Urology 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. The 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.
Urology has traditionally been on the cutting edge of surgical technology in the field of medicine, including minimally invasive robotic and laparoscopic surgery, laser-assisted surgeries, and a host of other scope-guided procedures. Urologists are trained in open and minimally invasive techniques, employing real-time ultrasound guidance, fiber-optic endoscopic equipment, and various lasers in the treatment of multiple benign and malignant conditions. In addition, urologists are pioneers in the use of robotics in laparoscopic surgery. 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-after surgical specialties for physicians, with new urologists comprising less than 1.5% of United States medical school graduates each year.
Urologic surgeons, or urologists, undergo a post-graduate surgical training period for a minimum of five years, of which 12 months must be completed in general surgery and 36 months must be completed in clinical urology. The remaining 12 months are spent in general surgery, urology, or other clinical disciplines relevant to urology. 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, neurourology, and androurology and sexual medicine. Additionally, some urologists supplement their fellowships with a master’s degree (2–3 years) or a Ph.D. (4-6 years) in related topics to prepare them for an academic as well as a focused clinical job.
In 2014, there were 126 residency programs that offered 296 categorical positions. Urology is one of the early match programs, with results given to applicants by late January (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 68% to 77% of US seniors matching between 2012 and 2015. Thankfully, the number of positions has grown over the past few years, from 278 in 2012 to 296 in 2015. 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 2005-09 that 20 schools sent more than 15 students into urology (1 sd above median), with Northwestern University sending 44 students over those 5 years.
After urology residency, there are 7 subspecialties recognized by the AUA (American Urological Association):
- Female Urology
- Transplant (renal)