thinners, medicines for blood pressure, diabetes and the prostate, and about any antibiotics in recent weeks. Do not stop anything on your own before the appointment. Also mention your allergies, especially to antibiotics, anaesthetics and contrast agents.
Drink water: a full bladder for the ultrasound
Ultrasound is part of most urology examinations and is done on the spot. For the bladder, the prostate and the lower parts of the ureters to be seen clearly, the bladder needs to be moderately full: drink half a litre to a litre of water about an hour before your appointment and do not pass urine until then. It does not need to be bursting – a clear urge is enough. Afterwards the doctor can measure the urine left in the bladder – valuable information when there are problems with the prostate and bladder emptying.
If you are unable to pass urine or are in severe pain, do not force yourself to drink – mention this when you book. On the day before the examination, avoid fizzy drinks and foods that cause bloating – gas makes the image of the kidneys worse. If you are due to have a PSA test, avoid ejaculation and cycling for 48 hours beforehand and do not have the test during a urinary tract infection.
What happens in the consulting room
The examination starts with a conversation, followed by a physical examination – looking at and feeling the abdomen, the lower back and the external genitals. In men over 45–50 or if there are prostate complaints, a digital rectal examination is also done: it takes seconds and is unpleasant rather than painful. Next comes the ultrasound of the kidneys, bladder, prostate or testicles, and if your stream is weak the doctor may also arrange a measurement of your urine flow. Finally, Dr Penev explains what he has found, which tests are needed and what the plan is. An initial consultation usually takes twenty to thirty minutes; children are examined calmly, with a parent present. More details on the pages on the urology consultation and the prostate check.
Allow yourself time
Arrive about ten minutes early and do not plan important commitments straight after the appointment – sometimes a urine test on the spot or a longer conversation is needed. For the practice in Karlovo, the schedule is confirmed when you book. Feeling anxious is natural, but for a urologist your symptoms are everyday matters: there is no awkward question, and being open shortens the path to a diagnosis.
When not to wait for an appointment
Some conditions cannot wait for the next free slot. If you have sudden severe pain in a testicle (especially in boys and young men), are unable to pass urine with a full bladder, have a high temperature with pain in the lower back, or blood clots in your urine, go to an emergency department straight away or call 112 (the European emergency number). Painless blood in the urine is not an emergency measured in minutes, but it needs to be checked within days, not months. If you are not sure whether your symptom is one for a urologist, see the ten symptoms that mean you should see a urologist.
Symptoms described, test results gathered, a list of medicines, a moderately full bladder and enough time – that is all the preparation you need. Book an appointment with Dr Penev in Plovdiv or Karlovo and come with your questions; the answers are usually more reassuring than you expect.
Frequently asked questions
Do I need to fast before a urology appointment?
No. The examination and the ultrasound do not require fasting – have a light breakfast. Only if you are having blood tests the same morning should they be taken on an empty stomach.
Can I come for an examination during my period?
Yes, the examination itself and the ultrasound are not a problem. A urine test, however, may give a misleading result, so where possible it is done on another day or after suitable preparation.
What should I do if I cannot hold my urine until the ultrasound?
Tell the doctor – there is no need to feel embarrassed. The kidneys and other organs are examined first, you drink some water in the consulting room and the bladder is examined a little later.
Can I bring someone with me?
Of course. Children are always examined with a parent present, and older patients or people who feel anxious are welcome to bring someone close to them. If you wish, part of the conversation with the doctor can be in private.
Will I get a diagnosis at the first appointment?
In many cases, yes – the conversation, the examination and the ultrasound are often enough to give a clear direction. When further tests are needed, the results are discussed at a follow-up consultation.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.