Urology
Urology from Greek oupov ouron “urine” and ʎoyia-logia “Study Of”
Urology, also known as genitourinary surgery, is a branch of medicine that deals with surgical and medical diseases of male and female urinary tract and male reproductive organs.
The urinary and reproductive tracts are closely linked and diseases of one often affect the other. Thus a majority of conditions managed in urology come under genitourinary disorders.
The organs under the domain of urology include kidneys, adrenal glands, ureters, urinary bladder, urethra and male reproductive organs testes, epididymis, vas deferens, seminal vesicles, prostate and penis.
Surgeons specialized in the field of urology are called Urologist.
Historically, the subject which clearly established the specialty of urology as being distinct from general surgery was the treatment of obstructive uropathy. This treatment ranges from the correction of obstructing posterior urethral valves or ureteropelvic junction obstruction in the infant to the correction of bladder outlet obstruction from benign prostatic hyperplasia in the older male.
Urology combines
• Management of medical conditions such as urinary tract infections
• Management of surgical conditions such as obstructive uropathy, urinary cancers, congenital abnormalities and traumatic injuries,
• Combined medical and surgical management for conditions such as BPH (Benign prostatic hyperplasia) and urinary calculus disease (Stone).
Urology has traditionally been on the cutting-edge of surgical technology in the field of medicine. Urologists are well trained in minimally invasive techniques like endoscopy and laparoscopy, employing real time ultrasound guidance, fiber optic endoscopic equipment, and various lasers in the treatment of multiple benign and malignant conditions. In addition, urologists are pioneers in the use of robotics in laparoscopic surgery.
A knowledge and association with medicine, pediatrics, gynecology, nephrology, endocrinology and gastroenterology is required by the urologist because of the wide variety of clinical problems encountered.
In consideration of wide scope, multiple subspecialities have emerged in urology.
• Endourology for stones and prostate
• General urology
• Pediatric urology
• Uro-oncology
• Renal Transplantation
• Male infertility and andrology
• Female Urology
• Neuro-Urology
• Reconstructive Urology
• Laparoscopy in Urology
• Lasers in Urology
Endourology
Endourology is a branch or urology that deals with closed manipulation of 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 urethra, enabling prostate surgery, surgery of tumors of urothelium, stone surgery, and urethral and ureteral procedures.
Recently, the addition of laparoscopy and robotics has further subdivided this branch of urology.
Stone disease of the urinary tract has always provided a substantial portion of urologic practice. The recent introduction of rigid and flexible ureteroscopy has greatly improved the capacity of urologist to deal with the problem while the management of stones in the kidney has been revolutionized twice in the immediate past: first with the introduction of percutaneous methods for stone disintegration and extraction, and secondly by the application of extracorporeal shockwave lithotripsy. Collectively these techniques have largely rendered open surgical procedures for dealing with kidney and ureteral stones obsolete.
In addition, advances in the diagnosis and metabolic management or recurrent nephrolithiasis allow urologists to reduce the risk of recurrent stone formation.
Diseases of prostate are common in geriatric age group. Benign enlargement or prostate need either medical management or surgical interventions in the form or transurethral resection of prostate (TURP) or most recent technology of laser treatment for prostate (HOLEP) making open surgery for prostate obsolete.
General Urology
Urinary tract infections affecting every age group in both sexes comprise a significant fraction of urological practice.
While urinary tract infection may be the obvious and definitive clinical symptom at presentation, it may also reflect other disorders of the urinary tract such as stone or obstructive uropathy.
Much recent interest has been focused on the characterization of pathogenic bacteria that are particularly prone to cause persistent urinary tract infections, specifically pyelonephritis.
Bacteriuria is such a common clinical problem that there is inevitably a large cross-disciplinary approach to this problem. Urologists often interact with physician, pediatricians and gynecologists in the management of patients with bacteriuria.
Trauma to the genitourinary system involves the urologist as one member of the trauma team during initial evaluation of multiply-injured patient.
Recent improvements in imaging techniques for the evaluation of renal trauma and standardization of approaches to the problem of lower urinary tract trauma have significantly improved the care of such patients.
There are a vast number of operative approaches to the problem of late correction of injuries to the lower urinary tract which fall under the general heading of reconstructive surgery.
Pediatric urology
Pediatric urology concerns urologic disorders in children.
Major portion of pediatric urologic diseases are congenital anomalies. The urinary tract is affected by congenital anomalies more than any other organ system. The congenital urological abnormalities include relatively common problem of phimosis, undescended testes (cryptorchidism), pelviureteric junction obstruction, vesicoureteric reflux to the complex area of intersexuality.
Other urological diseases in children requiring care are urinary tract infections and nocturnal enuresis.
Urologic oncology
Urologic oncology concerns the surgical treatment of malignant diseases of genitourinary tract.
It includes cancer of prostate, adrenal glands, bladder, kidneys, ureter, testicles, and penis. The treatment of malignant disease is a very large portion of urologic practice.
The treatment of genitourinary cancer is managed by either urologist alone or with medical oncologist, depending on the treatment type (Surgical or medical). Some of the most encouraging results in the medical and surgical management of solid tumors have involved genitourinary tumors, namely testis tumors and Wilms’ tumor.
The development of multimodal therapy in which chemotherapy, radiation therapy and surgical treatment are used in conjunction, will hopefully improve the results of treatment of other genitourinary malignancies.
Most uro-oncologists use minimally invasive techniques (laparoscopy or endourology, robotic-assisted surgery) to manage urologic cancers amenable to surgical management.
Newer diagnostic methods for the detection of prostate cancer have recently emerged and currently the diagnosis and treatment of prostate cancer occupies much of many urologists time.
Renal transplantation
Involvement of urologist in the problems of renal insufficiency and end-stage renal disease (ESRD-CKD) has been necessitated by an enormous increase in the number of patients on dialysis and requiring transplantation. Urologist is an important member of surgical team of renal transplantation.
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 procedure, vasectomy reversals, and the implantation of penile prostheses.
The management of impotence has been revolutionized first and foremost by the introduction of prosthetic devices in urology. The area of prosthetics in urology has gradually expanded to encompass various forms of penile prostheses.
The management of infertility in the male has generally focused on the surgical correction of various acquired and congenital obstructions within the genital system, and increasingly sophisticated efforts to diagnose and treat the problem of coexisting male subfertility and varicocele.
Continued improvements in the medical management of male infertility require a high level of expertise in the area of reproductive physiology and endocrinology.
Female Urology
Female Urology, also known as Uro-gynecology, is a branch of urology dealing with urological problems in females.
There is a significant overlap of this branch with neuro-urology and reconstructive urology.
Common urological diseases in female are urinary tract infections, overactive bladder, pelvic organ prolapsed, and urinary incontinence.
The diagnosis and therapy of urinary incontinence constitute a significant portion of most urology practices.
Through 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.
Neuro-Urology
Neuro-urology 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 dys-synergia.
Urodynamic studies play and important diagnostics role in neuro-urology.
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 (painful bladder syndrome also known as interstitial cystitis)
Reconstructive Urology
Reconstructive urology is a highly specialized field of urology that restores both structure and function to the genitourinary tract.
The common reconstructive procedures are pyeloplasty, ureteric reimplantation or reconstruction of urethra for either stricture urethra both traumatic and inflammatory or hypospadias.
Laparoscopy in Urology
Laparoscopy is a rapidly evolving branch of urology and has replaced many open urological procedures.
Laparoscopy is useful for both ablative and reconstructive urological procedures.
Urological procedures performed by laparoscopy include adrenalectomy, nephrectomy, partial nephrectomy, donor nephrectomy, radical nephrectomy, radical prostatectomy, pyelolithotomy and ureterolithotomy in special situations.
Robot assisted surgery of the prostate, Kidney, and ureter has been expanding this field. This has created controversy, as robotics greatly increase the cost of surgery and the benefit for the patient may or may not be proportional to the extra cost
Lasers in Urology
Laser stands for light amplification by stimulated Emission of Radiation.
Four types of lasers are used in Urology. These are Nd-YAG, KTP or Green light laser, Holmium laser and diode laser.
Of all these, holmium laser is most versatile having indications in prostate (HOLEP), Stone (URS, RIRS, UMP), tumor and stricture (Laser VIU).
Use of lasers is the most happening thing in urology in recent times.
The specialty of urology is constantly changing. Much of this change has been the result of improved technology. Refinements in the area of ureteral and renal endoscopic surgery have already revolutionized the therapy of urinary tract stones and working in conjunction with the new generation of extracorporeal lithotripters many of the traditional open surgical approaches to the problems of renal and ureteral calculi are now largely obsolete. Other traditional urologic procedures, specifically vasovasostomy and hypospadias repair have improved results in selected cases with the use of surgical microscope. Skill and experience using the surgical microscope will undoubtedly be an important part of urologic practice in the future. Laser is the most happening thing in urology in recent times. Much recent research effort has evolved in the area of laparoscopic surgery. Many urologic operations which have been done by open surgery in the past can now be performed through the laparoscope. The development of new cancer chemotherapeutic agents has significantly altered therapy for some urologic cancers. In summary, Urology is a rapidly changing and exciting area of medicine which requires practicing urologists to be actively involved in continuing education.
Common urological diseases are
• Urinary stones- Kidney, ureter, bladder
• Benign Prostatic Hyperplasia (Enlarged Prostate - BPH)
• Urinary Cancer- Adrenal, Kidney, Ureter, Bladder, Prostate, Penis, Testes
• Erectile Dysfunction
• Male infertility
• Incontinence of urine (SUI, OAB, etc)
• Interstitial Cystitis/Painful Bladder Syndrome
• CKD / ESRD requiring Kidney Transplantation
• Congenital anomalies- Hypospadias, Undescended Testes, Ureteropelvic junction Obstruction, Vesicoureteral Reflux (VUR)
• Peyronie’s Disease
• Urethral Stricture
• Urinary Tract infection- Pyelonephritis, Cystitis, Prostatitis and Epididymo orchitis
• Nocturnal enuresis