Andrew Siegel MD 9/8/2018
Fact: Chances are that if you haven’t yet seen a urologist, you will at some point in your life. Sooner or later human plumbing problems surface!
Image above by-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)%5D, from Wikimedia Commons
Male Reproductive System
Image above by Sheldahl [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)%5D, from Wikimedia Commons
“Urology” (“uro”—urinary tract and “logos”—study of) is a surgical specialty concerned with the diagnosis and treatment of diseases of the urinary tract in females and of the urinary and genital tracts in males. Urology uses both medical and surgical strategies to treat a variety of conditions and employs many minimally-invasive technologies including fiber-optic endoscopy that enables visualization of the entire inner lining of the urinary tract, as well as ultrasound, lasers, laparoscopy and robotics. Today’s entry explores what urologists do, how they are trained, and demographics.
Urologists are the male counterparts to gynecologists and the go-to physicians when it comes to expertise in male pelvic health. Organs under the “domain” of urology include the adrenal glands, kidneys, the ureters (tubes connecting the kidneys to the urinary bladder), the urinary bladder and the urethra (the channel that conducts urine from the bladder to the outside). The male reproductive organs include the testicles, epididymides (structures located above and behind the testicles where sperm mature and are stored), vas deferens (sperm duct), seminal vesicles (the structures that produce the bulk of semen), prostate gland and, of course, the scrotum and penis. The reproductive and urinary tracts are closely connected, and disorders of one oftentimes affect the other…thus urologists are referred to as “genitourinary” specialists.
There is overlap in what urologists do with other medical and surgical disciplines, including nephrology (doctors who specialize in medical diseases of the kidney); oncology (cancer specialists); radiation oncology (radiation cancer specialists); radiology (imaging); gynecology (female genital specialists); and endocrinology (hormone specialists).
Urologists treat many serious and potentially life-threatening illnesses, particularly cancers of the genital and urinary tracts. In the United States, prostate cancer accounts for almost 20% of new cancer cases in men, bladder cancer for 7%, and cancer of the kidney and renal pelvis (the inner part of the kidney that collects the urine) for 5%. Testicular cancer is relatively rare but is also under the treatment domain of urologists. Urologists treat women with kidney and bladder cancer, although the prevalence of these cancers is much less so in females.
Common reasons for a referral to a urologist are the following: blood in the urine, whether visible or picked up on a urinalysis; blood in the semen, an elevated PSA (Prostate Specific Antigen) or an accelerated PSA over time; prostate enlargement; irregularities of the prostate on digital rectal examination; urinary difficulties ranging from urinary incontinence to the inability to urinate (urinary retention) and urinary tract infections.
Urologists manage a variety of non-cancer issues. Kidney stones, which can be extraordinarily painful, are especially prevalent in the hot summer months. Infections are a large part of urology practice and can involve the bladder, kidneys, prostate, testicles and epididymis. Sexual dysfunction is a very common condition managed by the urologist—under this category is erectile dysfunction, ejaculation problems, and libido and testosterone issues. Urologists treat not only male infertility, but also create male infertility when it is desired by performing voluntary male sterilization (vasectomy). Urologists are responsible for caring for many scrotal issues including testicular pain and swelling.
Training to become a urologist involves attending 4 years of medical school following college and 1–2 years of general surgery training followed by 4 years of urology residency. Thereafter, many urologists like myself pursue additional sub-specialty training in the form of a fellowship that can last anywhere from 1–3 years. Urology board certification can be achieved if one graduates from an accredited residency and passes a written exam and an oral exam and has an appropriate log of cases that are reviewed by the board committee. Thereafter, one must maintain board certification by participating in continuing medical education and passing recertification exams. Becoming board certified is the equivalent of a lawyer passing the bar exam.
In addition to obtaining board certification in general urology, there are two specialties in which specialty board certification can be obtained—pediatric urology, which is the practice of urology limited to children, and female pelvic medicine and reconstructive surgery (FPMRS), which involves female urinary incontinence, pelvic organ prolapse and other urological/gynecological issues.
Urology is largely a male specialty, although women have been entering the urological workforce with increasing frequency because female students now comprise more than 50% of the United States medical school population. There are approximately 10,000 practicing urologists in the USA, of which about 500 are women. The aging population will demand more urological services; this coupled with the aging of the urological workforce and the contraction of the number of practicing urologists due to retirement does not bode well for the balance of supply and demand in the forthcoming years. Hopefully, there will be enough urologists to provide the urological care to those that need it.
The index finger (nice and narrow) of yours truly, one of the most vital instruments used by the urologist
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.
Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:
MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health
PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food
These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.
Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx
New video on female pelvic floor exercises: Learn about your pelvic floor
Tags: Andrew Siegel MD, human plumbing, urinary tract, urologist, urology
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