What type of procedure do Urologists do on a day-to-day basis?

[Pre-Medguy1995]

MS2 here trying to learn more about urology as we go through the GI/GU block. Surprisingly, it's one of the specialties that I can't seem to find much information about and we don't have an in the house urology department. What kind of conditions do urologists usually treat?

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[DoctwoB]

The website is pretty dead now but this is a good place to start

Choosing Urology | Urology Match

www.urologymatch.com

The short answer is that Urologists are physicians who specialize in the medical and surgical management of the urinary tract and male genital tract (with the exception of medical management of kidney disease, which goes to nephrologists).

Main areas of focus include cancers of the prostate, kidney, bladder, and testis, stone disease, female urology (mostly stress jncotinence and pelvic organ prolapse) problems of bladder emptying (overactive bladder, urinary retention, recurrent UTIs, etc) and male infertility and sexual health,

 

[armybound]

The website is pretty dead now but this is a good place to start

Choosing Urology | Urology Match

www.urologymatch.com

The short answer is that Urologists are physicians who specialize in the medical and surgical management of the urinary tract and male genital tract (with the exception of medical management of kidney disease, which goes to nephrologists).

Main areas of focus include cancers of the prostate, kidney, bladder, and testis, stone disease, female urology (mostly stress jncotinence and pelvic organ prolapse) problems of bladder emptying (overactive bladder, urinary retention, recurrent UTIs, etc) and male infertility and sexual health,

I wish SDN would somehow assimilate urologymatch. We could do so much for their website.

Urology is a nice hidden gem and poorly understood. It's too bad you don't have a home program. Do you have one near your hometown? Most urologists would be happy to have you shadow or meet with you.

You can modify your practice based on what you like to see or want to see, especially if you've done a fellowship. I am a general urologist and will see pretty much any diagnosis, though I may not do all surgeries.

My clinic tomorrow, for example, has a couple of vasectomy evaluations, some elevated PSAs, kidney stones, prostate cancer, bladder cancer, and a woman with voiding complaints/overactive bladder. We'll get a lot of consults for kidney stones, renal masses, problems with urinating (too much or having difficulty), blood in the urine, lumps/bumps/pain in the scrotum, infertility or undesired fertility (vasectomy)... the list goes on and on.

A lot of things can be evaluated in clinic with scopes and biopsies. We are heavy users of radiologic imaging.

 

[NotaCop]

I wish SDN would somehow assimilate urologymatch. We could do so much for their website.

Some other company/org acquired (purchased) UroMatch in the not so distant past and was supposed to revamp/relaunch it but I’ve yet to see or hear anything since the original announcement so I’ve mostly lost hope. I assume they mothballed the idea or something. Who knows. Pretty sad though, it looked like it must’ve been a great resource when it was in its prime.

If you scroll back on their twitter a year or so you’ll see a retweet of the announcement with this news.

 

[armybound]

People just need to spread the word about SDN then. There are some really great folks giving advice here, like cpants.

 

[solitarius]

Urology is a nice hidden gem and poorly understood. It's too bad you don't have a home program. Do you have one near your hometown? Most urologists would be happy to have you shadow or meet with you.

Urology is nice exactly because it is a hidden gem. And because they screen out people who shouldn't be in urology.

 

[mestielest]

MS2 here trying to learn more about urology as we go through the GI/GU block. Surprisingly, it's one of the specialties that I can't seem to find much information about and we don't have an in the house urology department. What kind of conditions do urologists usually treat?

Your options as a urologist:

-Community Urology:
Outpatient: UTIs, chronic cystitis and pelvic pain, OAB syndromes, ureteral stone management, infertility first-step evaluation, urethra dilation
Daily basis surgery: hydroceles, varicoceles, circumcisions, internal urethrotomy, bladder tumor follow-up with cystoscopy, diagnostic cystoscopy
Other surgery: TUR-P, TUR-BT, ureterorenoscopy

-Endourology Specialist:
Community cases (TUR-P and TUR-BT,URS) + complex percutaneous nephrolithotomy and retrograde intrarenal surgery.

-Endourology and Oncology Specialist:
Community cases + laparoscopic renal surgery +robotic prostatectomy and cystectomy + robotic RPLND

-Functional Urologist:
Community cases + incontinence surgery (from TOT to laparoscopic/robotic sacrocolpopexy) + bladder augmentation + sacral implantation

-Andrologist:
Community cases + penile prosthesis implantation + vasectomy and reversal + microsurgical reconstructions + rare but revascularization

-Infertility specialist:
community cases + micro-tese and medical management

-reconstructive urologist
community cases + male-female or f-m surgeries, hypospadias repairs and revision, epispadias repairs

-pediatric urology
orchiopexy, circumcision, UNC, up plasty, bed-wetting and biofeedback therapy, bladder augmentation, epispadias repairs, bladder extrophy repairs,hypospadias repairs and revisions

Maybe I have forgotten some

 

[DoctwoB]

Your options as a urologist:

-Community Urology:
Outpatient: UTIs, chronic cystitis and pelvic pain, OAB syndromes, ureteral stone management, infertility first-step evaluation, urethra dilation
Daily basis surgery: hydroceles, varicoceles, circumcisions, internal urethrotomy, bladder tumor follow-up with cystoscopy, diagnostic cystoscopy
Other surgery: TUR-P, TUR-BT, ureterorenoscopy

-Endourology Specialist:
Community cases (TUR-P and TUR-BT,URS) + complex percutaneous nephrolithotomy and retrograde intrarenal surgery.

-Endourology and Oncology Specialist:
Community cases + laparoscopic renal surgery +robotic prostatectomy and cystectomy + robotic RPLND

-Functional Urologist:
Community cases + incontinence surgery (from TOT to laparoscopic/robotic sacrocolpopexy) + bladder augmentation + sacral implantation

-Andrologist:
Community cases + penile prosthesis implantation + vasectomy and reversal + microsurgical reconstructions + rare but revascularization

-Infertility specialist:
community cases + micro-tese and medical management

-reconstructive urologist
community cases + male-female or f-m surgeries, hypospadias repairs and revision, epispadias repairs

-pediatric urology
orchiopexy, circumcision, UNC, up plasty, bed-wetting and biofeedback therapy, bladder augmentation, epispadias repairs, bladder extrophy repairs,hypospadias repairs and revisions

Maybe I have forgotten some

Good list, I’ll just add that a well trained non specialized urologist can and will do many (but not all) of the things on the specialist lists.

 

[mestielest]

Good list, I’ll just add that a well trained non specialized urologist can and will do many (but not all) of the things on the specialist lists.

Yep! That's where urology also shines

 

[Elessar]

Good list, I’ll just add that a well trained non specialized urologist can and will do many (but not all) of the things on the specialist lists.

Can a well trained general urologist in the community do pediatric cases? (i.e. orchiopexy, circs, hypospadias)

 

[DoctwoB]

Yes. Many of the practices I interviewed with do a moderate volume of pediatric cases without dedicated pediatric sub specialists. Most of what they do was more bread and butter peds (hernias, orchiopexies, distal hypos). Most of these practices were all close to a major children’s hospital and would refer complex peds ( Very proximal hypos, dsd, less common congenital issues (e.g epispadias)) to the children’s hospital.

 

[stickflip723]

Sorry to bump a two month old thread but I'm also a student trying to figure out what the hell to do with my life. I'm in love with the big whacks of urology, and I even think all the scoping looks pretty fun and interesting too. However, I have pretty much zero interest in operating on the penis or dealing with problems of fertility. Every specialty has stuff you don't like as much that you tolerate to get to the fun stuff, but do the things I mentioned make up a large percentage of a general urologist's practice/training? Would it be foolish to pursue urology if those are not at least somewhat interesting to me?

 

[DoctwoB]

Sorry to bump a two month old thread but I'm also a student trying to figure out what the hell to do with my life. I'm in love with the big whacks of urology, and I even think all the scoping looks pretty fun and interesting too. However, I have pretty much zero interest in operating on the penis or dealing with problems of fertility. Every specialty has stuff you don't like as much that you tolerate to get to the fun stuff, but do the things I mentioned make up a large percentage of a general urologist's practice/training? Would it be foolish to pursue urology if those are not at least somewhat interesting to me?

As a general urologist, male infertility is a pretty small part of your practice and easy to avoid/refer especially if you’re in a decent metro area. Things like ED and low T are more common and tougher to avoid as a general urologist unless you’re in a big enough group with enough internal specialization.

If you want to maximize your big whacks the best route is to do an oncology fellowship and find an academic (or private) oncology position, which is certainly doable.

So in short it is possible to tailor your practice to do less infertility or men’s health, you will see some of that during residency (though usually not a huge amount depending on the program), how much you see afterwards depends on fellowship and practice set up.

 

[armybound]

Circs are pretty rare in the adult population. There's not a lot of "penile" surgery for an adult general urologist. Even penile cancer is very rare and will go to an oncologist.

Infertility is quite uncommon. I might, very rarely, get a semen analysis or something, but not everyone offers a varicocelectomy and certainly not TESE and the like, so your infertility will go to an andrologist.

A lot of us send low T to an endocrinologist to deal with.

 

[cpants]

Sorry to bump a two month old thread but I'm also a student trying to figure out what the hell to do with my life. I'm in love with the big whacks of urology, and I even think all the scoping looks pretty fun and interesting too. However, I have pretty much zero interest in operating on the penis or dealing with problems of fertility. Every specialty has stuff you don't like as much that you tolerate to get to the fun stuff, but do the things I mentioned make up a large percentage of a general urologist's practice/training? Would it be foolish to pursue urology if those are not at least somewhat interesting to me?

Certainly you will have to deal with operating on the penis and infertility at least in training. Easy to avoid infertility work in general practice as that is rare to begin with.

Probably would need to subspecialize if you only want to do big whacks, but you might be surprised how your interests evolve during training and practice. Endoscopic surgery is quite satisfying and also can be more lucrative than doing big cases with less risk.

 

[stickflip723]

Thank you all who responded, I really appreciate it! Urologic oncology is definitely where my interests lie, but the endoscopic procedures seem very satisfying as well like cpants mentioned. It sounds like I would encounter some of the things I mentioned in training but would be able to structure a practice how I wanted once out of residency.

 

[mestielest]

Sorry to bump a two month old thread but I'm also a student trying to figure out what the hell to do with my life. I'm in love with the big whacks of urology, and I even think all the scoping looks pretty fun and interesting too. However, I have pretty much zero interest in operating on the penis or dealing with problems of fertility. Every specialty has stuff you don't like as much that you tolerate to get to the fun stuff, but do the things I mentioned make up a large percentage of a general urologist's practice/training? Would it be foolish to pursue urology if those are not at least somewhat interesting to me?

@DoctwoB and @armybound made very good points. I, who often undertakes complex penile surgery, also agree with them. If you don't like penile surgery then you just refer the patients. The same applies to infertility. I want to add that in infertility the most important part is the laboratory facilities. mTESE and others, namely TESA and PESA, are not technically demanding procedures, however, one needs to be patient and enduring to carry out a satisfactory mTESE. The magical hand is mostly the embryologists'. After initiating your own practice your mind will change. As @cpants said, routine endourology, semirigid and flexible ureterorenoscopy, PNL, TUR-P, TUR-MT, and internal urethrotomy, is very satisfactory both mentally and financially. That's the point where urology shines. However, if you want to focus on oncological urology you may consider getting into a fellowship and then keep up your way. The branch will probably go into a more multidisciplinary approach considering the advancement in the focal treatment options for prostate cancer and bladder sparing approaches.