Urology

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. It has evolved to encompass a broad range of minimally invasive and endoscopic urologic procedures. As opposed to open surgery, endourology is performed using small cameras and instruments inserted into the urinary tract. Transurethral surgery has long been a cornerstone of endourology as most of the urinary tract can be accessed via the urethra, enabling prostate surgery, surgery of tumors of the urothelium, stone surgery, and simple urethral and ureteral procedures. The addition of laparoscopy and robotic surgery has further subdivided this branch of urology.

Laparoscopy

Laparoscopy is a rapidly evolving branch of urology and has replaced some open surgical procedures.

Robotic surgery

Robotic surgery of the prostate, kidney, and ureter has been expanding this field. Today, many prostatectomies in the United States are carried out by 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 which further fuels the cost-effectiveness controversy.

Urologic oncology

Urologic oncology is the branch of medicine that focuses on the surgical treatment of malignant genitourinary diseases. This includes cancers of the prostate, adrenal glands, bladder, kidneys, ureters, testicles, and penis, as well as the skin, subcutaneous tissue, muscle, and fascia of these areas, a domain that partially overlaps with dermatologic oncology and related oncology subspecialties. Management of genitourinary cancers may be handled by a urologist or an oncologist, depending on whether the treatment is surgical or medical. In Western countries, most urologic oncologists employ minimally invasive techniques, such as laparoscopy, endourology, or robotic-assisted surgery, to treat cancers that are suitable for surgical intervention.

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 focused on male health, particularly conditions affecting 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 addresses female-specific medical issues, especially those related to reproductive and urologic health.

Reconstructive urology

Reconstructive urology is a highly specialized branch of male urology focused on restoring both the structure and function of the genitourinary tract. Reconstructive procedures may be required following prostate surgeries, full or partial hysterectomies, trauma (such as automobile accidents, gunshot wounds, industrial accidents, or straddle injuries), disease, obstructions, or blockages like urethral strictures, and occasionally even childbirth. Areas commonly addressed in reconstructive urology include the urinary bladder, ureters (the tubes connecting the kidneys to the bladder), and the genitalia, among others, depending on the nature and extent of the injury or condition.

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 complete a 1–3-year fellowship after completion of a 5–6-year urology residency. 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.

Journals and organizations

There are a number of peer-reviewed journals and organizations associated with urology, see Category: Urology journals ad Category:Urology organizations.

List of urological topics

• Benign prostatic hyperplasia
• Bladder cancer
• Bladder stones
• Cystitis
• Development of the urinary and reproductive organs
• Epididymitis
• Erectile dysfunction
• Hard flaccid syndrome
• Interstitial cystitis
• Kidney cancer
• Kidney stone
• Kidney transplant
• Peyronie's disease
• Postorgasmic illness syndrome
• Prostate cancer
• Prostatitis
• Replantation
• Retrograde pyelogram
• Retrograde ureteral
• Testicular cancer
• Vasectomy
• Vasectomy reversal