urology

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Urology (from Greek οὖρον - oûron, "urine" and -λογία, -logia "study of") is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological disorders. The organs covered by urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate and penis). Urology is one of the most competitive specialties to enter for physicians.^[1]

The urinary and reproductive tracts are closely linked, and disorders of one often affect the other, so a major part of the conditions managed in urology fall in the area of genitourinary disorders. Urology combines management of medical (i.e., non-surgical) problems such as urinary tract infections and benign prostatic hyperplasia, as well as surgical problems such as the surgical management of cancers, the correction of congenital abnormalities, and correcting stress incontinence. Urology is closely related to, and in some cases overlaps with, the medical fields of oncology, nephrology, gynecology, andrology, pediatric surgery, gastroenterology, and endocrinology.

Subdisciplines

As a discipline that involves the study of many organs and physiological systems, urology can be broken down into subdisciplines. At larger centers and especially university hospitals, many urologists specialize within a particular subdiscipline of urology.

Endourology

Endourology^[2] is the branch of urology that deals 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. 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 proportional to the extra cost. Moreover, current (2011) market situation for robotic equipment is a de-facto monopoly of one publicly held corporation^[3] 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. 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, formerly known as interstitial cystitis).

Pediatric urology

Pediatric urology concerns urologic disorders in children. Such disorders include cryptorchism (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 function to any of various structures of 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. Often, plastic surgeons assist in these procedures, although purely cosmetic procedures such as penis enlargement do not fall under the rubric 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.

See also

• Benign prostatic hyperplasia
• Bladder stones
• Bladder cancer
• Cystitis
• Development of the urinary and reproductive organs
• Epididymitis
• Erectile dysfunction
• Interstitial cystitis
• Kidney cancer
• Medical specialty
• Kidney stone
• Prostatitis
• Prostate cancer
• Retrograde pyelogram
• Retrograde ureteral
• Testicular cancer
• Urolithiasis
• Vasectomy
• Vasectomy reversal

References

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