KNOW YOUR SPE­CIAL­IST… Urol­o­gist

Wellness Update - - Health Watch MD -

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.

Sub­dis­ci­plines

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

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

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

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

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

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 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

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

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.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.