Urology

Last updated
Rtu.jpg
Occupation
Occupation type
Specialty
Activity sectors
Medicine, surgery
Description
Education required
Fields of
employment
Hospitals, Clinics

Urology (from Greek οὖρον ouron "urine" and -λογία -logia "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the male and female urinary-tract system and the male reproductive organs. Organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate, and penis).

Contents

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, kidney stones, congenital abnormalities, traumatic injury, and stress incontinence. [1]

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. [2] [3] Urology is closely related to (and urologists often collaborate with the practitioners of) oncology, nephrology, gynaecology, andrology, pediatric surgery, colorectal surgery, gastroenterology, and endocrinology.

Urology is one of the most competitive and highly sought surgical specialties for physicians, with new urologists comprising less than 1.5% of United States medical-school graduates each year. [4] [5]

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 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, neurourology, 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

In 2014, there were 126 residency programs that offered 296 categorical positions. [6] Urology is one of the early match programs, with results given to applicants by late January (6 weeks before NRMP match). Applications are accepted starting Sep 1, with some programs accepting applications until early Jan. [7]

It is a relatively competitive specialty to match into, with only 68% to 77% of US seniors matching between 2012 and 2015. [6] The number of positions has grown from 278 in 2012 to 296 in 2015. 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. [8]

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 sd above median), with Northwestern University sending 44 students over those 5 years. [9]

After urology residency, there are 7 subspecialties recognized by the AUA (American Urological Association):

Australia

Training is completed through the Royal Australasian College of Surgeons [11] (RACS). The program requires 6 years of full-time training (for those who commenced prior to 2016), or 5 years for those who commenced after 2016. [12] The program is accredited by the Australian Medical Council. [11]

Pre-requisites include: [13]

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 (4 and half year plus 1 year rotatery internship) and MS (Mastery of surgery) in general surgery (3 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. 19, 20 This degree is equivalent to Clinical PhD and called as "Chikitsa Bidhyabaridhi" by Tribhuvan University ( Government University ) and considered highest degree among the surgical discipline degrees. Besides Urology, Cardiothoracic and Vascular Surgery, Surgical Gastroenterology, Plastic Surgery and Neurosurgery MCh programme also run in 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. [14] 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 urethral 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 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 [15] 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, 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. [16] 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. [16]

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 , BMC Urology , Indian Journal of Urology , Nature Reviews Urology , and Urology .

There are national organizations such as the American Urological Association, the American Association of Clinical Urologists, [17] European Association of Urology, the Large Urology Group Practice Association, [17] and The Society for Basic Urologic Research. Urology is also included under the auspices of the International Continence Society.

Teaching organizations include the European Board of Urology, as well as the Vattikuti Urology Institute in Detroit, which also hosts an annual International Robotic Urology Symposium devoted to new technologies. The American non-profit IVUMed teaches urology in developing countries.

Urology in the COVID19 pandemic

During the COVID-19 pandemic, urology services around the Globe were suspended their activities in affected countries and regions. International Associations (such as European Association of Urology, New Zeland and Australia Association of Urology) and Urology Departments from universities (Cleveland Clinic and others), have provided guidelines and recommendations on which urological procedures should or should not be prioritized during the Pandemic. Optimizing resources and preventing patients with priority diseases from being negatively impacted. A systematic review was published in the European Journal Urology Focus, summarizing such recommendations. [18]

List of urological topics

See also

Related Research Articles

Ureter

The ureters are tubes made of smooth muscle that propel urine from the kidneys to the urinary bladder. In the human adult, the ureters are usually 20–30 cm (8–12 in) long and around 3–4 mm (0.12–0.16 in) in diameter. The ureter is lined by urothelial cells, a type of transitional epithelium, and has an additional smooth muscle layer in third closest to the bladder that assists with peristalsis.

Hematuria

Hematuria is defined as the presence of blood or red blood cells in the urine. An anatomical framework is helpful in developing a comprehensive differential diagnosis. Blood or red blood cells can enter and mix with urine at multiple anatomical sites. These include the urinary system, female reproductive system, and integumentary system.

Pediatric urology is a surgical subspecialty of medicine dealing with the disorders of children's genitourinary systems. Pediatric urologists provide care for both boys and girls ranging from birth to early adult age. The most common problems are those involving disorders of urination, reproductive organs and testes.

Cystectomy

Cystectomy is a medical term for surgical removal of all or part of the urinary bladder. It may also be rarely used to refer to the removal of a cyst. The most common condition warranting removal of the urinary bladder is bladder cancer.

Prostatectomy Surgical removal of all or part of the prostate gland

Prostatectomy as a medical term refers to the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for prostate cancer and for other cancers of the pelvis.

Vesicoureteral reflux

Vesicoureteral reflux (VUR), also known as vesicoureteric reflux, is a condition in which urine flows retrograde, or backward, from the bladder into one or both ureters and then to the renal calyx or kidneys. Urine normally travels in one direction from the kidneys to the bladder via the ureters, with a 1-way valve at the vesicoureteral (ureteral-bladder) junction preventing backflow. The valve is formed by oblique tunneling of the distal ureter through the wall of the bladder, creating a short length of ureter (1–2 cm) that can be compressed as the bladder fills. Reflux occurs if the ureter enters the bladder without sufficient tunneling, i.e., too "end-on".

Alexander Gershman is an Russian American surgeon He is considered to be one of the first surgeons in the world to apply the method of laparoscopic surgery and robotic-assisted surgery to urological surgery and is considered one of the world’s leading experts on minimally invasive surgery. After many years teaching, researching and conducting clinical studies on laparoscopic surgery throughout the world, Gershman is in private practice in Beverly Hills, California. His client list includes numerous Hollywood celebrities and professional athletes.

Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra and, in men, the prostate. Although LUTS is a preferred term for prostatism, and is more commonly applied to men, lower urinary tract symptoms also affect women.

Mani Menon

Mani Menon, born 9 July 1948 in Trichur, India, is an American surgeon whose pioneering work has helped to lay the foundation for modern robotic cancer surgery. He is the founding director and the Raj and Padma Vattikuti Distinguished Chair of the Vattikuti Urology Institute at the Henry Ford Hospital in Detroit, MI, where he established the first cancer-oriented robotics program in the world. Menon is widely regarded for his role in the development of robotic surgery techniques for the treatment of patients with prostate, kidney, and bladder cancers, as well as for the development of robotic kidney transplantation.
Menon is the recipient of the Gold Cystoscope award, Hugh Hampton Young award, the Keyes Medal, the prestigious B.C. Roy award.

Urologic diseases or conditions include urinary tract infections, kidney stones, bladder control problems, and prostate problems, among others. Some urologic conditions do not affect a person for that long and some are lifetime conditions. Kidney diseases are normally investigated and treated by nephrologists, while the specialty of urology deals with problems in the other organs. Gynecologists may deal with problems of incontinence in women.

Ashutosh Tewari

Ashutosh K. Tewari is the chairman of urology at the Icahn School of Medicine at Mount Sinai Hospital in New York City. He is a board certified American urologist, oncologist, and principal investigator. Before moving to the Icahn School of Medicine in 2013, he was the founding director of both the Center for Prostate Cancer at Weill Cornell Medical College and the LeFrak Center for Robotic Surgery at NewYork–Presbyterian Hospital. Dr. Tewari was the Ronald P. Lynch endowed Chair of Urologic Oncology and the hospital's Director of Robotic Prostatectomy, treating patients with prostate, urinary bladder and other urological cancers. He is a world leading urological surgeon, and has performed over 9,000 robotically assisted procedures using the da Vinci Surgical System. Academically, he is recognized as a world-renowned expert on urologic oncology with over 250 peer reviewed published papers to his credit; he is on such lists as America's Top Doctors, New York Magazine's Best Doctors, and Who's Who in the World. In 2012, he was given the American Urological Association Gold Cystoscope Award for "outstanding contributions to the field of urologic oncology, most notably the treatment of prostate cancer and the development of novel techniques to improve the outcomes of robotic prostatectomy."

Douglas S. Scherr, M.D. is an American surgeon and specialist in Urologic Oncology. He is currently the Clinical Director of Urologic Oncology at the Weill Medical College of Cornell University in New York City. He also holds an appointment at the Rockefeller University in New York as a Visiting Associate Physician. Dr. Scherr was the first physician at Cornell to perform a robotic prostatectomy as well as a robotic cystectomy.

Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology.

The Urology Center of Westchester (UCW) is a community-based practice of academic and specialist urologists affiliated with Westchester Medical Center, the major teaching hospital in the Hudson Valley region of lower New York State, USA. UCW was incorporated in 1988 and consists of specialists in urology, the surgical and medical field dealing with the genito-urinary system. Services provided include: robotics, stone disease and management, treatments for cancers of the prostate, bladder, kidney, and testis, incontinence disorders, erectile dysfunction and urinary problems in men and women.

Michael Palese

Dr. Michael A. Palese, is an American urologist specializing in robotic, laparoscopic and endoscopic surgery, with a special emphasis on robotic surgeries relating to kidney cancer and kidney stone disease.

Mahesh Desai is an Indian urologist who treats various kidney and urological diseases in India. He performs renal transplants in Gujarat, India.. He is considered to be the legend of Indian Urology.

Narmada Prasad Gupta is an Indian urologist, medical researcher, writer and the Chairman of Academics and Research Division Urology at the Medanta, the Medicity, New Delhi. He is credited with over 10,000 urological surgical procedures and the highest number of URobotic surgeries in India. He is a former head of department of Urology of the All India Institute of Medical Sciences Delhi and a former president of the Urological Society of India. He received Dr. B. C. Roy Award, the highest Indian award in the medical category, from the Medical Council of India in 2005. The Government of India awarded him the fourth highest civilian honour of the Padma Shri, in 2007, for his contributions to Indian medicine.

Jerry Blaivas is an American urologist and senior faculty at the Icahn School of Medicine at Mount Sinai in New York City and adjunct professor of Urology at SUNY Downstate Medical School in Brooklyn, as well as professor of clinical urology at College of Physicians and Surgeons, Columbia University and clinical professor of Urology at Weill Medical College of Cornell University. He has four patents pending; received four research grants for which he served as the principal investigator; as of 2018 published 216 peer-reviewed articles, 14 books and 219 book chapters and served as a major in the United States Army assigned to the Walson Army Hospital. He served as president, Urodynamic Society.

The Urology Foundation

The Urology Foundation (TUF), is a charity that works across the UK and Ireland with the aim of improving the knowledge and skills of surgeons who operate on diseases of the male and female urinary-tract system and the male reproductive organs and funds research to improve outcomes of all urological conditions and urological cancers.

René Sotelo Surgeon

René Sotelo is a Venezuelan robotic surgeon, urologist-oncologist and university professor.

References

  1. "Urology". American Medical Association. Retrieved 28 April 2020.
  2. "Urologist in Noida". Full Details Information. 27 March 2019.
  3. Marks AJ; Teichman JM (2007). "Lasers in clinical urology: State of the art and new horizons". World Journal of Urology. 25 (3): 227–233. doi:10.1007/s00345-007-0163-x. PMID   17393172.
  4. Ahmed K; Jawad M; Dasgupta P; Darzi A; et al. (2010). "Assessment and maintenance of competence in urology". Nat Rev Urol. 7 (7): 403–13. doi:10.1038/nrurol.2010.81. PMID   20567253.
  5. "Facts: Applicants, Matriculants, Enrollment, Graduates, MD/PhD, and Residency Applicants Data - Data and Analysis". AAMC. Retrieved 2013-09-01.
  6. 1 2 https://residency.wustl.edu/Choosing/SpecDesc/Pages/Urology.aspx
  7. "American Urological Association - Accredited U.S. Urology Residency Programs". www.auanet.org.
  8. "Urology Residency Guide - Urology Match". www.urologymatch.com.
  9. Kutikov, A; Bonslaver, J; Casey, J. T.; Degrado, J; Dusseault, B. N.; Fox, J. A.; Lashley-Rogers, D; Richardson, I; Smaldone, M. C.; Steinberg, P. L.; Trivedi, D. B.; Routh, J. C. (2010). "The Gatekeeper Disparity: Why Do Some Medical Schools Send More Medical Students into Urology?". The Journal of Urology. 185 (2): 647–652. doi:10.1016/j.juro.2010.09.113. PMC   3058515 . PMID   21168862.
  10. "Urology - An Overview - Urology Match". www.urologymatch.com.
  11. 1 2 (RACS), Royal Australasian College of Surgeons. "Urology". www.surgeons.org. Retrieved 2018-01-24.
  12. "Overview - Urological Society of Australia and New Zealand". www.usanz.org.au. Retrieved 2018-01-24.
  13. "Urology". Australian Medical Association. 2016-02-17. Retrieved 2018-01-24.
  14. "Website of the Endourologic Society". Endourology.org. Retrieved 2013-09-01.
  15. "Intuitive Surgical, Inc". Intuitivesurgical.com. Retrieved 2013-09-01.
  16. 1 2 http://sufuorg.com/Professional-Resources/Fellowships/Fellowship-Programs.aspx
  17. 1 2 "Clinical Urologists Group Supports Genomic Testing for Prostate Cancer". ClinicalOMICs. 6 March 2018. Retrieved 9 March 2018. The Association, which represents nearly 4,000 member urologists nationwide, said in the one-page statement.... The AACU’s statement has won support from the Large Urology Group Practice Association (LUGPA), which represents more than 2,300 physicians who make up more than 25% of the nation’s practicing urologists.
  18. Heldwein, Flavio Lobo; Loeb, Stacy; Wroclawski, Marcelo Langer; Sridhar, Ashwin Narasimha; Carneiro, Arie; Lima, Fabio Sepulveda; Teoh, Jeremy Yuen-Chun (2020-06-05). "A Systematic Review on Guidelines and Recommendations for Urology Standard of Care During the COVID-19 Pandemic". European Urology Focus. 0 (0). doi: 10.1016/j.euf.2020.05.020 . ISSN   2405-4569. PMID   32532703.

19. https://nams.org.np/about.php 20. http://www.iom.edu.np/?page_id=21