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
(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
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
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