Common Questions · Everyday urology
The everyday urology around the five specialist areas — stones first among it. Short, referenced answers to the questions that come before a diagnosis exists, written to be read at eleven at night, by someone who has not told anyone yet. Each is referenced to guidelines, systematic reviews and trials, with the studies listed at the foot of its page.
Blood, infection, stones, pain, lumps, foreskins and vasectomy — and what going private actually buys.
Across 229,701 people investigated for visible blood in the urine, 17% had bladder cancer.
All fifty-five, across every condition, are on the practice page.
What I treat · Everyday urology
Kidney and bladder stones, visible blood in the urine, recurrent infections, a scrotal lump or swelling, and foreskin problems — the everyday urology around the five specialist areas. Each has a referenced answer of its own; stones, first among them, are set out in full below. Bring any recent scans or results to the appointment.
Size settles it more reliably than pain does — and stone pain with a fever is an emergency, not a clinic appointment.
Set out below ↓ Blood in the urine “It happened once, and then it stopped.”The one urinary symptom that should never be watched and waited on. Not because it usually means cancer, but because it often enough does.
Read the answer → Recurrent infection “This is my fourth course of antibiotics.”When infections keep coming back in a man, the question stops being which antibiotic and becomes why this keeps happening.
Read the answer → A lump in the scrotum “I found a lump.”Most are harmless. The reason to have one examined is not that it is probably serious — it is that examination alone cannot always tell.
Read the answer → Foreskin problems “My foreskin won’t retract.”Often it does not need a circumcision: in a placebo-controlled trial a steroid cream cleared two-thirds of cases against one in six on placebo. But one cause defeats every alternative, and it is visible on examination.
Read the answer → Pelvic and testicular pain “It has hurt for months.”The hardest condition in everyday urology, and the one where patients are owed the most honesty about how weak the evidence is.
Read the answer →Kidney stones
Most men arrive having already had the pain and already had the scan. The question they want answered is narrower than the one they ask: will this one pass, and what happens if it does not.
Size settles it more reliably than pain does. Stones under about five millimetres pass spontaneously in the large majority of cases; between five and ten the odds fall steeply; above ten, spontaneous passage is uncommon enough that waiting usually postpones the answer rather than avoiding it. Position matters alongside size — a stone already close to the bladder behaves quite differently from one sitting at the top of the ureter. How much it hurts, by contrast, tells you very little.
Treatment divides three ways. Shockwave lithotripsy breaks the stone from outside the body with no incision and no telescope. Ureteroscopy passes a fine telescope to the stone and fragments it with a laser — the workhorse for stones in the ureter. Percutaneous surgery makes a track through the flank into the kidney itself, and is reserved for large or complex stone burdens. For kidney stones in the ten to twenty millimetre range the two keyhole routes clear stones comparably well, so the choice turns on bleeding risk and recovery rather than on success rates.
The leaflets above are published by the British Association of Urological Surgeons (BAUS) and open in a new tab. They are linked, not hosted or altered.
Written and reviewed by Mr Musaab Yassin, Consultant Urological Surgeon & Andrologist. FRCS (Urol) · GMC 6118378 ·
The other areas
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