What to Expect on your First Visit to the Urologist

Establishing Care

I didn't know what to expect my first visit with my urologist. I was hoping that we could get things moving along quickly.

I thought that I would have a cystoscopy (sis-tos-ku-pee, "cysto" for short). 

A cystoscopy is a procedure that allows your doctor to examine the lining of your bladder. A hollow tube called a cystoscope is inserted into your urethra (the duct by which urine is conveyed out of the body from the bladder) . The cystoscope has a camera, a light, and a tube that can pull out urine or push saline in. The saline is used to fill the bladder to help with visualization of the bladder. Here is the article I wrote about a cystoscopy and my experience.

Because the urinalysis (UA) at my primary care doc showed microscopic hematuria (blood in my urine that can only be seen under a microscope), I thought we would jump right into a cysto. That wasn't the case. Turns out my urologist wanted a CT scan before having a cystoscopy.

As with all physicians, the first visit will always be to establish care. Your chart and information from the ER or from your primary care physician would have been transferred to them already. Hopefully, before the initial visit, your doctor will have looked at these previous visits and test result. 

Unfortunately that was not the case with my urologist Dr. B. He was super busy, and glanced at my chart when I was sitting in front of him for the first time. Another huge warning sign. The first warning sign was when we had scheduling problems. He didn't really care about me or my case of bladder cancer.

When you get to the office, you will need to fill out basic paperwork to help your urologist, and their staff, to learn about you and why you are there. They might send you this paperwork before you come. You’ll be asked about various health conditions you have, the reason for your visit, and any medications or supplements you’re taking. Be as thorough as you can in your answers. Your replies will help your doctor get a good picture of your medical history and the symptoms you’re experiencing. 

The urologist will want to do their own assessment, have their own tests run, and take a history from you directly. They will review your full medical history, focusing on your current and past urological issues. 

 

So try and be patient. I know you have already said all of these things to the ER physician or your primary care physician. Your urologist also needs to hear it. I know you already peed in a cup and verified that there is blood in your urine. You will need to do it again. Your visit will likely start with a urine sample. So be sure you have had enough fluid before you come in to the office, so you can give them a urine sample for a UA. 

 The Exam - Early October 2020 - First Visit with Urologist

Seeing a new doctor can feel intimidating, and talking about some medical conditions may feel embarrassing to you. Writing down questions you have, or things you’d like to make sure you cover in advance, is a good idea so that you don’t forget anything during your appointment. Tell your doctor what you’re experiencing, how long you’ve experienced it, what and how makes the condition worse, and anything else you think may be relevant to your condition.

Once your doctor has a good idea of your history and concerns, he or she will perform a physical exam. 

I know that doctors get called away to emergencies. Especially specialists. I’ve had many hours of waiting for doctors, like most people.

My first visit to my urologist, Dr. B, was one of those days of waiting to see a doctor. I waited an hour and a half to see him, plus the hour and a half of driving, it made for a very long day.

I never leave home without a book to read, so I was happy as a clam. No worries.

When Dr. B finally came in the room, he apologized for taking so long. He said “I have a patient that was newly diagnosed with cancer. As you can imagine, I needed to spend some extra time with them.”

This melted my heart. I wasn’t annoyed at waiting, but I wasn’t super happy about it either. 

However, after I heard the reason for needing to wait, I was more than ok with waiting. It also made me really like Dr. B as well.

I thought “If I was ever in that kind of situation of getting a cancer diagnosis, he would take the time needed with me as well. I love this doctor! I’m so lucky to have him!” 

Ha! You can read about my traumatizing experience with Dr. B, finding out I have cancer. This situation is so ironic. Later, when he tells me that I have cancer, he was the absolutely opposite of being understanding. He was rushed, he was callous. It was a really traumatic experience for me.

Do you know that urologists get paid $300 for an initial visit? Well I didn’t. I couldn't believe the bill when I got it later. 

Dr. B talked with me for a total of 2 minutes. I was not impressed with his questions or the information he was giving me. This visit was another huge red flag. I wish I had been paying attention! 

Dr. B asked if the blood I had on my tissue was red, real red, like blood.

I was nice, but in my mind I was thinking very loudly “I’m a nurse. I’m a 41 year old woman. I’ve had a period for almost 20 years. Do you seriously think I don’t know what blood looks like?”

I told him as nicely as possible, without even a hint of sarcasm "yes, it is very red - like blood."

He asked if I was a smoker. "Nope." (this is in my chart and in the paper work I just filled out...)

He asked if anyone in my family had a history of cancer. "Nope." (also in the paper work and chart...)

Then he said “That’s good. This probably isn’t cancer. Ok, we’ll get you scheduled for a CT of your kidneys and bladder and then we’ll do a cystoscopy the next time you come in.”

I asked him why he couldn’t do the scope now, and he said that this was the order that he liked to do things. Okay, that is fine.

He didn’t explain to me what to expect with a cystoscopy, or even what it was. He didn’t tell me what the risks involved were. I was expecting he would do this at my appointment that I was getting the cysto. 

This is important to know because at my next visit when I was to get my first cysto, he also didn't tell me anything, and when I started asking him questions about it, he got annoyed and superficially educated me on the subject.

Another huge red flag! Looking back at these experiences, it's amazing to me what I was willing to tolerate with this provider. I stayed because I had been referred to him by my PCP, because others say "he's the best", and because it would be a pain to change. I have severe disabling bipolar depression. To find a new provider, and to change over is a really huge deal. Plus, I had already been waiting 3 months just to see this guy. By the time I get to another provider its going to probably be many more months.  

*sigh* So it goes with healthcare.

CAT Scan With and Without Contrast

So my urologist ordered a CT with (called CT Urogram) and without contrast. If you want to know more about what that test is, please click here.