KNOW YOUR SPECIALIST… Urologist
Urology focuses on surgical and medical diseases of the male and female urinary tract system and the male reproductive organs. Organs under the care of a urologist include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate and penis). Urologic surgeons, or urologists, undergo a rigorous post-graduate surgical training period for a minimum of five years, of which 12 months must be training in general surgery and 36 months training in clinical urology. The remaining 12 months are spent in general surgery, urology or other clinical disciplines relevant to urology. Upon successful completion of a residency program, some urologists choose to undergo further advanced training in a sub-specialty area of expertise through a fellowship lasting an additional 12 to 36 months. 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. Urology has traditionally been on the cutting-edge of surgical technology in the field of medicine. Urologists are well-trained in minimally-invasive techniques, employing real-time ultrasound guidance, fiberoptic endoscopic equipment, and various lasers in the treatment of multiple benign and malignant conditions. Urologists have been pioneers in the use of robotics in laparoscopic surgery. And because urology is closely related to such medical fields as oncology, nephrology, gynecology, andrology, pediatric surgery, colorectal surgery, gastroenterology, andendocrinology, urologists often collaborate with other medical professionals.
As a medical discipline involving the care of many organs and physiological systems, urology can be broken down into several subdisciplines. Urologists often specialize within a particular subdiscipline of urology.
Endourology is the branch of urology dealing with the closed manipulation of the urinary tract. It has lately grown to include all urologic minimally invasive 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 is a rapidly evolving branch of urology and has replaced some open surgical procedures. Robotassisted surgery of the prostate, kidney, and ureter has been expanding this field. Today, many prostatectomies in the United States are done by robotic assistance.
Urologic oncology centers on the surgical treatment of malignant genitourinary diseases such as cancer of the prostate, adrenal glands, bladder, kidneys, ureters, testicles, and penis. 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 focuses on the 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 y 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 xin in into the bladder wall and advanced and less commonly used therapies such as sacralneuromodulation. Less marked ke ked neurological abnormalities can cause urological disorders s as well—for example, abnormalities of the sensory nervous us 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 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 focuses on the male reproductive system. It is mainly concerned with male infertility, erectile dysfunction and ejaculatory disorders. Since male sexuality is largely controlled by hormones, andrology overlaps with endocrinology. Surgery in this field includes fertilization procedures, vasectomy reversals, and the implantation of penile prostheses. Vasectomies may also be included here, although most urologists perform this procedure.
Reconstructive urology is a highly specialized field of 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 require 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.
Urogynecology is a branch dealing with overactive bladder, pelvic organ prolapse, and urinary incontinence. Thorough knowledge of the female pelvic floor together with urodynamic skills 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.