Most urological conditions are much easier to treat when they are found early, yet this is exactly where people most often put up with symptoms and put things off. Below, ten important symptoms are arranged in three groups according to how quickly you need to act: urgent – today, at an emergency department or by calling 112 (the European emergency number); soon – within a few days; planned – at the first convenient appointment. The list does not replace a consultation, but it helps you not to underestimate something serious.
Urgent: get help today
1. Sudden severe pain in a testicle
Sharp, sudden pain in one testicle, often with swelling and nausea, may mean twisting of the spermatic cord (torsion), which cuts off the blood supply. The testicle is most reliably saved in the first few hours – roughly up to six – especially in boys and young men. Do not wait until the morning and do not book an appointment: go to an emergency department or call 112. More about testicular torsion.
2. You cannot pass urine
A strong urge, a full and painful bladder, but no urine comes out or it barely dribbles – this is acute urinary retention. It most often affects men with an enlarged prostate, sometimes after a chill, alcohol or certain medicines. The bladder must be emptied with a catheter the same day; waiting brings pain, kidney damage and infection.
3. Renal colic with a temperature or vomiting that will not stop
Severe pain in the lower back that moves down towards the groin is most often a stone on its way down the urinary tract. A colic attack is usually controlled with painkillers and a consultation within a day, but when a high temperature, chills, vomiting that will not stop or reduced urine output are added, the stone has probably blocked an infected kidney – urgent drainage in hospital is needed, not a free appointment slot.
Soon: book within a few days
4. Blood in the urine
Pink, red or cola-coloured urine always needs investigating, even if it happens once and without pain. Painless blood in the urine, especially in smokers and people over 50, is the main early warning sign of a tumour of the bladder or kidney. More often the cause is an infection or a stone, but that is established by tests, not by waiting. More about blood in the urine.
5. Stinging, frequent urination and pain low in the abdomen
A urinary tract infection is unpleasant, but it responds quickly once it has been confirmed with a urine test. Repeated infections, and infections in men and children, deserve a consultation and an ultrasound scan, because there is often another cause behind them. With a temperature, chills and pain in the lower back, the infection has probably reached the kidney – then do not wait for days.
6. A lump, hardening or enlargement of a testicle
A painless hard lump in a testicle should not be watched at home. Testicular cancer is the most common cancer in men aged 15 to 40 and responds very well to treatment when it is found in time. An ultrasound scan gives an answer within minutes. More on the page about a lump in the testicle.
7. Discharge from the urethra, a rash or small warts on the genitals
Discharge from the urethra, stinging, small sores or small warts (genital warts caused by HPV) are a reason for a consultation within the next few days – for your sake and your partner’s. Putting it off does not solve the problem; it gives the infection time to spread.
Planned: book an appointment over the next few weeks
8. A weak stream, straining and getting up at night
The stream gradually weakens, passing urine is hard to start and stops and starts, you are left with a feeling of incomplete emptying, and you get up at night two or more times. In men over 50 the cause is most often an enlarged prostate; in younger men, a narrowing of the urethra or a problem with the bladder. The consultation can be planned calmly, but it should not be put off for years, because the bladder gradually loses strength. More about difficulty passing urine.
9. Leaking urine and sudden strong urges
Leaking when you cough, laugh or exert yourself, and uncontrollable urges where you do not reach the toilet in time, are common in women and men, but they are not a “normal part of ageing”. There are exercises, medicines, magnetic therapy and operations depending on the type of incontinence; the first step is to clarify the mechanism at a consultation.
10. Changes in erections
Weaker or unreliable erections for more than three months are not just an intimate problem – they are often the first visible sign of damage to the blood vessels, diabetes or a hormonal disorder, years before heart disease. A painful erection or a curved penis also need a consultation. The conversation is confidential, and there are many treatment options.
What to expect at the consultation
The consultation with Dr Penev starts with a conversation, followed by a physical examination and an on-the-spot ultrasound scan of the kidneys, bladder, prostate or testicles, and if needed, a urine test, PSA or a measurement of urine flow. Usually the very first visit gives a clear direction. More on the page about the urology consultation. The initial consultation is €50 and a follow-up consultation €30.
When to see a doctor even if the symptom is not on the list
The simple rule: any new complaint related to passing urine or the genitals that lasts more than one to two weeks, keeps coming back or worries you deserves a consultation. The same applies to an incidental finding on an ultrasound scan – a stone, a kidney cyst, an enlarged prostate – and to a raised PSA.
A urology consultation is short, painless and in most cases reassuring. If you have recognised your own complaint in the list, book an appointment with Dr Penev in Plovdiv or Karlovo, and with the urgent conditions in the first group, do not wait – get emergency help straight away.
Frequently asked questions
Do women see a urologist?
Yes. Cystitis, incontinence, kidney stones, blood in the urine and frequent urination are just as much urological problems in women. For some of them the urologist and the gynaecologist work together.
When should children be taken to a urologist?
With pain or swelling in the scrotum, an undescended testicle, difficulty passing urine, repeated infections and bedwetting after the age of 5–6. Dr Penev also sees children, always with a parent present.
What should I do if the symptom goes away on its own?
Mild stinging for a day or brief discomfort can be watched. Blood in the urine, a lump in the testicle or an episode of being unable to pass urine need a consultation even after they have passed – the cause is still there.
Who should I see first – my GP or a urologist?
With problems passing urine or with the genitals, you can book directly with a urologist. In emergencies, go to the nearest emergency department, and with general symptoms such as a temperature without a clear cause, your GP is a good first step.
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.