“Urology” (uro—urinary tract; logos—study of) is the branch of medicine that diagnoses and treats diseases of the urinary tract in males and females and the reproductive tract in males. The urinary organs under the “domain” of urology include the kidneys, the ureters (tubes connecting kidneys to the urinary bladder), the urinary bladder, and the urethra (channel that conducts urine from the bladder out). These body parts are responsible for the production, storage and release of urine. The male reproductive organs that a urologist cares for are the testes, epididymis (structures above and behind the testicle where sperm mature and are stored), vas deferens (sperm duct), seminal vesicles (structures that produce the bulk of semen), prostate gland and the scrotum and penis. These body parts are responsible for the production, storage, and release of reproductive fluids. The reproductive and urinary tracts are closely connected, and disorders of one oftentimes affect the other…thus urologists are referred to as “genitourinary” specialists.
Urology is a balanced specialty – urologists treat men and women young and old, from pediatric to geriatric. Whereas most physicians are either medical doctors or surgeons, a urologist is both, with time divided between a busy office practice and the operating room. Although most urologists are men, more and more women are entering the urological workforce.
It takes extensive training to become a urologist. My pathway to urology was 4 years of college, 4 years of medical school, 2 years of general surgery residency, 4 years of urology residency and 1 year of specialty fellowship training in pelvic medicine and reconstructive urology. I started practicing at age 33.
Board certification is the equivalent of a lawyer passing the bar exam. There are three board certifications in urology: general urology, pediatric urology, and female pelvic medicine and reconstructive surgery. Thereafter, one must maintain board certification by participating in continuing medical education and pass a recertification exam every ten years. Every urologist at New Jersey Urology is either board-certified or board-eligible (the younger urologists who have not yet sat for the board exam). Some, like myself, are double board-certified.
A Comprehensive Team Approach
Although urology is a unique and niche specialty, there is some overlap with other medical and surgical disciplines, including nephrology (specialists in medical diseases of the kidney); oncology (medical cancer specialist); radiation oncologist (radiation cancer specialists); radiology (imaging specialists); gynecology (female specialists); endocrinology (hormone specialists); and infectious disease (infection specialists).
When Does One Need Urologic Care?
Although many of our patients are sent over by their primary care physicians, many others directly seek our care. Urologists are the male counterparts to gynecologists and the go-to physicians when it comes to expertise in male pelvic health. Although gynecologists treat only females, urologists care for both genders. Providing healthcare to females is a routine part of urology and commonly treated female issues include recurrent urinary infections, urinary incontinence and pelvic organ prolapse.
Common reasons for a referral or visit to a urologist include:
- Blood in the urine or semen (whether visible or found on a urine test)
- Elevated PSA (Prostate Specific Antigen)
- Prostate enlargement
- Irregularities of the prostate on digital rectal examination (DRE)
- Pelvic organ prolapse
- Urinary disease:
- Urinary leakage or control issues
- Inability to urinate (urinary retention)
- Urinary frequency
- Urinary infections
- Kidney Stones
- Urologic Cancers
Sexual dysfunction is a common condition managed by the urologist—erectile dysfunction, ejaculation problems, and testosterone issues. Urologists treat not only male infertility, but also create male infertility when it is desired by performing voluntary male sterilization (vasectomy). Testicular pain and swelling are also the domain of urologists.
Another large component of urological practice is the management of infections that may involve the bladder, kidneys, prostate, testicles and epididymis. Kidney stones are another key issue that keeps urologists busy. To manage stones that fail to pass spontaneously, urologists have at their disposal minimally invasive, outpatient techniques with new generation shockwave devices and miniaturized fiberoptic telescopes with laser technology.
Urological surgery involves operating on patients with potentially life-threatening illnesses, and cancers of the genital and urinary tracts are common and a major part of urological practice. These include prostate cancer, bladder cancer, and cancer of the kidney and renal pelvis (the inner part of the kidney that collects the urine).
Men age 40 and older who have a life expectancy of 10 years or greater should be screened for prostate cancer, the most common male cancer (aside from skin cancer), whether it is by their primary care physician or urologist. Screening is vital since prostate cancer does not cause symptoms until it progresses to advanced stages and screening aims to detect prostate cancer in its earliest and most curable states. Screening is as simple as an annual digital rectal examination and a PSA blood test.
Women with kidney and bladder cancer are also managed by urologists, although the prevalence of these cancers is much less in females. Urologists are the specialists who treat testicular, penile, and adrenal cancer. After definitive cancer care, patients will need follow-up for an indefinite period of time and it is urologists who provide this aftercare.
Cutting-Edge Surgical Advancement
Urology has always been on the cutting edge of surgical advancements (no pun intended) with continued evolution into improved and less invasive techniques. Urologists have at their disposal a host of minimally invasive technologies including fiber-optic scopes to view the entire inside of the urinary tract, as well as ultrasound, lasers, laparoscopy and robotics. As a result, many procedures that used to be done on an inpatient basis are now performed on an outpatient basis.
New Jersey Urology has been at the forefront of robotic-assisted laparoscopic surgery that has largely replaced open surgery. The urologist with a dedicated team of assistants harnesses the powers of the robot, an extraordinary example of human-machine symbiosis. It affords numerous advantages including high-quality 3D vision, motion scaling, and enhancement of surgeon dexterity, which translates to numerous benefits and advantages to the patient. New Jersey Urology has the largest experience in robotic urology procedures in New Jersey, particularly cancer and reconstructive urological surgery. Single-port access – even more minimally-invasive than the conventional multi-port robotic technology – is the latest iteration and evolution and New Jersey Urology has the largest clinical experience with this in the Northeastern United States.
Standard robotic laparoscopic surgeries require 5-6 small incisions, whereas the revolutionary single port robotic procedure combines them into one keyhole incision.
Clinical research is a vital part of urology and New Jersey Urology has numerous ongoing clinical trials in prostate cancer, bladder cancer, benign prostate hypertrophy, and overactive bladder. Dr. Elan Diamond is the medical director of clinical research and the center for advanced prostate cancer therapeutics that offers many novel medications and immunotherapy. Genomic science has enabled the ability to determine the molecular blueprint of cancers, the key to assessing their biological potential. Determining a cancer’s unique genetic profile provides the potential for “precision medicine,” individualized and customized treatment strategies with agents targeted against the specific mutations, a treatment based upon cancer biology and no longer only cancer histology.