Urology (from
Greek οὖρον ''ouron'' "urine" and ''
-logia'' "study of"), also known as genitourinary surgery, is the branch of
medicine
Medicine is the science and Praxis (process), practice of caring for a patient, managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, and Health promotion ...
that focuses on surgical and medical diseases of the
urinary-tract system and the
reproductive organ
A sex organ (or reproductive organ) is any part of an animal or plant that is involved in sexual reproduction. The reproductive organs together constitute the reproductive system. In animals, the testis in the male, and the ovary in the female, a ...
s. Organs under the domain of urology include the
kidney
The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; bloo ...
s,
adrenal glands,
ureter
The ureters are tubes made of smooth muscle that propel urine from the kidneys to the urinary bladder. In a human adult, the ureters are usually long and around in diameter. The ureter is lined by urothelial cells, a type of transitional e ...
s,
urinary bladder,
urethra, and the male reproductive organs (
testes,
epididymis,
vas deferens,
seminal vesicles,
prostate, and
penis).
The urinary and reproductive tracts are closely linked, and disorders of one often affect the other. Thus a major spectrum of the conditions managed in urology exists under the domain of
genitourinary disorders. Urology combines the management of medical (i.e., non-surgical) conditions, such as
urinary-tract infections and
benign prostatic hyperplasia, with the management of surgical conditions such as bladder or
prostate cancer
Prostate cancer is cancer of the prostate. Prostate cancer is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men. The prostate is a gland in the male reproductive system that sur ...
,
kidney stones, congenital abnormalities, traumatic injury, and
stress incontinence
Stress incontinence, also known as stress urinary incontinence (SUI) or effort incontinence is a form of urinary incontinence. It is due to inadequate closure of the bladder outlet by the urethral sphincter.
Pathophysiology
It is the loss of sma ...
.
Urological techniques include minimally invasive
robotic and
laparoscopic surgery, laser-assisted surgeries, and other scope-guided procedures. Urologists receive training in open and minimally invasive surgical techniques, employing real-time ultrasound guidance, fiber-optic endoscopic equipment, and various lasers in the treatment of multiple benign and malignant conditions. Urology is closely related to (and urologists often collaborate with the practitioners of)
oncology,
nephrology
Nephrology (from Greek'' nephros'' "kidney", combined with the suffix ''-logy'', "the study of") is a specialty of adult internal medicine and pediatric medicine that concerns the study of the kidneys, specifically normal kidney function (ren ...
,
gynaecology,
andrology,
pediatric surgery,
colorectal surgery,
gastroenterology, and
endocrinology
Endocrinology (from ''endocrine'' + '' -ology'') is a branch of biology
Biology is the scientific study of life. It is a natural science with a broad scope but has several unifying themes that tie it together as a single, coherent field ...
.
Urology is one of the most competitive and highly sought surgical specialties for
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
s, with new urologists comprising less than 1.5% of United States medical-school graduates each year.
Urologists are physicians which have specialized in the field after completing their general degree in medicine. Upon successful completion of a residency program, many urologists choose to undergo further advanced training in a subspecialty area of expertise through a fellowship lasting an additional 12 to 36 months. Subspecialties may include: urologic surgery, urologic oncology and urologic oncological surgery, endourology and endourologic surgery,
urogynecology and urogynecologic surgery, reconstructive urologic surgery (a form of
reconstructive surgery), minimally-invasive urologic surgery,
pediatric urology and pediatric urologic surgery (including adolescent urology, the treatment of premature or delayed puberty, and the treatment of congenital urological syndromes, malformations, and deformations),
transplant
Transplant or Transplantation may refer to:
Sciences
*Transplanting a plant from one location to another
*Organ transplantation, moving an organ from one body to another
*Transplant thought experiment, an experiment similar to Trolley problem
*Tra ...
urology (the field of transplant medicine and surgery concerned with transplantation of organs such as the kidneys, bladder tissue, ureters, and, recently, penises),
voiding dysfunction
Paruresis, also known as shy bladder syndrome, is a type of phobia in which a person is unable to urination, urinate in the real or imaginary presence of others, such as in a public restroom. The analogous condition that affects bowel movement i ...
,
paruresis,
neurourology
Urology (from Greek οὖρον ''ouron'' "urine" and ''-logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive orga ...
, and androurology and
sexual medicine. Additionally, some urologists supplement their fellowships with a master's degree (2–3 years) or with a Ph.D. (4–6 years) in related topics to prepare them for academic as well as focused clinical employment.
Training
United States
As of 2022, there are 146 residency programs that offered 356 categorical positions.
Urology is one of the early match programs, with results given to applicants by early February (6 weeks before NRMP match). Applications are accepted starting Sep 1, with some programs accepting applications until early Jan.
It is a relatively competitive specialty to match into, with only 65.6% of US seniors matching in the 2022 match cycle.
The number of positions has grown from 278 in 2012 to 356 in 2022. Matching is significantly more difficult for IMGs and students who have a year or more off before residency - match rates were 27% and 55% respectively in 2012.
The medical school environment may also be a factor. A study in 2012 also showed after an analysis of match rates from schools between 2005 and 2009 that 20 schools sent more than 15 students into urology (1
standard deviation
In statistics, the standard deviation is a measure of the amount of variation or dispersion of a set of values. A low standard deviation indicates that the values tend to be close to the mean (also called the expected value) of the set, whi ...
above the
median
In statistics and probability theory, the median is the value separating the higher half from the lower half of a data sample, a population, or a probability distribution. For a data set, it may be thought of as "the middle" value. The basic fe ...
), with Northwestern University sending 44 students over those 5 years.
After urology residency, there are seven subspecialties recognized by the AUA (American Urological Association):
* Oncology
* Calculi
* Female Urology
* Infertility
* Pediatrics
* Transplant (renal)
* Neurourology.
Australia
Training is completed through the
Royal Australasian College of Surgeons (RACS). The program requires six years of full-time training (for those who commenced prior to 2016), or five years for those who commenced after 2016. The program is accredited by the
Australian Medical Council.
Nepal
In Nepal, the formal urologist degree awarded is MCh (Magister Chirurgiae). This is a three years course post masters and includes thesis and a mandatory publication. This degree is awarded after completing MBBS (four and half year plus a one-year rotatory internship) and MS (Mastery of surgery) in general surgery (three years course). Till now two universities Tribhuvan University and Kathmandu University as well as two Autonomous institutes BP Koirala Institute of health sciences and National Academy of Medical Sciences (Bir Hospital) run the MCh Urology programme. This degree is equivalent to Clinical PhD and called as "Chikitsa Bidhyabaridhi" by Tribhuvan University (Government University) and is considered to be the highest degree among the surgical discipline degrees.
Ethiopia
Urology is a relatively new field in Ethiopia. By 2001, there were only five qualified Urologists in the country. All trained abroad, in countries like India, Tanzania and Hungary. Before this chapter all urology cases were managed by general surgeons. The only urological unit in the country was at Tikur Anbessa Tertiary Hospital. The services provided included
ESWL and endo-urology. The urology training program was started in 2009 with a curriculum for general surgeons which had a three-year training program. Up to 2019, six urologists have graduated by this program for general surgeons. The first residency program started accepting general practitioners in 2010 for a five-year program.
The first two years were trainings in general surgery, the next three years were dedicated urology training program, which included the same three-year training as of the general surgeons three year curriculum. It started with two residents who graduated in 2015 with a certificate in specialty of urology. Up to 2019, seventeen urologists have graduated from this five-year residency program. From the start these programs in 2009 up to 2019, a total of 23 urologists have been trained in Tikur Anbessa Tertioary Hospital. As of 2020, there were 26 trainees in the program. All of the urologists who graduated from Tikur Anbessa Tertioary Hospital were as of 2020 working in different parts of the country.
Subdisciplines
As a medical discipline that involves the care of many organs and physiological systems, urology can be broken down into several subdisciplines. At many larger academic centers and university hospitals that excel in patient care and clinical research, urologists often specialize in a particular sub discipline.
Endourology
Endourology is the branch of urology that deals with the closed manipulation of the urinary tract. It has lately grown to include all minimally invasive urologic surgical procedures. As opposed to open surgery, endourology is performed using small cameras and instruments inserted into the urinary tract. Transurethral surgery has been the cornerstone of endourology. Most of the urinary tract can be reached via the urethra, enabling prostate surgery, surgery of tumors of the
urothelium, stone surgery, and simple urethral and ureteral procedures. Recently, the addition of laparoscopy and robotics has further subdivided this branch of urology.
Laparoscopy
Laparoscopy is a rapidly evolving branch of urology and has replaced some open surgical procedures.
Robot-assisted surgery
Robotic surgery are types of surgical procedures that are done using robotic systems. Robotically assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabil ...
of the prostate, kidney, and ureter has been expanding this field. Today, many prostatectomies in the United States are carried out by so-called robotic assistance. This has created controversy, however, as robotics greatly increase the cost of surgery and the benefit for the patient may or may not be proportional to the extra cost. Moreover, current (2011) market situation for robotic equipment is a de facto monopoly of one publicly held corporation
which further fuels the cost-effectiveness controversy.
Urologic oncology
Urologic oncology concerns the surgical treatment of malignant genitourinary diseases such as cancer of the prostate, adrenal glands, bladder, kidneys, ureters, testicles, and penis, as well as the skin and subcutaneous tissue and muscle and fascia of those areas (that particular subspecialty overlaps with dermatological oncology and related areas of oncology). The treatment of genitourinary cancer is managed by either a urologist or an oncologist, depending on the treatment type (surgical or medical). Most urologic oncologists in Western countries use minimally invasive techniques (laparoscopy or endourology, robotic-assisted surgery) to manage urologic cancers amenable to surgical management.
Neurourology
Neurourology concerns
nervous system control of the genitourinary system, and of conditions causing abnormal
urination. Neurological diseases and disorders such as a stroke,
multiple sclerosis
Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. Thi ...
,
Parkinson's disease, and
spinal cord injury can disrupt the lower urinary tract and result in conditions such as
urinary incontinence,
detrusor overactivity,
urinary retention, and
detrusor sphincter dyssynergia.
Urodynamic studies play an important diagnostic role in neurourology. Therapy for nervous system disorders includes clean intermittent self-catheterization of the bladder, anticholinergic drugs, injection of Botulinum toxin into the bladder wall and advanced and less commonly used therapies such as sacral
neuromodulation.
Less marked neurological abnormalities can cause urological disorders as well—for example, abnormalities of the sensory nervous system are thought by many researchers to play a role in disorders of painful or frequent urination (e.g. painful bladder syndrome also known as
interstitial cystitis).
Pediatric urology
Pediatric urology concerns urologic disorders in
children. Such disorders include
cryptorchidism (undescended testes), congenital abnormalities of the genitourinary tract,
enuresis, underdeveloped genitalia (due to delayed growth or delayed puberty, often an endocrinological problem), and
vesicoureteral reflux.
Andrology
Andrology is the medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urological problems that are unique to men such as prostate cancer, male fertility problems, and surgery of the male reproductive system. It is the counterpart to gynaecology, which deals with medical issues that are specific to female health, especially reproductive and urologic health.
Reconstructive urology
Reconstructive urology is a highly specialized field of male urology that restores both structure and function to the genitourinary tract. Prostate procedures, full or partial hysterectomies, trauma (auto accidents, gunshot wounds, industrial accidents, straddle injuries, etc.), disease, obstructions, blockages (e.g., urethral strictures), and occasionally, childbirth, can necessitate reconstructive surgery. The urinary bladder, ureters (the tubes that lead from the kidneys to the urinary bladder) and genitalia are other examples of reconstructive urology.
Female urology
Female urology is a branch of urology dealing with
overactive bladder,
pelvic organ prolapse, and
urinary incontinence. Many of these physicians also practice neurourology and reconstructive urology as mentioned above. Female urologists (many of whom are men) complete a 1–3-year fellowship after completion of a 5–6-year urology residency.
Thorough knowledge of the female pelvic floor together with intimate understanding of the physiology and pathology of voiding are necessary to diagnose and treat these disorders. Depending on the cause of the individual problem, a medical or surgical treatment can be the solution. Their field of practice heavily overlaps with that of urogynecologists, physicians in a sub-discipline of gynecology, who have done a three-year fellowship after a four-year OBGYN residency.
Journals and organizations
There are a number of peer-reviewed journals and publications about urology, including ''
The Journal of Urology'', ''
European Urology'', the ''
African Journal of Urology'', ''
British Journal of Urology International
''BJU International'' (or ''BJUI'', formerly known as the ''British Journal of Urology'') is a monthly peer-reviewed medical journal that was established in 1929. The editor-in-chief is Freddie Hamdy and the journal is published by Wiley-Blackwel ...
'', ''
BMC Urology'',
Indian Journal of Urology
The ''Indian Journal of Urology'' is a peer-reviewed open access medical journal published by Medknow Publications on behalf of the Urological Society of India. The journal cover research in urology, including oncology, sexual dysfunction, inconti ...
'', ''
Nature Reviews Urology'', and ''
Urology''.
There are national organizations such as the
American Urological Association, the American Association of Clinical Urologists,
European Association of Urology, the Large Urology Group Practice Association (LUGPA),
and
The Society for Basic Urologic Research. Urology is also included under the auspices of the
International Continence Society
The International Continence Society (ICS) is a registered UK charity with a global health focus on the development in the field of incontinence.
It strives to improve the quality of life for people affected by urinary, bowel and pelvic floor di ...
.
Teaching organizations include the
European Board of Urology, as well as the
Vattikuti Urology Institute
The Vattikuti Urology Institute (VUI) at the Henry Ford Hospital in Detroit, Michigan, is a clinical and research center for urological care.
It is known for being the first institute to implement robotic surgery as a type of treatment for patie ...
in
Detroit
Detroit ( , ; , ) is the largest city in the U.S. state of Michigan. It is also the largest U.S. city on the United States–Canada border, and the seat of government of Wayne County. The City of Detroit had a population of 639,111 at ...
, which also hosts an annual
International Robotic Urology Symposium
International is an adjective (also used as a noun) meaning "between nations".
International may also refer to:
Music Albums
* ''International'' (Kevin Michael album), 2011
* ''International'' (New Order album), 2002
* ''International'' (The T ...
devoted to new technologies. The American non-profit
IVUMed teaches urology in
developing countries
A developing country is a sovereign state with a lesser developed Industrial sector, industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is al ...
.
List of urological topics
*
Benign prostatic hyperplasia
*
Bladder cancer
*
Bladder stones
*
Cystitis
*
Development of the urinary and reproductive organs
*
Epididymitis
*
Erectile dysfunction
*
Interstitial cystitis
*
Kidney cancer
*
Kidney stone
*
Kidney transplant
*
Postorgasmic illness syndrome
*
Prostate cancer
Prostate cancer is cancer of the prostate. Prostate cancer is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men. The prostate is a gland in the male reproductive system that sur ...
*
Prostatitis
*
Replantation
*
Retrograde pyelogram
*
Retrograde ureteral
Ureteroscopy is an examination of the upper urinary tract, usually performed with a ureteroscope that is passed through the urethra and the bladder, and then directly into the ureter. The procedure is useful in the diagnosis and treatment of diso ...
*
Testicular cancer
*
Vasectomy
Vasectomy, or vasoligation, is an elective surgical procedure for male Sterilization (medicine), sterilization or permanent contraception. During the procedure, the male vas deferens, vasa deferentia are cut and tied or sealed so as to prevent sp ...
*
Vasectomy reversal
See also
*
:Urology journals
*
:Urology organizations
References
External links
NAMS
{{Authority control
Surgical specialties