A weak stream, straining, frequent urges, getting up at night, stinging or a feeling that the bladder has not emptied completely are among the most common reasons for seeing a urologist. They may be caused by an enlarged prostate, an overactive bladder, an infection, a narrowing of the urethra or a bladder stone. The consultation with Dr Penev identifies the cause with a few painless tests at the very first visit and ends with a treatment plan tailored to you.
When it is recommended
Book a consultation if you notice:
- a weak or interrupted stream, straining or waiting before the stream starts;
- passing urine more often than usual and sudden urges that are hard to put off;
- getting up to go to the toilet two or more times a night;
- a feeling of incomplete emptying or dribbling after you have finished;
- stinging or pain when passing urine;
- leaking urine involuntarily when you cough or exert yourself, or immediately after an urge.
Being unable to pass urine with increasing pain low in the abdomen, and difficulty passing urine with a high temperature and chills, are emergencies – go to an emergency department or call 112 (the European emergency number) without waiting for a booked appointment. Painless visible blood in the urine also needs a consultation as soon as possible, even if it happened only once.
What happens during the consultation
The consultation begins with a conversation about your symptoms, fluid intake, medicines and past illnesses; for men, Dr Penev also uses a short questionnaire on the severity of the symptoms.
This is followed by an examination of the abdomen and the external genitals and, in men, a rectal examination of the prostate, which takes less than a minute. An ultrasound scan of the kidneys, bladder and prostate is done straight away at the practice and shows the size of the prostate, the bladder wall, any stones or growths and, after you have passed urine, the residual urine – a key measure when passing urine is difficult.
If the stream is weak, uroflowmetry is arranged: you pass urine into a special device, and the flow curve shows how weak the stream is and points to the cause. A urine test and a urine culture show whether there is an infection, and in men PSA is also checked where appropriate. If there is blood in the urine or a suspected narrowing of the urethra, the doctor may schedule a separate cystoscopy. The visit takes about 20 to 30 minutes.
Preparation
- Come with a moderately full bladder: drink about half a litre of water an hour beforehand and do not pass urine just before the consultation. If you cannot hold on, say so when you arrive.
- Bring previous test results, hospital discharge summaries and a list of your medicines.
- It is useful to keep a diary of drinking, passing urine and leaking for two to three days.
You will find more guidance in the article how to prepare for a urology appointment.
Results and treatment options
At the end of the visit Dr Penev explains what the tests show and what the options are. For many people, changes in habits are enough – spreading fluids through the day, less coffee and alcohol in the evening, bladder training and pelvic floor training. For an enlarged prostate there are medicines that relax the prostate and the bladder neck or reduce the size of the prostate over time; for an overactive bladder, medicines that calm its involuntary contractions; for leaking, pelvic floor exercises and, depending on the doctor’s assessment, magnetic therapy.
When medication is not enough or there are complications, Dr Penev discusses the endoscopic and surgical options at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv, with you. A follow-up consultation after a few weeks assesses the effect of the treatment.
Where it is done
Consultations take place at Dr Penev’s private practice at 5 Anri Barbyus St, Plovdiv, by appointment, and for patients from Karlovo and the surrounding area at Vita Med Medical Centre, 18 Todor i Ana Pulevi St, Karlovo, on a schedule confirmed when you book. Uroflowmetry and cystoscopy are done according to the equipment available at the respective practice or at Kaspela University Hospital.
Price
Initial consultation €50; follow-up consultation €30. The price of any additional tests is confirmed when you book.
Urinary problems rarely go away on their own, but in most cases they have a clear cause and a good solution. Book an appointment with Dr Penev and discuss your symptoms in an unhurried way.
Frequently asked questions
How many times a day is it normal to pass urine?
With a normal fluid intake, most people pass urine roughly 4 to 7 times a day and no more than once at night. Being outside this range is not a disease in itself, but if it bothers you or is new for you, it deserves a consultation.
Are urinary problems only a men's problem?
No. In men the leading cause is an enlarged prostate, but women also often see a urologist because of frequent urges, stinging, infections or leaking urine. The consultation is suitable for both sexes.
Is the examination painful?
No. The conversation, the ultrasound and the uroflowmetry are completely painless. The rectal examination of the prostate in men takes less than a minute and is unpleasant rather than painful.
Should I stop my medicines before the consultation?
Do not stop anything on your own. Bring a list of all the medicines you take, including those for blood pressure, diuretics and sedatives – some of them affect urination.
Does everyone need a cystoscopy?
No. Cystoscopy is done only for specific reasons – blood in the urine, a suspected narrowing of the urethra or a growth in the bladder. For most patients, ultrasound, a urine test and uroflowmetry are enough.
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.