Urology (from Greek οὖρον ouron "urine" and -λογία -logia "study of"), 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 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.
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.
WHAT DO THEY DO?
Urology is a part of health care that deals with diseases of the male and female urinary tract (kidneys, ureters, bladder and urethra). It also deals with the male organs that are able to make babies (penis, testes, scrotum, prostate, etc.). Since health problems in these body parts can happen to everyone, urologic health is important.
Urology is known as a surgical specialty. Besides surgery, a urologist is a doctor with wisdom of internal medicine, pediatrics, gynecology and other parts of health care. This is because a urologist encounters a wide range of clinical problems. The scope of urology is big and the American Urological Association has named seven subspecialty parts:
Pediatric Urology (children's urology)
Urologic Oncology (urologic cancers)
Renal (kidney) Transplant
Calculi (urinary tract stones)
Neurourology (nervous system control of genitourinary organs)
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 sub discipline.
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 urethral procedures. Recently, the addition of laparoscopy and robotics has further subdivided this branch of urology.
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 (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 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 (that particular subspecialty overlaps with dermatological oncology and related areas of oncology). 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 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 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 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 such as prostate cancer, male fertility problems, and surgery of the male reproductive system. It is the counterpart to gynaecology, which deals with medical issues which are specific to female health, especially reproductive and urologic health.
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 (auto accidents, gunshot wounds, industrial accidents, straddle injuries, etc.), disease, obstructions, blockages (e.g., urethral strictures), and occasionally, childbirth, can necessitate 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.
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 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.
There are various requirements for a Urologist that they need to fulfil to pursue a career in being a Urologist. The requirements are classified under three heads –
EDUCATIONAL AND GENERAL QUALIFICATIONS:
In order to work as a licensed urologist, a medical degree is required. Urologists are required to complete three years of college before entering medical school, and most students have a bachelor's degree in chemistry or biology upon enrolment. Once a urologist completes the required medical school requirements, they will complete a residency in a hospital specializing in urology. The residency period is five years, and when the five years are completed, the student will then be required to pass a board exam in their specialty. After they have completed their residency and passed the board exam, they can apply for work at various hospitals, and many urologists open up their own practices.
Urologists are also required to comply with the newest medical technology, which can mean updating their practices when necessary, and also means they will have to continue on with their education when required to do so.
Aspiring candidates have to follow the below-given steps to become a Urologist.
Students who have appeared or are appearing in +2 (with Physics, Chemistry and Biology as main subjects) have to appear in an Medical Entrance Tests conducted by the various state and Independent bodies like PMT, taken by Punjab Government and CBSE-PMT (Pre Medical Test) taken by the Central board to admit candidates in various medical institutions affiliated with it. A separate test is conducted by some of the highly rated medical institutions like AIIMS, PGI, GMCH, AFMC Pune etc. These exams are generally held in the month of May-June.
After completing this four and half years of MBBS degree course and one year and six months compulsory training one has to go M.S (Urology) – a specialization - must work as a Urologist.
Aspiring MBBS doctors have to appear in Post Graduate Medical Entrance Tests like All India Post Graduate Medical/Dental Entrance Exam, and Jawaharlal Institute of Post-graduate Medical Education and Research Entrance Exam. However, some institutes also provide admission on the basis of marks obtained in MBBS course and work experience of the aspiring candidates.
After completing M.S(Urology) the aspiring candidates can enrol for M.Ch.- a 3 years courses-for further specialization.
After completion of three years of MS (Urology) course and getting the requisite registration from Medical Council of India, the budding Urologist can get jobs in reputed Government and Private Hospitals like AIIMS etc. The urologist can also open their own Kidney and Uro stone Clinic and provide services to the patients.
Urologists must consistently update their practice based on new medical technologies, requiring that they commit to being lifetime students in their field. Serving as a urologist can frequently require working long and irregular hours.
Urologists need a special blend of skills and personal qualities. These include:
practical skills such as good hand-eye co-ordination and manual dexterity
excellent vision and visuo-spatial awareness
good organisational ability and stamina to cope with a busy and demanding role
excellent communication skills and the ability to deal effectively with people of all ages
the ability to lead and manage a team effectively
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Career prospect for Urologists appears bright in the coming times due to growing and ageing population and increased need for urology services especially for Urologists with special training and vast experience. There are ample job opportunities for young Urologist in upcoming Uro and kidney stone Centers. They can also get placed in the Urology department of reputed Hospitals like AIIMS, MAX etc. More enterprising Urologists can also open their own Clinic. Some Urologists may also become teachers in different medical schools and colleges and teach their students basic techniques and treatments.
Urologist in government sector can expect to get nearly Rs.50,000 to Rs.60,000 depending upon his experience and expertise. Besides, they are also entitled to government accommodation and other perks as admissible. However, experienced Urologist working in corporate sector can expect anything between Rs.80,000 to Rs.1,00,000 per month. Urologist successfully running their own clinic has the ability to earn that much in a couple of days or a week's time.
Job outlook for urologists is expected to grow significantly over the next 10 years. Many urologists and surgeons are reaching the age of retirement and will need to be replaced, so more and more positions are opening up for availability. More jobs are also becoming available due to the aging baby boomer generation, as more men are affected by reproductive organ diseases and disorders as they age.
Many surgeons will advance their careers by joining a group practice with surgeons in related fields, or by opening a practice of their own. Many urologists start off working in a hospital, and eventually work in a private practice or even open one of their own.
Most urologists work in a hospital setting or in a private clinic. The environment can become stressful or intense if patients come in suffering extreme pain, so it is important for them to be able to keep patients calm and relaxed while observing symptoms and preparing them for treatment.
Urologists must also be able to handle the intense surgery environment. Surgery often comes with unpleasant smells or sights, and a surgeon must be able to continue working regardless of what happens once they are cut open. Some people may respond negatively to surgery and bleed excessively, so a surgeon will need to be able to quickly fix any issues without being interrupted.
Many surgeons work long or odd hours, and urologists will have to prepare to work later than planned or start a last-minute emergency surgery that could go all night. It is not unusual for a surgeon to work for 24 hours straight before getting time off.