Urology (from Greek οὖρον ouron "urine" and -logia "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary 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, epididymides, vasa deferentia, 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 exists under the domain of genitourinary disorders. Urology combines the management of medical (i.e., non-surgical) conditions, such as urinary-tract infections and benign prostatic hyperplasia, with the management of surgical conditions such as bladder or prostate cancer, kidney stones, congenital abnormalities, traumatic injury, and stress incontinence.

Urological techniques include minimally invasive 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 (and urologists often collaborate with the practitioners of) oncology, nephrology, gynaecology, 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.

Urologists are physicians which have specialized in the field after completing their general degree in medicine. 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: urologic surgery, urologic oncology and urologic oncological surgery, endourology and endourologic surgery, urogynecology and urogynecologic surgery, reconstructive urologic surgery (a form of reconstructive surgery), minimally-invasive urologic surgery, pediatric urology and pediatric urologic surgery (including adolescent urology, the treatment of premature or delayed puberty, and the treatment of congenital urological syndromes, malformations, and deformations), transplant urology (the field of transplant medicine and surgery concerned with transplantation of organs such as the kidneys, bladder tissue, ureters, and, recently, penises), voiding dysfunction, paruresis, neurourology, and androurology and sexual medicine. Additionally, some urologists supplement their fellowships with a master's degree (2–3 years) or with a Ph.D. (4–6 years) in related topics to prepare them for academic as well as focused clinical employment.

Treatment Spectrum

Urology is a specialized medical and surgical field dedicated to the comprehensive management of the urinary tract – including the kidneys, ureters, bladder, and urethra – in both men and women, as well as the male reproductive organs. The specialty encompasses conservative (non-surgical, mostly pharmacological), minimally invasive, and surgical treatments, including endourological, laparoscopic, and open procedures, as well as lithotripsy and laser-based techniques for removing stones or cutting and vaporizing pathological tissue.

Conservative treatment options in urology include pharmacological therapy for a wide range of conditions, such as:

  • Sexually transmitted infections (as part of urological venereology)
  • Erectile dysfunction and other male sexual dysfunctions
  • Benign prostatic hyperplasia (BPH)
  • Lower urinary tract symptoms (LUTS)
  • bladder dysfunction, including storage and voiding disorders
  • Urinary incontinence
  • Urological malignancies treated with systemic therapies, including hormonal therapy and cytostatic agents in oncological settings
  • Pharmacological management of urolithiasis (stone disease)

Conservative treatment in urology is not limited to pharmacological therapy. It also includes lifestyle modifications and non-invasive interventions such as dietary changes, pelvic floor muscle training, and weight management.

Surgical treatment in urology includes a wide range of operative interventions, such as:

  • Transurethral resection of the prostate (TURP) and bladder tumors
  • Percutaneous and endoscopic stone removal procedures (e.g. percutaneous nephrolithotomy)
  • Radical prostatectomy, including nerve-sparing techniques aimed at preserving erectile function and continence
  • Organ-preserving surgery for renal tumors (partial nephrectomy)
  • Radical cystectomy with urinary diversion or orthotopic neobladder reconstruction
  • Reconstructive urological surgery, including urethral reconstruction and gender-affirming procedures
  • Surgery for conditions of the external genitalia
  • Incontinence surgery, including sling procedures and artificial urinary sphincter implantation
  • Kidney transplantation, including donor nephrectomy and graft implantation
  • Vasectomy for male sterilization

These surgical approaches are part of standard urological practice and are reflected in clinical guidelines issued by leading international societies, including the European Association of Urology and the American Urological Association.

In Urology, minimally invasive and endoscopic procedures are increasingly used as alternatives to traditional open surgery, reflected in current guidelines of leading international urological societies, including the European Association of Urology and the American Urological Association. Depending on the individual case, these procedures can often be performed as outpatient interventions without general anesthesia, offering reduced patient burden and pain, and shorter recovery times compared with conventional invasive interventions. These procedures are primarily part of Endourology (see below) and include:

  • Minimally invasive laparoscopic surgery in the retroperitoneal space
  • Laser therapy for benign prostatic hyperplasia, including laser enucleation (e.g. HoLEP, ThuLEP) and laser vaporisation techniques (e.g. photoselective vaporisation of the prostate, PVP)
  • Laser lithotripsy for kidney and ureteral stones
  • Laser ablation of tumors in the kidney and prostate, as well as laser treatment for bladder cancer
  • Robotic and laparoscopic surgery of the prostate, kidney, and ureter
  • Laparoscopic radical prostatectomy and robot-assisted laparoscopic prostatectomy
  • Flexible ureteroscopy and other endoscopic interventions including cystoscopy for diagnosis, biopsy, and treatment

Training

United States

As of 2022, there are 146 residency programs that offered 356 categorical positions. Urology is one of the early match programs, with results given to applicants by early February (6 weeks before NRMP match). Applications are accepted starting Sep 1, with some programs accepting applications until early Jan.

It is a relatively competitive specialty to match into, with only 65.6% of US seniors matching in the 2022 match cycle. The number of positions has grown from 278 in 2012 to 356 in 2022. 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 and 2009 that 20 schools sent more than 15 students into urology (1 standard deviation above the median), with Northwestern University sending 44 students over those five years.

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

  • Oncology
  • Calculi
  • Female Urology
  • Infertility
  • Pediatrics
  • Transplant (renal)
  • Neurourology

Australia

Training is completed through the Royal Australasian College of Surgeons (RACS). The program requires six years of full-time training (for those who commenced prior to 2016), or five years for those who commenced after 2016. The program is accredited by the Australian Medical Council.

Nepal

In Nepal, the formal urologist degree awarded is MCh (Magister Chirurgiae). This is a three years course post masters and includes thesis and a mandatory publication. This degree is awarded after completing MBBS (four and half year plus a one-year rotatory internship) and MS (Mastery of surgery) in general surgery (three years course). Till now two universities Tribhuvan University and Kathmandu University as well as two Autonomous institutes BP Koirala Institute of health sciences and National Academy of Medical Sciences (Bir Hospital) run the MCh Urology programme. This degree is equivalent to Clinical PhD and called as "Chikitsa Bidhyabaridhi" by Tribhuvan University (Government University) and is considered to be the highest degree among the surgical discipline degrees.

Ethiopia

In Ethiopia, in 2001, there were only five qualified urologists. All trained abroad, in countries like India, Tanzania and Hungary. Before this chapter all urology cases were managed by general surgeons. The only urological unit in the country was at Tikur Anbessa Tertiary Hospital. The services provided included ESWL and endo-urology. The urology training program was started in 2009 with a curriculum for general surgeons which had a three-year training program. Up to 2019, six urologists have graduated by this program for general surgeons. The first residency program started accepting general practitioners in 2010 for a five-year program. The first two years were trainings in general surgery, the next three years were dedicated urology training program, which included the same three-year training as of the general surgeons three year curriculum. It started with two residents who graduated in 2015 with a certificate in specialty of urology. Up to 2019, seventeen urologists have graduated from this five-year residency program. From the start these programs in 2009 up to 2019, a total of 23 urologists have been trained in Tikur Anbessa Tertioary Hospital. As of 2020, there were 26 trainees in the programme. All of the urologists who graduated from Tikur Anbessa Tertioary Hospital were as of 2020 working in different parts of the country. It has evolved to encompass a broad range of minimally invasive and endoscopic urologic procedures. As opposed to open surgery, endourology is performed using small cameras and instruments inserted into the urinary tract. Transurethral surgery has long been a cornerstone of endourology as most of the urinary tract can be accessed via the urethra, enabling prostate surgery, surgery of tumors of the urothelium, stone surgery, and simple urethral and ureteral procedures. The addition of laparoscopy and robotic surgery has further subdivided this branch of urology.

In recent years, endourologic techniques have continued to evolve, particularly through the increasing use of laser-assisted procedures in contemporary urologic practice. These include laser lithotripsy for urinary stone disease, laser-based treatment of urothelial tumors, and laser enucleation procedures such as holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia. The growing role of these minimally invasive approaches is also reflected in guidelines published by leading international urological societies, including the American Urological Association and the European Association of Urology.

Laparoscopy

Laparoscopy is a rapidly evolving branch of urology and has replaced some open surgical procedures.

Robotic surgery

Robotic surgery of the prostate, kidney, and ureter has been expanding this field. Today, many prostatectomies in the United States are carried out by 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 (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 is the branch of medicine that focuses on the surgical treatment of malignant genitourinary diseases. This includes cancers of the prostate, adrenal glands, bladder, kidneys, ureters, testicles, and penis, as well as the skin, subcutaneous tissue, muscle, and fascia of these areas, a domain that partially overlaps with dermatologic oncology and related oncology subspecialties. Management of genitourinary cancers may be handled by a urologist or an oncologist, depending on whether the treatment is surgical or medical. In Western countries, most urologic oncologists employ minimally invasive techniques, such as laparoscopy, endourology, or robotic-assisted surgery, to treat cancers that are suitable for surgical intervention.

Neurourology

Neurourology 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 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 also known as interstitial cystitis).

Pediatric urology

Pediatric urology concerns urologic disorders in children. Such disorders include cryptorchidism (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.

Andrology

Andrology is the medical specialty focused on male health, particularly conditions affecting the male reproductive system and urological problems that are unique to men, such as prostate cancer, male fertility problems, and surgery of the male reproductive system. It is the counterpart to gynaecology, which addresses female-specific medical issues, especially those related to reproductive and urologic health.

Reconstructive urology

Reconstructive urology is a highly specialized branch of male urology focused on restoring both the structure and function of the genitourinary tract. Reconstructive procedures may be required following prostate surgeries, full or partial hysterectomies, trauma (such as automobile accidents, gunshot wounds, industrial accidents, or straddle injuries), disease, obstructions, or blockages like urethral strictures, and occasionally even childbirth. Areas commonly addressed in reconstructive urology include the urinary bladder, ureters (the tubes connecting the kidneys to the bladder), and the genitalia, among others, depending on the nature and extent of the injury or condition.

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 complete a 1–3-year fellowship after completion of a 5–6-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 sub-discipline of gynecology, who have done a three-year fellowship after a four-year OBGYN residency. European Association of Urology, the Large Urology Group Practice Association (LUGPA),