Doctor’s Orders: Have the Balls to Visit a Urologist

Hematuria, lumps, and other reasons men should go see their urologist.


As men get older, some of the most common health problems they develop are related to their bladder and prostate. There are a number of symptoms men may develop and not understand what they mean or why they are having them. Therefore, it is important to be on the lookout for some of the most common conditions and get checked to see if they need further treatment. Many men go on living with symptoms that may be underlying problems to larger conditions that require treatment.

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1. Hematuria (aka blood in the urine)

Blood in the urine is not normal. It may be an early warning sign of a number of serious health conditions, such as a bladder or kidney infection, kidney stones, kidney cancer, or bladder cancer. If you see blood in your urine, the urologist will start by doing a simple urine test called a urinalysis to test for the presence and amount of microscopic blood in the urine. They may also do a cystoscopy to look inside your bladder, or refer you for an x-ray or CT scan. Do not wait to see a urologist if you see blood in your urine. It usually means something is wrong and in that case, will not go away on its own.

2. Prostate exam (PSA test and DRE)

Check your PSA. PSA, or prostate-specific antigen, is a protein produced in the prostate. A PSA test, which is a simple blood test, can measure the level of PSA in the blood. A PSA that rises or is elevated, such as above 4.0 ng/mL, may indicate prostate cancer. However, the PSA test is not specific for prostate cancer. An elevated PSA could also mean an enlarged prostate or prostatitis (a prostate infection). Most doctors don’t test the PSA, except for urologists.

When should you start checking your PSA? Men should have a baseline PSA test starting at age 40 and check it annually. The risk for prostate cancer goes significantly up after 50, however men can develop it younger than 50. It’s especially important for men who are at a higher risk for prostate cancer to check their PSA. Men who have a higher risk for prostate cancer include African-American men, men over 50, and men who have a family history of prostate cancer. African-American men are often diagnosed with more aggressive prostate cancers, so it’s important to check it early and keep track of any changes in the PSA level. With early detection, prostate cancer is highly treatable and curable.

A DRE, or digital rectal exam, can detect growths or enlargement of the prostate. Any abnormalities, such as firmness, nodules, or other irregularities, may indicate prostate cancer. Men should have an annual DRE starting at age 40 to check for any changes in the prostate from the previous prostate exam. Again, men who have a higher risk for prostate cancer, such as African-American men and men with a family history of prostate cancer, should get tested annually.

While I stress that men should have an annual prostate exam starting at age 40, this does not mean you should worry if you are older. The risk of prostate cancer does go up after 50, but due to the possibility that men can be diagnosed and have been diagnosed earlier than 50, I think all men should start checking at 40.

3. Testicular pain or lump

Testicular pain occurs in or around one or both testicles. The pain felt in your testicles does not always mean the source is in your testicles; it could be pain caused by another area of the body such as in the abdomen or groin. Testicular pain may be caused by a number of different things including inflammation, hydrocele, kidney stones, inguinal hernia, scrotal mass, urinary tract infection, varicocele, or even testicular cancer.

A testicular lump is an abnormal mass in the testicles, and are actually pretty common. They can occur in both adult men and teenage boys. A testicular lump should not be ignored because while it may not always be serious, it is a sign that there is something wrong with the testicle. While most testicular lumps are caused by an injury, they can also indicate a varicocele, hydrocele, epididymal cyst, testicular torsion, or testicular cancer. If it is testicular cancer, do not panic. With detected early, testicular cancer is highly treatable and curable.

So, if you are experiencing mild testicular pain that lasts longer than a few days, or you feel a lump or swelling in or around a testicle, see a urologist.

4. Kidney pain or mass

If you are experiencing abdominal pain, your primary care doctor may refer you to have a CT scan or an ultrasound. While the scan may or may not show what is causing the pain, it can identify if there is a mass on the kidney. If a mass has been found in your kidney, do not let anyone do a biopsy the mass until you have seen a urologist. While it is assumed that the mass could be kidney cancer, it can also mean a cyst (fluid-filled sac), an infection, or hydronephrosis (partial blockage of kidney). It’s important to see a urologist before having your kidney biopsied in order to rule out other causes of the mass. A urologist may do a urine cytology, a cystoscopy, additional blood work, or order additional scans to check what could be causing the mass.

5. If you and your partner are having trouble conceiving

In order to get your partner pregnant, you must be able to produce healthy sperm (which is produced in the testicles), sperm have to be carried into the semen, there must be a good sperm count (higher than 15 million sperm per milliliter), and your sperm must be well-functioning and have good motility. So if you and your partner are having trouble conceiving, it could mean that you are infertile. Checking for male infertility is also important because it could mean other serious health conditions too, such as a varicocele, infection, hormone imbalance, or testicular cancer. These conditions can often be missed by primary care doctors who will then refer men to a fertility doctor, who may also miss them.

Make sure you talk to your doctor about checking for any of the other health conditions so that you can determine what else might be causing the male infertility.

Dr. David B. Samadi is the chairman of urology and chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel’s Medical A-Team and the chief medical correspondent for AM-970 in New York City. Visit Dr. Samadi’s blog at

Doctor’s Orders: Have the Balls to Visit a Urologist