Urology

Urology, also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the male and female urinary tract system and the male reproductive organs. Organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate, and penis).

The urinary and reproductive tracts are closely linked, and disorders of one often affect the other. Thus, a major spectrum of the conditions managed in urology exist under the domain of genitourinary disorders. Urology combines the management of medical conditions, such as urinary tract infections and benign prostatic hyperplasia, with the management of surgical conditions, such as bladder or prostate caner, kidney stones, congenital abnormalities, traumatic injury, and stress incontinence.

Urological techniques include minimally invase robotic and laparoscopic surgery, laser-assisted surgeries, and other scope-guided procedures. Urologists receive training in open and minimally invasive surgical techniques, employing real-time ultrasound guidance, fiber-optic endoscopic equipment, and various lasers in the treatment of multiple benign and malignant conditions. Urology is closely related to oncology, nephrology, gynecology, andrology, pediatric surgery, colorectal surgery, gastroenterology, and endocrinology.

Urology is one of the most competitive and highly sought surgical specialties for physicians, with new urologists comprising less than 1.5% of United States medical school graduates each year.

Training
Urologic surgeons undergo a post-graduate surgical training period for a minimum of five years, of which 12 months must be completed in general surgery and 36 months must be completed in clinical urology. The remaining 12 months are spent in general surgery, urology, or other clinical disciplines relevant to urology. Upon successful completion of a residency program, many urologists choose to undergo further advanced training in a subspecialty area of expertise through a fellowship lasting an additional 12 to 36 months. Subspecialties may include: Additionally, some urologists supplement their fellowships with a master's degree (2 to 3 years) or with a Ph.D. (4 to 6 years) in related topics to prepare them for academic as well as focused clinical employment.
 * Urologic surgery
 * Urologic oncology
 * Endourology
 * Endourologic surgery
 * Urogynecology
 * Urogynecologic surgery
 * Reconstructive urologic surgery
 * Minimally invasive urologic surgery
 * Pediatric urology
 * Pediatric urologic surgery
 * Transplant urology
 * Neurourology
 * Androurology

In 1024, there were 126 residency programs that offered 296 categorical positions. Urology is one of the early match programs, with results given to applicants by late January (6 weeks before NRMP match). Applications are accepted starting September 1, with some programs accepting applications until early January.

Urology is a relatively competitive specialty to match into, with only 68 to 77% of United States seniors matching between 2012 and 2015. The number of positions has grown over the past few  years from 278 in 2012 to 296 in 2015. Matching is significantly more difficult for IMGs and students who have a year or more off before residency - match rates were 27% and 55% respectively in 2012.

The medical school environment may also be a factor. A study in 2012 also showed after an analysis of match rates from schools between 2005 to 2009 that 20 schools sent more than 15 students into urology, with Northwestern University sending 44 students over those five years.

After urology residency, there are seven subspecialties recognized by the American Urological Association:


 * Oncology


 * Calculi


 * Female Urology


 * Infertility


 * Pediatrics


 * Transplant (renal)


 * Neurourology

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 subdiscipline.

Endourology
Endourology is the branch of urology that deals with the closed manipulation of the urinary tract. It has lately grown to include all minimally invasive urologic 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 the urethra, enabling prostate surgery, surgery of tumors of the urothelium, stone surgery, and simple urethral and ureteral procedures. Recently, the addition of laparoscopy and robotics has further subdivided this branch of urology.

Laparoscopy
Laparoscopy is a rapidly evolving branch of urology and has replaced some open surgical procedures. Robot-assisted surgery of the prostate, kidney, and ureter has been expanding this field. Today, many prostatectomies in the United States are carried out by so-called 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 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 concerns the surgical treatment of malignant genitourinary diseases such as cancer of the prostate, adrenal glands, bladder, kidneys, ureters, testicles, and penis, as well as the skin and subcutaneous tissue and muscle and fascia of those areas. The treatment of genitourinary cancer is managed by either a urologist or an oncologist, depending on the treatment type. Most urologic oncologists in western countries use minimally invasive techniques to manage urologic cancers amenable to surgical management.

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

Pediatric urology
Pediatric urology concerns urologic disorders in children. Such disorders include cryptorchidism, congenital abnormalities of the genitourinary tract, enuresis, underdeveloped genitalia, and vesicoureteral reflux.

Andrology
Andrology focuses on the male reproductive system. It is mainly concerned with male infertility, erectile dysfunction, and ejaculatory disorders, along with some issues regarding pediatrics, such as growing so much that the body cannot handle. Since male sexuality is largely controlled by hormones, andrology overlaps with endocrinology. Surgery in this field includes fertilization procedures, vasectomy reversals, and the implantation of penile prostheses. Vasectomies may also be included here, although most urologists perform this prodecure.

Reconstructive urology
Reconstructive urology is a highly specialized field of male urology that restores both structure and function to the genitourinary tract. Prostate procedures, full or partial hysterectomies, trauma, disease, obstructions, blockages, and occasionally childbirth can necessitate reconstructive surgery. The urinary bladder, ureters, and genitalia are other examples of reconstructive surgery.

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 (many of whom are men) complete a one to two year fellowship after completion of a five to six 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 subdiscipline of gynecology, who have done a three-year fellowship after a four-year OB/GYN residency.

List of urological topics

 * Benign prostatic hyperplasia
 * Bladder stones
 * Bladder cancer
 * Cystitis
 * Development of the urinary system
 * Epididymitis
 * Erectile dysfunction
 * Interstitial cystitis
 * Kidney transplantation
 * Kidney cancer
 * Kidney stones
 * Prostatitis
 * Prostate cancer
 * Retrograde pyelogram
 * Retrograde ureteral
 * Testicular cancer
 * Urolithiasis
 * Vasectomy
 * Vasectomy reversal