Treating Urinary and Male Reproductive Tract Disorders
A urologist is a physician who specializes in disorders of the female and male urinary tract as well as those of the male reproductive organs. Organs that fall under the realm of a urologist include the kidneys, adrenal glands, ureter, bladder, and urethra as well as the testes, epididymis, prostate gland, and penis in men. These organs are referred to collectively as the genitourinary system.Urologists are among the most sought-after medical specialists in the United States with practitioner numbers projected to decrease by 29 percent by 2025, according to a 2013 study in the journal Urology. This is due in part to the extensive training involved to become a urologist, which includes four years of undergraduate studies, four years of medical school, and five years in a urology residency program.
Although urology is classified as a surgical specialty, a strong knowledge of internal medicine, pediatrics, gynecology, and other specialties is needed to treat the wide range of genitourinary disorders.
Urologists are seen by different people in different ways. Some consider them to be “men’s health specialists” trained to treat infertility, erectile dysfunction, prostate problems, or other conditions affecting the male organs. Others think of them as someone you see if you have a urinary problem that your primary care doctor cannot treat. Both are correct.The practice of urology is focused on the two systems that are ultimately linked by the urethra (the tube that removes urine or semen from the body). It is this physiological route that largely defines the practice.
Urology can frequently overlap with other medical specialties, including gynecology, neurology (nervous system disorders), endocrinology (hormonal disorders), nephrology (kidney disorders), and oncology (cancer).
Urologists not only treat men and women but children as well.
A urologist can diagnose and treat a diversity of medical conditions in both females and male. Some are known conditions that are either persistent or severe. Others are unknown and characterized symptoms such as dysuria (painful urination), hematuria (blood in urine), or urinary urgency (the urge to urinate frequently).
Some of the more common urologic conditions include:
- Acute cystitis (bladder infection)
- Bladder stones (also known as vesical calculus)
- Inguinal hernia (involving the lower abdomen)
- Interstitial cystitis (also known as bladder pain syndrome)
- Kidney stones (also known as renal calculus)
- Pyelonephritis (kidney infection)
- Renal cell carcinoma (kidney cancer)
- Sexually transmitted infections (like chlamydia or gonorrhea)
- Transitional cell carcinoma (bladder cancer)
- Urethritis (inflammation of the urethra)
- Urinary incontinence (including bedwetting and overactive bladder)
- Urinary tract infections (commonly known as UTIs)
Urologic conditions affecting women include:
- Cystoceles (a fallen or prolapsed bladder)
- Labial fusion (a congenital defect in which inner lips of the vagina fuse, occasionally affecting urination)
- Postpartum incontinence(incontinence after pregnancy)
Urologic conditions affecting men include:
- Benign prostatic hyperplasia (enlarged prostate)
- Erectile dysfunction
- Epididymitis (inflammation of the tube that carries sperm from the testicle)
- Epispadias (a birth defect in which the urethra opens on the top of the penis instead of the end)
- Hypospadias (a birth defect in which the urethra opens on the underside of the penis)
- Male infertility
- Peyronie’s disease (the formation of scar tissue that causes the penis to bend abnormally)
- Prostate cancer
- Prostatitis (prostate inflammation)
- Retrograde ejaculation (in which semen is diverted to the bladder during ejaculation)
- Testicular cancer
- Testicular torsion (a twisted testicle)
- Ureteroceles (a birth defect that prevents the normal flow of urine from the kidneys to the bladder)
- Varicoceles (the enlargement of the veins in the scrotum)6 Urological Emergencies That Can Be Treated
A urologist is trained to use a variety of tools and techniques to diagnose and treat genitourinary problems. If you are referred to a urologist, you will likely undergo a physical exam and other tests to either pinpoint the cause or characterize the nature of the disease.
A physical exam is central to the diagnosis. Depending on your symptoms, it may involve an examination of the abdomen, rectum, groin, or genitals. Women with urinary symptoms will typically undergo a pelvic exam, while men may be given a digital rectal exam to manually evaluate the prostate gland.Palpation (the touching of superficial tissues) may reveal an inguinal hernia or testicular torsion, while percussion (the gentle tapping of tissue) may help confirm urinary retention.
Blood tests are commonly used to diagnose genitourinary disorders. Most of the tests are unable to directly diagnoses disease but are rather used to support the diagnosis. These include:
- Alpha-fetoprotein test (used to diagnose testicular cancer)
- Bladder tumor antigen test (used to detect bladder cancer)
- Blood calcium test (used to screen for kidney disease)
- Creatinine and blood urea nitrogen (BUN) tests (used to measure kidney function)
- Prostate-specific antigen test (used to detect prostate cancer)
- STD screening (used to detect sexually transmitted infections)
- Testosterone test (use to detect low testosterone levels)
Urinalysis is critical to diagnosing urologic disorders. The urinalysis would include a gross examination of the color, appearance, and odor of the sample as well as a chemical and microscopic analysis.The chemical analysis would measure factors like proteinand glucose, high levels of which may suggest kidney disease or diabetes. Increased nitrites or the presence of white blood cells may be suggestive a bacterial infection. The presence of blood in urine may be detected visually or with a urine dipstick test.A microscopic analysis may be useful in detecting epithelial cells (surface cells commonly shed with kidney cancer). Urinary crystals may also be spotted and used to confirm the presence of kidney stones. A urine culturemay also be performed to confirm a bacterial infection otherwise undetected by blood tests.
When a problem is not readily visible, there are imaging techniques commonly used by urologists. These include traditional and specialized technologies, such as:
- Kidney, ureter, and bladder (KUB) X-ray (typically the first imaging study performed in an evaluation)
- Intravenous pyelogram (IVP) X-ray (which uses an injected dye to define the structures of the urinary tract)
- Voiding cystourethrogram (VCUG) X-ray (performed while the bladder fills and empties with a special radioactive fluid)
- Retrograde urethrogram (an X-ray series using contrast dyes to detect lesions, injuries, or the narrowing of the urethra)
- Ultrasound (using sound waves to detect tumors, cysts, stones, or the abnormal movement of the bladder or urethra)
- Computed tomography (CT) scan (a computed X-ray technique that creates three-dimensional “slices” of internal organs)
- Magnetic resonance imaging (MRI) scan (which uses powerful magnetic waves to create high-resolution images of soft tissue)
- Positron emission tomography (PET) scan (which uses radioactive tracers to detect changes in metabolism consistent with cancer)
Another type of exploratory technique is cystoscopy. This is a slightly more invasive procedure that requires a local anesthetic to numb the urethra before a narrow scope is inserted through it to view the bladder.Urodynamic studies are used to diagnose to evaluate incontinence or urinary problems associated with an enlarged prostate. It involves the use of sensors and gauges to measure the pressure, speed, and amount of urine produced during urination.Semen analysis, also known as a seminogram, is used to evaluate the amount, quality, and motility of sperm in a sample of ejaculated semen.
Surgical and Non-Surgical Treatment
The treatments and procedures used by a urologist are as far-ranging at the types of conditions treated. As surgeons, urologists are trained to perform delicate and often complicated surgeries. But they just as often use medications, medical devices (like pessaries and urethral inserts) and non-invasive pelvic floor exercises to treat incontinence.
- Alpha-blockers (used to relax the bladder neck and improve urine flow in men with an enlarged prostate)
- Androgen-deprivation therapy (used to reduce male hormones so that they don’t enhance the growth of prostate cancer)
- Antibiotics (used to treat bacterial infections)
- Anticholinergics (used to calm an overactive bladder)
- Chemotherapy drugs (used to treat cancer)
- Myrbetriq (mirabegdron) (a drug used to relax bladder muscles so that the bladder can hold more urine)
- Phosphodiesterase 5 (PDE5) inhibitors (used to treat erectile dysfunction)
Open or laparoscopic (“keyhole”) surgery may be used to repair hernias, perform a prostatectomy, remove tumors, or eliminate scarring associated with urethral narrowing. Laser therapy is commonly used to break up urinary stones, ablate prostate cancer cells, or reduce an enlarged prostate.Other more complicated surgeries, such as a suburethral sling, may be used to support a prolapsed bladder. Some urologists are even involved in kidney transplants.Urologists also commonly perform vasectomies (a form of male sterilization) and can sometimes even reverse a vasectomy with surgery.Brand Names Drugs Commonly Used in Urology
The American Urological Associaton currently recognizes seven urology subspecialties:
- Urologic oncology (genitourinary cancer)
- Calculi (urinary stones)
- Female urology
- InfertilityKidney transplant
- Pediatric urology
- Neurourology (involving nervous system disorders like Parkinson’s disease and stroke that affect urinary control).
For its part, the American Board of Urology (ABU), which sets the standard for board certification, only recognizes pediatric urology and female pelvic medicine and reconstructive surgery as accredited subspecialties.
Training and Certification
The steps to becoming a board-certified urologist are similar to those for other surgical specialties.All urologists must first complete postgraduate education at an accredited medical school. The entry requirements include a bachelor’s degree and the passing of the Medical Competency Aptitude Test (MCAT).
While you can enter medical school with a non-science degree (as long as you complete the prerequisite math, science, and humanities courses), most enter with a bachelor’s degree in chemistry, biology, or a related science.
You can attend a medical school that offers either a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. The first two years consist primarily of classroom or laboratory studies. The second two years involves clinical rotations in medical facilities to gain hands-on exposure to different fields of medicine.After graduation, you would enter a urology residency, most of which begin in September and last for five years. The first year is spent in general surgery, with the remaining four years devoted to the diagnosis and treatment of urological disorders, Including congenital deformities and urological cancers. After the completion of residency, you will need to be licensed in the state in which you intend to practice. You would do so by passing the U.S. Medical Licensing Examination (USMLE). Urologists with a DO degree can opt to take the Comprehensive Osteopathic Medical Licensing Exam (COMLEX) instead of the USMLE. Some states also require you to pass a state licensing exam as well.
Although it is not required, you can gain board certification by taking the two-part exam administered by the ABU. The initial qualifying exam is taken immediately after residency and consists of 300 multiple-choice questions.
Candidates who pass the written board exam must spend at least 16 months practicing before they are eligible to take the final, three-part oral exam, given annually in Dallas, Texas.
Board certification is essentially a stamp of approval of your skills as a urologist. It increases your job opportunities in a highly competitive field and is required for employment in many hospital, academic, and research facilities.
Although some people will see a urologist as their first point of contact for a genitourinary disorder, most are referred by their primary care doctor or gynecologist.It is not uncommon to feel uncomfortable about meeting a urologist since a visit commonly involves an examination of the genitals and pelvis. It often helps to share these concerns with the urologist when you first meet and ask that you be walked through the procedures. For some people, “breaking the ice” is all that is needed to overcome anxieties.
How to Find a Urologist
Generally, the best way to find a urologist is through a referral from your primary care physician or someone you know. The next step would be to verify the doctor’s credentials.
The ABU does not offer a credential verification service, but you can usually check on a doctor’s qualifications through the DocInfo website managed by the Federation of State Medical Boards.
There, you can find detail about a doctor’s education, licenses, board certification, and any legal, civil, or disciplinary actions filed against the physician.You should also take the opportunity to interview the urologist, particularly if you require surgery or other invasive procedures. You can ask, for example, how experienced the doctor is in a certain procedure or how many patients he or she has treated with the procedure.
When arriving for your appointment, bring your insurance card, ID, and any medical reports or imaging studies relevant to your condition. You can also ask your primary care doctor or referring physician to forward any pertinent files electronically in advance of your appointment.If you have health insurance, double check that the office accepts it. If also helps to know what labs and other facilities they use to check whether they are in-network or out-of-network providers.6 Questions to Ask Your Urologist
A Word From Verywell
Urology can be a rewarding career and one that can provide you a better work-life balance than some other medical specialties. That is not to say it is not without its stresses.Many people fear urologists because the practice involves intimate examinations or require urinary catheters to perform certain tests. Urologists are ever-cognizant of these stresses and need a certain emotional resiliency to deal with them.There may also be emergencies to deal with on weekends and evenings, including urgent calls about kidney stones or post-surgical complications. With that said, many urologists work normal office hours, often in high-paying individual or group practices.
Because they are so in-demand, urologists are among the highest paid medical specialists. According to the Medscape Urologist Compensation Report, urologists across all specialties earned an average of $373,000 in 2018.