United Medical Education College (UMEC) Urology Research and Education Centre

The UMEC Urology is a part of Joint Urology Research Consortium. Urological health is important in medical practice as it is part of healthcare that deals with diseases of the male and female urinary tract such as kidneys, ureters, bladder and urethra, including dealing with the male sexual organs like penis, testes, scrotum, prostate, etc.). Urology is known as a surgical specialty, but Urologists also have knowledge of other medical and surgical specialties such as internal medicine, pediatrics, gynecology and other parts of health care. This is because urologists deal with a wide range of clinical problems in the communities they practice. Hence, the UMEC Urology Research and Education Centre was established in 1969 to look into the various trends and issues in urological research, education and practice.

The Urology Research and Education Project Team

The Urology Reproach Group consists of well qualified and enthusiastic team members. For details, please contact us at info@umec.org.uk

Introduction to the Science of Urology

The term Urology is from the Greek word: ‘οὖρον’ ouron, which means "urine" and –‘λογία’ -logia, which means the “study of". Urology is also known as genitourinary surgery, which is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the 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).

Link between Urology and Other Specialties

The urinary and reproductive tracts are closely linked, and disorders of one often affect the other. Hence, 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):

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.

Urologists Education and Training

Urologists are physicians which have specialized in the field after completing their general degree in medicine. Upon successful completion of a residency programme, 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:

Urological surgery
Urological oncology
Urological oncological surgery
Endourology
Endourological surgery
Erogynecology
Urogynecological surgery
Reconstructive urologic surgery (a form of reconstructive surgery
Minimally-invasive urologic surgery
Paediatric 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
Androurology and sexual medicine.

In addition, 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.

International Modes of Training in Urology

United States of America

As of 2023, there are about 150 residency/training programmes that offered 360 categorical positions. Urology is one of the early match programmes, with results given to applicants by early February (6 weeks before NRMP match). Applications are accepted starting 1 September with some programmes accepting applications until early Jan.

It is a relatively competitive specialty to match into, with only about 66% of US seniors matching in the 2023 match cycle. The number of positions has grown from 278 in 2012 to 360 in 2023. 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 and 2009 that 20 schools sent more than 15 students into urology (1 standard deviation above the median), with Northwestern University sending 44 students over those 5 years.

After urology residency, there are seven subspecialties recognized by the AUA (American Urological Association):

Oncology
Calculi
Female Urology
Infertility
Pediatrics
Transplant (renal)
Neurourology.[11]

Australia

Training is completed through the Royal Australasian College of Surgeons (RACS). The programme requires six years of full-time training (for those who commenced prior to 2016), or five years for those who commenced after 2016. The programme is accredited by the Australian Medical Council.

Nepal

In Nepal, the formal urologist degree awarded is MCh (Magister Chirurgiae). This is a three years course post masters and includes thesis and a mandatory publication. This degree is awarded after completing MBBS (four and half year plus a one-year rotatory internship) and MS (Mastery of surgery) in general surgery (three years course). Till now, two universities Tribhuvan University and Kathmandu University as well as two Autonomous institutes BP Koirala Institute of health sciences and National Academy of Medical Sciences (Bir Hospital) run the MCh Urology programme. This degree is equivalent to Clinical PhD and called as "Chikitsa Bidhyabaridhi" by Tribhuvan University (Government University) and is considered to be the highest degree among the surgical discipline degrees.

Ethiopia

Urology is a relatively new field in Ethiopia. By 2001, there were only five qualified Urologists in the country. All trained abroad, in countries like India, Tanzania and Hungary. Before this chapter all urology cases were managed by general surgeons. The only urological unit in the country was at Tikur Anbessa Tertiary Hospital. The services provided included ESWL and endo-urology. The urology training program was started in 2009 with a curriculum for general surgeons, which had a three-year training program. Up to 2019, six urologists have graduated by this program for general surgeons. The first residency program started accepting general practitioners in 2010 for a five-year program. The first two years were trainings in general surgery, the next three years were dedicated urology training program, which included the same three-year training as of the general surgeons three year curriculum. It started with two residents who graduated in 2015 with a certificate in specialty of urology. Up to 2019, seventeen urologists have graduated from this five-year residency program. From the start these programs in 2009 up to 2019, a total of 23 urologists have been trained in Tikur Anbessa Tertioary Hospital. As of 2020, there were 26 trainees in the program. All of the urologists who graduated from Tikur Anbessa Tertioary Hospital were as of 2020 working in different parts of the country.

Subdisciplines of Urology Covered by the UMEC Urology Centre

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

Endourology is the branch of urology that deals with the closed manipulation of the urinary tract.[19] 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 ureteral procedures. Recently, the addition of laparoscopy and robotics has further subdivided this branch of urology.

Laparoscopy

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

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

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

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

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 that are specific to female health, especially reproductive and urologic health.

Reconstructive urology

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

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.

Journals and organisations of Urology

Journals of Urology

There are a number of peer-reviewed journals and publications about urology, including:

Organisations of Urology

There are national organizations such as:

the American Urological Association
the American Association of Clinical Urologists,
European Association of Urology
the Large Urology Group Practice Association (LUGPA),
The Society for Basic Urologic Research.
Urology is also included under the auspices of the International Continence Society.

Teaching organizations include:

the European Board of Urology
the Vattikuti Urology Institute in Detroit, which also hosts an annual International Robotic Urology Symposium devoted to new technologies.
The American non-profit IVUMed teaches urology in developing countries.

List of urological topics

The Centre for research and education in Urology also deals with the trends and issues in the following topics:

As a result of the big scope, the urology team members undertake projects in the following areas of urology:

Paediatric Urology (children's urology)
Urological Oncology (urological cancers)
Renal (kidney) Transplant
Male Infertility
Calculi (urinary tract stones)
Female Urology
Neurourology (nervous system control of genitourinary organs)
The Prostate and Prostate Diseases, including Prostate Cancer and Benign Prostatic Hyperplasia (BPH).

For more information about the work of the Urology Research and Education Group, please contact: info@umec.org.uk