urology

Urology is the 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 ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate and penis).

In men, the urinary system overlaps with the reproductive system, and in women the urinary tract opens into the vulva. In both sexes, the urinary and reproductive tracts are close together, and disorders of one often affect the other. Urology combines management of medical (i.e. non-surgical) problems such as urinary infections, and surgical problems such as the correction of congenital abnormalities and the surgical management of cancers. Such abnormalities within the genital region are called genitourinary disorders.

Urology is closely related to, and in some cases overlaps with, the medical fields of oncology, nephrology, gynecology, andrology, pediatric surgery, plastic surgery, proctology, dermatology and endocrinology.

Branches of urology

As a discipline that involves the study of many organs and physiological systems, urology can be broken down into subfields. In many countries office urologists treat general urologic health problems and carry out basic surgical procedures while more complicated cases are referred to the hospital. At larger centers and especially university hospitals, most urologists sub-specialize within a particular field of urology.

Endourology is the branch of urology that deals with minimal invasive surgical procedures. As opposed to open surgery, endourology is carried out through instruments. Traditionally, transurethral surgery has been the cornerstone of endourology. Via the urethra, the complete urinary tract can be reached, enabling prostate surgery, surgery of tumors of the urothelium, stone surgery and simple urethral and ureteral procedures. During the last years, laparoscopy has evolved rapidly and is about to replace certain formerly open surgical procedures. Robotic tumor surgery of the prostate is the lastest development in endourology and the fastest growing. Today, approximately 80% of prostatectomies in the U.S. are carried out by robotic surgery.

Oncologic urology concerns the surgical treatment of malignant genitourinary diseases such as cancer of the prostate, bladder, kidneys, testicles and penis. The medical treatment of advanced genitourinary cancer is in some countries done by urologic oncologists, in some countries by urologists.

Neurourology concerns nervous system control of the genitourinary system, and of conditions causing abnormal urination. Neurological diseases and disorders such as 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 bladder 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).[1]

Pediatric urology concerns urologic disorders in children. Such disorders include cryptorchism, congenital abnormalities of the genito-urinary tract, enuresis, vesicoureteral reflux.

Andrology focusses 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 refertilisation procedures and the implantation of penile prostheses.

Plastic and reconstructive urology reestablishes functionality of the genito-urinary tract. Strictures of the urethra or the ureter often require reconstructive surgery. Another frequent procedure is the reconstruction of the urinary bladder from small bowel in conjunction with cancer surgery. In children, typical plastic procedures are the surgical correction of hypospadias and epispadias. Cosmetic surgery such as penis enlargement is rarely done in urology. True penile lengthening is technically not feasible with today’s state of the art.

Gynecologic urology. Urinary incontinence in women is a common problem. The complex anatomy of the female pelvic floor with reproductive and urinary organs positioned close to each other makes women susceptible to developing problems in this region of the body. 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
• Erectile dysfunction
• Interstitial cystitis
• Kidney stones
• Medical specialty
• Prostatitis
• Prostate cancer
• Retrograde pyelogram
• Testicular cancer
• Vasectomy