Urology: no more emergency cases – prevention and early diagnosis are needed

The ongoing demographic shift and the progressive ageing of the population call for a fundamental review of public health strategies. The clinical and policy challenge of our time lies not in the extension of life expectancy, but in maintaining functional integrity, independence and quality of life in old age. In this context, urological and andrological health lies at the heart of the biological and social determinants that define an individual’s well-being and the future sustainability of healthcare systems.

Despite the epidemiological impact of urological conditions – whether cancerous, benign or degenerative – a structural imbalance persists in our country regarding access to primary and secondary prevention between the female and male populations. Whilst for women, specialist assessment is an established part of their life course, men tend to delay consulting a urologist until overt clinical symptoms appear. Such a delay in diagnosis can compromise the effectiveness of treatment options and reduce the likelihood of being able to use treatment approaches with a lower functional impact.

To mark the sixth National Urology Day, the Italian Society of Urology aims to promote a shift away from reactive medicine – which intervenes only in emergency situations – towards a culture of prevention and early diagnosis. A urological assessment should not be viewed as a corrective measure, but as a preventive step to be planned in the absence of symptoms. In the field of prostate cancer, for example, it must be made clear that understanding one’s risk cannot be limited to a single measurement of prostate-specific antigen (PSA), which is an organ-specific marker but not specific to cancer. Accurate risk stratification requires a multidisciplinary approach that assesses personal and family medical history, clinical examination and, where indicated, further diagnostic investigations, in order to determine the necessary follow-up and avoid both diagnostic delays and overdiagnosis.

At the same time, the urogenital system serves as a sensitive indicator of overall health. Changes in the urinary stream, urgency, difficulty in passing urine or symptoms such as nocturia are not simply the physiological and inevitable consequences of ageing, but signs of functional changes that warrant further investigation: frequent night-time urination, in particular, disrupts sleep and may be an indicator of problems not only relating to the prostate, but also cardiovascular and metabolic issues. Similarly, sexual health and fertility are integral components of men’s wellbeing: the onset or worsening of erectile dysfunction may be a sign of vascular disease or a metabolic disorder – even if subclinical – which should not be underestimated; similarly, assessing a couple’s fertility requires a prompt evaluation of both partners.

Prevention is also achieved through a healthy lifestyle, starting with avoiding smoking (the main risk factor for bladder cancer), as well as through the identification and management of modifiable and environmental risk factors. Adhering to the Mediterranean diet and ensuring regular and adequate hydration (taking care to reduce fluid intake in the evening to preserve sleep quality) help to protect the kidneys and the urinary tract; at the same time, particular attention must be paid to protection against occupational exposure to chemicals, such as paints, solvents, pesticides and aromatic amines, as well as to sources of heat, which are known to have a negative impact on reproductive health and, in some cases, on cancer risk. It is also essential to encourage self-examination of the genitals and prompt consultation with a specialist in the event of any persistent lesions or abnormalities, as well as to monitor the polypharmacy typical of older age, given that certain medicines can interfere with urination, erectile function and kidney function.