Urology is one of the surgical medical sciences. Urology, which was a department in general surgery in the past, has now become a separate department. There are many sub-branches of urology. In general, Urology deals with diseases in its field in men, women and children. Urology deals with urinary and genital system diseases in men and urinary system diseases in women. Female genital tract diseases in women are treated by obstetricians. In this article, I will give general information on what a Urologist or Urology specialist is and what diseases they deal with.

Who is called a urologist?

A urologist  is a specialist doctor who deals with the diagnosis and treatment of urinary and genital system diseases. The genital and urinary systems are closely related to each other. Disease symptoms in these systems are not independent of each other, so sometimes the urinary and genital systems are used together as the “urogenital system”.

The diseases that are in the field of interest of the urologist are mainly divided into two groups:

1. Urinary system
2. Diseases of the genital system

What are urinary system diseases?

Urinary system diseases are common in men and women. It includes medical and surgical diseases of similar organs.

• Kidney diseases
• Adrenal gland (adrenal gland) diseases
• Bladder diseases
• Ureteral diseases
• Diseases of the urethra

What are genital system diseases?

The urologist only looks at diseases of the male genital tract. Diseases of the female genital system Obstetrics is in the field of interest. Male genital system and its diseases;

• Testicular diseases
• Penile diseases
• Prostate diseases
• Other genital system organ diseases
• Male infertility (infertility in men)
• Sexual dysfunctions in men (erection problem, erectile dysfunction, premature ejaculation)

What kind of education is required to become a urologist?

In order to become a “urologist” or “urology specialist”, after completing 6 years of medical school, the “medical specialization exam” is taken. After passing this exam, it is necessary to do specialization (specialization training) for 5 years. During this 5-year residency period, specialist candidates receive training on the diagnosis and treatment of diseases in the fields of interest of urology. During their specialization education, they also receive training in certain disciplines related to urology, with rotation and limited periods of time. At the end of the specialization training, if the candidate who takes the “specialty exam” passes the exam, he gets the title of “Urologist” and “Urologist”. A physician who has the title of urologist has the authority to diagnose and treat diseases in his field, and to manage a Urology clinic alone.

In addition, as in many parts of medicine today, there are “sub-branches” or “upper specialization” areas in Urology. Such as Andrology, Pediatric Urology (Pediatric urology), Female Urology, Endourology, Urooncology (The field related to urological cancers). Each of them does not have a special education or specialization, some of them do. In order to become a minor specialist, it is necessary to work in the relevant field for 2-3 years and finally get the title of specialist in this branch. Urologists who have a special interest in one or more of these branches can develop themselves in this field and have more knowledge and experience about diseases related to this subject.

What are the subdivisions/sub-branches of urology?

A Urologist receives the necessary training on the diagnosis and treatment of urological diseases during his Urology education. Afterwards, the urologist continues his profession in the field of interest and mainly deals with this subject. Sub-branches of urology are:

• Urological oncology: It is a sub-branch related to urological cancers.
• Pediatric urology: A sub-branch dealing with urological diseases in children
• Kidney transplantation (kidney transplant)
• Andrology: Male sexual dysfunction, infertility
• Sexual medicine: It deals with sexual dysfunctions.
• Infertility: Related to male infertility
• Reconstructive urology: Congenital anomalies are related to tervamas.
• Minimally invasive Urology: Robotic, laparoscopic, endoscopic surgery
• Neurourology: deals with neurological diseases of the urinary tract.

What is the difference between Urology and Nephrology?

Sometimes Nephrology and Urology, Nephrologist and Urologist are confused with each other. However, these two disciplines are very different from each other. Nephrology is an internal science, Urology is a surgical science. The nephrologist deals with the medical, i.e., drug treatment of the kidney and its related disorders. Urolologist deals with surgical diseases of the urogenital system. In other words, a Nephrologist is not a surgeon, does not operate, but a Urologist is a surgeon and deals with the surgical treatment of diseases in his field of interest.

Common and frequently encountered diseases in the field of interest of the urologist

Some urological diseases that are followed and treated by a urologist are as follows;

• Unier system stone diseases
• Urinary incontinence (in women and men)
• Male infertility (male infertility)
• Varicocele disease
• Hydrocele, epididymal cyst
• Orchitis, epididymitis, chronic peostatitis
• Hematuria (bloody urination in men and women, blood in the urine)
• Benign prostatic enlargement (BPH)
• Interstitial cystitis
• Peyronie’s disease
• Congenital penile curvature
• Overactive bladder disease
• Urological cancers (kidney, bladder, prostate, testicular cancer…)
• Erectile dysfunction (ED, erectile dysfunction, impotence, impotence)

What are the urological surgeries frequently performed by the urologist?

The urologist treats urological diseases that are in his field of interest with medication or surgery. Some of these diseases are below;

• Urological cancer surgeries
• Laparoscopic, robotic, endoscopic urological surgeries
• Testicular prosthesis surgery
• Penile prosthesis surgery
• Micropenis surgeries
• Penis lengthening and thickening surgeries
• Kidney stone surgery (open stone surgery, PCNL, RIRS, URS, rigid and flexible URS, laser lithotripsy)
• BPH surgery (TURP, HOLEP, plasmakinetic, TUIP etc…)
• Cystoscopy, ureterorenoscopy (endoscopic urological procedures)
• Microsurgical varicocele surgery
• Pelvic organ prolapse surgery in women
• Female urinary incontinence surgery (TOT, TVT)
• Congenital diseases
• Kidney transplant
• Urological diseases in children (undescended testis, hypospadias, VUR surgeries)

Which complaints should go to the Urologist?

Patients with urogenital complaints in men and urinary system in women should consult a urologist. Common urological complaints are:

• Bloody urination (hematuria)
• Burning while urinating,
• Frequent urination
• Frequent urination at night (nocturia)
• Kidney pain (renal colic)
• Urinary incontinence
• Those with sexual dysfunction
• premature ejaculation
• Lack of sexual desire
• Those with sexually transmitted diseases (sexually transmitted diseases)
• Those with kidney stone disease
• If men have infertility problems
• Those with urinary system cancer
• Men with enlarged prostate
• Genital warts

What are the new urological treatment methods made by the urologist?

Today, advances in technology have been largely reflected in medicine. Technological innovations that have been used in modern medicine in recent years have also been widely used in the field of urology. Surgical procedures that require modern advanced technology to be performed by a urologist are as follows;

• Robotic surgery (for urological cancers)
• Laparoscopic surgery
• Endoscopic diagnosis and treatment interventions
• Tissue engineering applications
• Laser surgery (HOLEP, laser prostate surgery, laser kidney stone surgery)

What can a patient who goes to a urologist for examination expect?

As in all branches of clinical medicine, patients who go to the urologist are questioned in detail by the doctor. The urologist listens to his patients and asks detailed questions that may aid the diagnosis. Then the patients are subjected to Urogenital system examination. At the end of this examination, the urologist requests laboratory and radiological diagnostic methods for the diagnosis of the disease.

What are the diagnostic methods frequently requested by the urologist?

A urologist requests some tests after questioning the patient who applied to him and performing a detailed examination. The frequently requested tests that are used in the diagnosis of patients and that will guide the treatment are as follows;

• Urine microscopy: Microscopic examination of the urine gives an idea about the diagnosis of most diseases, especially infection.
• Urine culture: Urine culture is performed to determine the specific agent in recurrent urinary tract infections and resistant bacterial infections.
• Tests for sexually transmitted diseases: There are special diagnostic methods and kits for these diseases.
• Blood tests: Special or routine blood tests are requested for diseases of the urogenital system, including cancer.
• Spermogram: It is the most important test requested in order to investigate the cause of male infertility in infertile men. It is requested to reveal the functions of sperm and the male factor in male infertility.
• Urinary system ultrasonography (Urinary USG): USG is very important in the diagnosis of urogenital system diseases. It is a diagnostic method that has no side effects, does not emit radiation, and is easily used in pregnant women. Today, it is one of the indispensable diagnostic methods of every urologist. Every urologist should have USG in his office.
• Direct urinary system radiography (X-ray): It is a diagnostic method used in the evaluation of urinary system stones.
• IVP: It is a diagnostic method in which the urinary system is evaluated by administering a contrast agent. It is especially important in stone patients. It also indicates obstructions in the urinary system. Caution should be exercised in patients with impaired renal function.
• Urethrography: This procedure is mostly performed to reveal urethral pathologies such as urethral stricture and urethral diverticulum.
• VCUG (voiding cystourethrography): This test is used in the diagnosis of vesicoureteral reflux (backward leakage of urine from the bladder to the kidneys), which is common in children. The pelvis is x-rayed by filling the bladder with contrast material and serum, and it is observed whether the contrast material has escaped into the ureters and kidney.
• Abdominal CT: CT is especially used in the diagnosis and staging of urinary system tumors.
• Non-contrast CT: Here, tomography is taken without the administration of contrast material. It is mostly used in the diagnosis of urinary system stone disease.
• Abdominal MRI: Abdominal MRI is a radiological imaging method that is generally requested in the diagnosis and staging of urogenital system tumors.

• Prostate biopsy: It is the procedure of taking a biopsy from the prostate in patients with suspected prostate cancer.
• Uroflowmetry: It is a diagnostic method that shows the urine flow in patients with urinary complaints. We mostly want it in BPH patients.
• Cystometry: It is a diagnostic method that shows the storage and contraction functions of the bladder. It is an important test in neurogenic bladder patients.
• Cystoscopy: It is an endoscopic procedure frequently used by the urologist in the diagnosis of bladder and lower urinary system diseases. It is very important in the diagnosis and follow-up of bladder tumors and in the diagnosis of intra-bladder pathologies.
• Penile color Doppler ultrasonography (USG): A urologist who is particularly interested in andrology often requests this diagnostic method. With this method, erectile dysfunction is evaluated. It is an important diagnostic method showing the arterial and venous system of the penis.
• Scrotal Doppler USG: If the urologist wants to diagnose testicular vascular diseases, scrotal Doppler USG will be very helpful in the diagnosis.
• Scrotal USG: It is an important radiological examination in the diagnosis of scrotal contents.
• Prostate USG: It is very important in distinguishing kidney diseases such as tumors, stones and cysts.
• Kidney and bone scintigraphy: It is possible to evaluate kidney functions with kidney scintigraphy. Bone scintigraphy is requested to examine the bone spread of urinary system cancers.
• PSA test: It is a very important blood test, especially in the differential diagnosis of prostate cancer.
• Kidney function tests: Urea in the blood to show kidney function. Blood tests such as creatinine, sodium, potassium are frequently requested by the urologist.
• Hormones tests: The hormones frequently requested by the urologist are FSH, LH, Testosterone and prolactin. These are blood tests that are especially requested in patients with infertility and sexual dysfunction.

In summary; A urologist or urology specialist is a specialist doctor who deals with the diagnosis and treatment of diseases of the urogenital system in women, men and children. Urinary and genital system in men, only urinary system disorders in women be of interest to the urologist.

Prof. Dr. Emin ÖZBEK

Urology Specialist