Urologists are physicians who specialize in the treatment of medical and surgical disorders of the adrenal gland and of the genitourinary system. They deal with the diseases of both the male and female urinary tract and of the male reproductive organs.
History of Urologist Career
Medieval “healers” who specialized in the surgical removal of bladder stones could be considered the first urologists, but due to his 1958 documentation of urethra, bladder, and kidney diseases, Francisco Diaz is the recognized founder of modern urology.
Advancements in urology came during the 19th century, when flexible catheters were invented to examine and empty the bladder. In 1877, Max Nitze developed the lighted cytoscope, which is used to view the interior of the bladder. By the 20th century, diseases of the urinary tract could be diagnosed by X ray.
The Job of Urologists
Technically, urology is a surgical subspecialty, but because of the broad range of clinical problems they treat, urologists also have a working knowledge of internal medicine, pediatrics, gynecology, and other specialties.
Common medical disorders that urologists routinely treat include prostate cancer, testicular cancer, bladder cancer, stone disease, urinary tract infections, urinary incontinence, and impotence. Less common disorders include kidney cancer, renal (kidney) disease, male infertility, genitourinary trauma, and sexually transmitted diseases (including AIDS).
The management and treatment of malignant diseases constitute much of the urologist’s practice. Prostate cancer is the most common cancer in men and the second leading cause of cancer deaths in men. If detected early, prostate cancer is treatable, but once it has spread beyond the prostate it is difficult to treat successfully.
Testicular cancer is the leading cause of cancer in young men between the ages of 15 and 34. Major advances in the treatment of this cancer, involving both surgery and chemotherapy, now make it the most curable of all cancers. Bladder cancer occurs most frequently in men age 70 and older, and treatment for it also has a high success rate.
Young and middle-aged adults are primarily affected by stone diseases, which represent the third leading cause of hospitalizations in the United States. Kidney stones, composed of a combination of calcium and either oxalate or phosphate, usually pass through the body with urine. Larger stones, however, can block the flow of urine or irritate the lining of the urinary system as they pass. What has become standard treatment today is called extracorporeal shock wave lithotripsy (ESWL). In ESWL, high-energy shock waves are used to pulverize the stones into small fragments that are carried from the body in the urine. This procedure has replaced invasive, open surgery as the preferred treatment for stone disease.
Urologists also consult on spina bifida cases in children and multiple sclerosis cases in adults, as these diseases involve neuromuscular dysfunctions that affect the kidneys, bladder, and genitourinary systems.
The scope of urology has broadened so much that the following are now considered subspecialties: pediatric urology, urologic oncology, and female urology.
Urologist Career Requirements
To become a urologist you must first earn an M.D. degree and become licensed to practice medicine (See “Physicians”). Then you must complete a five- or six-year residency in urology, of which the first two years are typically spent in general surgery, followed by three to four years of urology in an approved residency program. Currently, there are 122 residency programs.
Many urologic residency training programs are six years in length, with the final year spent in either research or additional clinical training, depending on the orientation of the program and the resident’s focus.
The vast majority of urologists enter into clinical practice after completing their residency program. However, fellowships exist in various subspecialties, including pediatrics, infertility, sexual dysfunction, oncology, and transplantation.
Certification or Licensing
At an early point in their residency period, all students are required to pass a medical licensing examination administered by the board of medical examiners in each state. The length of the residency depends on the specialty chosen.
Certification requires the successful completion of a qualifying written examination, which must be taken within three years of completing the residency in urology. The subsequent certifying examination, which consists of pathology, uroradiology, and a standardized oral examination, must be taken within five years of the qualifying examination. Certification by the American Board of Urology is for a 10-year period, with recertification required after that time.
Urologists need to enjoy working with people and to have a strong interest in promoting good health through preventive measures such as diet and exercise.
The urologist diagnoses and treats conditions of a very personal nature. Many patients are uncomfortable talking about problems relating to their kidneys, bladder, or genitourinary system. The urologist must show compassion and sensitivity to dispel the patient’s fears and put him or her at ease.
Excellent communication skills are essential to patient-physician interactions. You should be able to clearly articulate both the patient’s problem and the recommended forms of treatment, including all of the options and their attendant risks and advantages. Because of frequent consultations with other physicians, you also need to develop good working relationships with other medical specialists.
Like all surgeons, you should be in good physical condition; you must remain steady and focused while standing for hours. Urologists who work in hospital trauma units should be prepared for the frenetic pace and tension of split-second decision making.
According to the U.S. Department of Labor, the media annual salary for physicians with internal specialties was $168,500 in 2005. The lowest-paid 10 percent earned less than $44,850 a year, while the highest-paid 10 percent earned more than $200,000. Median annual earnings of surgeons was $190,280.
Urologist Career Outlook
Employment prospects for urologists are good. According to the Occupational Outlook Handbook, employment for physicians is expected to grow about as fast as the average through 2014. The demographics of American society illustrate that the increase in the aging population will increase demand for services that cater, in large part, to them. With baby boomers aging, the need for qualified urologists will continue to grow.