Urology has always had its own place within the medical profession. For centuries there has been a distinction between barbers/surgeons, for the cutting part of medicine, and the learned, university-educated, medical doctors, who used herbs and diets. Urologists come forth from the stonecutters, who used to travel around medieval Europe and practiced their skills on fairs, alongside the predecessors of dentists, and cured their, mostly male, patients of their bladder stones.

Historically, management of obstruction by the prostate, especially with the aid of a urinary catheter and the cystoscope as a diagnostic tool, helped to establish Urology as a surgical specialty distinct from General Surgery. The management of prostate diseases is still a major part of urologic practice. Urologic practices have included both open surgery (including microsurgery) and endoscopic procedures. Medical pharmacologic management is also a prominent feature of certain urologic disorders. The Specialty of Urology has continuously adopted new technologies and "minimally invasive surgery" has now become the mainstay of some subspecialty areas, e.g., management of urinary stone disease.

In addition to "General Adult Urology" there are several subspecialized areas in Urology. A Urologist deals with clinical problems relating to most of the subspecialty areas listed previously. Some Urologists choose to concentrate their clinical practice in one or two of the subspecialty areas. A brief description of each of the above subspecialty areas follows.

The genitourinary tract is the most common system affected by congenital anomalies ranging from undescended testes and congenital hydronephrosis to complex sexual differentiation anomalies. Obstetric ultrasonography has revolutionized the practice of Pediatric Urology in the recent years thus fetal and neonatal urology are rapidly expanding fields. Pediatric Urologists perform reconstructive surgery on many congenital abnormalities. As well, the Pediatric Urologist takes care of more general urologic problems such as oncology, stones, voiding dysfunction etc. in the pediatric population.

(malignancies of the relevant organ sites)

The management of urologic cancers comprises a major portion of Urologic practice. Prostatecancer is the most prevalent malignancies in males. As well, cancers of the kidney, bladder, testis, external genitalia and adrenal gland are all managed surgically by the Urologist. In most of these tumours, the Urologist works closely with the Radiation Oncologist and Medical Oncologist. Urologic Oncology is probably the most active area of urologic research and clinical work.

(urinary tract stone diseases)

Traditionally, stone disease had been a main feature of Urologic practice. Enormous progress has been made in this area in the past decade. The practice pattern has changed significantly over the years with the introduction of:

percutaneous stone disintegration and removal techniques
extracorporeal shock wave lithotripsy.

Electrohydraulic, ultrasonic and laser energies, as well as improved endoscopes and other instrumentation, have continuously modified the practice of stone disease management. The Urologist also takes part in the metabolic workup and medical therapy for stone diseases, often in association with a nephrologist.

Male sexual dysfunction and infertility have been placed under the umbrella of Andrology, "the study of male problems." This is one of the most rapidly expanding areas of Urology. Impotence management includes both diagnosis and treatment. Therapeutic modalities range from pharmacologic means, external assist devices, vascular reconstruction to surgical implantation of prostheses. The Urologist and the Gynecologist often collaborate in the treatment of the infertile couple. Surgical reversal of vasectomy using microsurgical techniques is performed by the Urologist. Microsurgical techniques are also used by Urologists in highly specialized techniques of sperm retrieval and intracytoplasmic injection.

The management of female pelvic outlet/pelvic floor relaxation disorders and urinary incontinence is in the domain of the Urologist and most progress in this area has originated from Urologists. Surgical correction of such disorders has evolved over the years. The subspecialty of Neurourology (vide infra) has facilitated understanding and evaluation of both female and male voiding dysfunction.

Urodynamics has provided better understanding of voiding dysfunction, incontinence, and neuromuscular disorders. The diagnosis, evaluation and management of the "neurogenic bladder" are part of the Urologist's practice.

Renal transplants are performed at some centres by Urologists and at other centres by the Surgical Transplant Team, with the Urologist as a member of the team. Some Urologists also participate in the medical management (immunosuppression) and have an active role in transplant immunology research as well as experimental transplant surgery such as xenografting. Urologists may also construct dialysis access sites for patients with end-stage renal disease. Renal artery reconstruction and surgical management of renovascular hypertension are also part of the practice of some Urologists

Click to find out