Urology
Encyclopedia
Urology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological disorders. The organs covered by urology include the kidney
s, adrenal glands, ureter
s, urinary bladder
, urethra
, and the male reproductive organs (testes, epididymis
, vas deferens
, seminal vesicle
s, prostate
and penis
). Urology is one of the most competitive specialties to enter for physician
s.
The urinary and reproductive tracts are closely linked, and disorders of one often affect the other, so a major part of the conditions managed in urology fall in the area of genitourinary disorders. Urology combines management of medical (i.e., non-surgical) problems such as urinary tract infection
s and benign prostatic hyperplasia
, as well as surgical problems such as the surgical management of cancers, the correction of congenital abnormalities, and correcting stress incontinence
. Urology is closely related to, and in some cases overlaps with, the medical fields of oncology
, nephrology
, gynecology, andrology
, pediatric surgery, gastroenterology
, and endocrinology
.
, stone surgery, and simple urethral and ureteral procedures. Recently, the addition of laparoscopy and robotics has further subdivided this branch of urology.
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 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.
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, formerly known as interstitial cystitis
).
ren. Such disorders include cryptorchism (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
.
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 procedures, vasectomy reversals, and the implantation of penile prostheses. Vasectomies may also be included here, although most urologists perform this procedure.
is a branch dealing with overactive bladder, pelvic organ prolapse, and urinary incontinence. Thorough knowledge of the female pelvic floor together with urodynamic skills 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.
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
s, adrenal glands, ureter
Ureter
In human anatomy, the ureters are muscular tubes that propel urine from the kidneys to the urinary bladder. In the adult, the ureters are usually long and ~3-4 mm in diameter....
s, urinary bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
, urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
, and the male reproductive organs (testes, epididymis
Epididymis
The epididymis is part of the male reproductive system and is present in all male amniotes. It is a narrow, tightly-coiled tube connecting the efferent ducts from the rear of each testicle to its vas deferens. A similar, but probably non-homologous, structure is found in cartilaginous...
, vas deferens
Vas deferens
The vas deferens , also called ductus deferens, , is part of the male anatomy of many vertebrates; they transport sperm from the epididymis in anticipation of ejaculation....
, seminal vesicle
Seminal vesicle
The seminal vesicles or vesicular glands are a pair of simple tubular glands posteroinferior to the urinary bladder of male mammals...
s, prostate
Prostate
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
and penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
). Urology is one of the most competitive specialties to enter for physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s.
The urinary and reproductive tracts are closely linked, and disorders of one often affect the other, so a major part of the conditions managed in urology fall in the area of genitourinary disorders. Urology combines management of medical (i.e., non-surgical) problems such as urinary tract infection
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
s and benign prostatic hyperplasia
Benign prostatic hyperplasia
Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
, as well as surgical problems such as the surgical management of cancers, the correction of congenital abnormalities, and correcting stress incontinence
Stress incontinence
Stress incontinence is a form of urinary incontinence.Stress urinary incontinence , also known as effort incontinence, is due essentially to insufficient strength of the pelvic floor muscles.-Pathophysiology:...
. Urology is closely related to, and in some cases overlaps with, the medical fields of oncology
Oncology
Oncology is a branch of medicine that deals with cancer...
, nephrology
Nephrology
Nephrology is a branch of internal medicine and pediatrics dealing with the study of the function and diseases of the kidney.-Scope of the specialty:...
, gynecology, andrology
Andrology
Andrology is the medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urological problems that are unique to men. It is the counterpart to gynaecology, which deals with medical issues which are specific to the female reproductive...
, pediatric surgery, gastroenterology
Gastroenterology
Gastroenterology is the branch of medicine whereby the digestive system and its disorders are studied. The name is a combination of three Ancient Greek words gaster , enteron , and logos...
, and endocrinology
Endocrinology
Endocrinology is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions called hormones, the integration of developmental events such as proliferation, growth, and differentiation and the coordination of...
.
Subdisciplines
As a discipline that involves the study of many organs and physiological systems, urology can be broken down into subdisciplines. At larger centers and especially university hospitals, many urologists specialize within a particular subdiscipline of urology.Endourology
Endourology is the branch of urology that deals with the closed manipulation of the 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 the urethra, enabling prostate surgery, surgery of tumors of the urotheliumUrothelium
The urothelium is a form of transitional epithelial tissue layer that lines much of the urinary tract, including the renal pelvis, the ureters, the bladder, and parts of the urethra.-Structure and function:...
, stone surgery, and simple urethral and ureteral procedures. Recently, the addition of laparoscopy and robotics has further subdivided this branch of urology.
Laparoscopy
LaparoscopyLaparoscopy
Laparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera...
is a rapidly evolving branch of urology and has replaced some open surgical procedures. Robot-assisted surgery
Robotic surgery
Robotic surgery, computer-assisted surgery, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures....
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 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 concerns the surgical treatment of malignant genitourinary diseases such as cancer of the prostate, adrenal glands, bladder, kidneys, ureters, testicles, and penis. The treatment of genitourinary cancer is managed by either a urologist or an oncologist, depending on the treatment type (surgical or medical). Most urologic oncologists in western countries use minimally invasive techniques (laparoscopy or endourology, robotic-assisted surgery) to manage urologic cancers amenable to surgical management.Neurourology
Neurourology concerns nervous systemNervous system
The nervous system is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. In most animals the nervous system consists of two parts, central and peripheral. The central nervous...
control of the genitourinary system, and of conditions causing abnormal urination
Urination
Urination, also known as micturition, voiding, peeing, weeing, pissing, and more rarely, emiction, is the ejection of urine from the urinary bladder through the urethra to the outside of the body. In healthy humans the process of urination is under voluntary control...
. Neurological diseases and disorders such as a stroke, multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
, Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...
, and spinal cord injury
Spinal cord injury
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
can disrupt the lower urinary tract and result in conditions such as urinary incontinence
Urinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
, detrusor overactivity, urinary retention
Urinary retention
Urinary retention, also known as ischuria, is a lack of ability to urinate. It is a common complication of benign prostatic hyperplasia , although it can also be caused by nerve dysfunction, constipation, infection, or medications...
, and detrusor sphincter dyssynergia
Bladder sphincter dyssynergia
Bladder sphincter dyssynergia is a consequence of a neurological pathology such as spinal injury or multiple sclerosis that disrupts central nervous system regulation of the micturition reflex resulting in dyscoordination of...
. Urodynamic studies
Urodynamic testing
Urodynamic testing refers to the process of performing urodynamics. Urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine...
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
Neuromodulation
In Neuromodulation several classes of neurotransmitters regulate diverse populations of central nervous system neurons...
.
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, formerly known as interstitial cystitis
Interstitial cystitis
Interstitial cystitis or bladder pain syndrome is a chronic, oftentimes severely debilitating disease of the urinary bladder...
).
Pediatric urology
Pediatric urology concerns urologic disorders in childChild
Biologically, a child is generally a human between the stages of birth and puberty. Some vernacular definitions of a child include the fetus, as being an unborn child. The legal definition of "child" generally refers to a minor, otherwise known as a person younger than the age of majority...
ren. Such disorders include cryptorchism (undescended testes), congenital abnormalities of the genitourinary tract, enuresis
Enuresis
Enuresis refers to an inability to control urination. Use of the term is usually limited to describing individuals old enough to be expected to exercise such control.Types of enuresis include:* Nocturnal enuresis* Diurnal enuresis...
, underdeveloped genitalia (due to delayed growth or delayed puberty, often an endocrinological problem), and vesicoureteral reflux
Vesicoureteral reflux
Vesicoureteral reflux is an abnormal movement of urine from the bladder into ureters or kidneys. Urine normally travels from the kidneys via the ureters to the bladder...
.
Andrology
AndrologyAndrology
Andrology is the medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urological problems that are unique to men. It is the counterpart to gynaecology, which deals with medical issues which are specific to the female reproductive...
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 procedures, vasectomy reversals, and the implantation of penile prostheses. Vasectomies may also be included here, although most urologists perform this procedure.
Reconstructive urology
Reconstructive urology is a highly specialized field of urology that restores function to any of various structures of the genitourinary tract. Prostate procedures, full or partial hysterectomies, trauma (auto accidents, gunshot wounds, industrial accidents, straddle injuries, etc.), disease, obstructions, blockages (e.g., urethral strictures), and occasionally, childbirth, can necessitate require reconstructive surgery. The urinary bladder, ureters (the tubes that lead from the kidneys to the urinary bladder) and genitalia are other examples of reconstructive urology. Often, plastic surgeons assist in these procedures, although purely cosmetic procedures such as penis enlargement do not fall under the rubric of reconstructive urology.Urogynecology
UrogynecologyUrogynecology
Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology.-History:In 1893, Howard Kelly, a gynecologist and pioneering urogynecologist, invented an air cystoscope which was simply a handheld, hollow tube with a glass partition...
is a branch dealing with overactive bladder, pelvic organ prolapse, and urinary incontinence. Thorough knowledge of the female pelvic floor together with urodynamic skills 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.
See also
- Benign prostatic hyperplasiaBenign prostatic hyperplasiaBenign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
- Bladder stones
- Bladder cancerBladder cancerBladder cancer is any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis...
- CystitisCystitisCystitis is a term that refers to urinary bladder inflammation that results from any one of a number of distinct syndromes. It is most commonly caused by a bacterial infection in which case it is referred to as a urinary tract infection.-Signs and symptoms:...
- Development of the urinary and reproductive organsDevelopment of the urinary and reproductive organsThe development of the urinary and reproductive organs as a part of the prenatal development, concerns the urinary system and sex organs. The latter is a part of the stages of sexual differentiation....
- EpididymitisEpididymitisEpididymitis is a medical condition in which there is inflammation of the epididymis . This condition comprises gradual onset of testicular pain that can vary from mild to severe, and the scrotum may become red, warm and swollen...
- Erectile dysfunctionErectile dysfunctionErectile dysfunction is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance....
- Interstitial cystitisInterstitial cystitisInterstitial cystitis or bladder pain syndrome is a chronic, oftentimes severely debilitating disease of the urinary bladder...
- Kidney cancerKidney cancerKidney cancer is a type of cancer that starts in the cells in the kidney.The two most common types of kidney cancer are renal cell carcinoma and urothelial cell carcinoma of the renal pelvis...
- Medical specialty
- Kidney stoneKidney stoneA kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine...
- ProstatitisProstatitisProstatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:...
- Prostate cancerProstate cancerProstate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
- Retrograde pyelogramRetrograde pyelogramRetrograde Pyelogram is a urologic procedure where the physician injects contrast into the ureter in order to visualize the ureter and kidney. The flow of contrast is opposite the usual flow of urine, hence the retrograde name.Reasons for performing a retrograde pyelogram include identification of...
- Testicular cancerTesticular cancerTesticular cancer is cancer that develops in the testicles, a part of the male reproductive system.In the United States, between 7,500 and 8,000 diagnoses of testicular cancer are made each year. In the UK, approximately 2,000 men are diagnosed each year. Over his lifetime, a man's risk of...
- UrolithiasisUrolithiasisA bladder stone is a solid concretion or crystal aggregation found in the urinary bladder...
- VasectomyVasectomyVasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream...
- Vasectomy reversal