If you want to operate on patients, urology is one of the best surgical specialties around. Other than hearing jokes about the Viagra phenomenon, most medical students have had little experience with urology. It is a highly focused area of medicine that treats diseases of a more sensitive nature—the urinary and male genital systems—and has rather good treatment outcomes. It is a specialty where you can have long-term relationships with patients (yet not be their primary care physician), where you can perform surgery and procedures (yet still get a decent night's sleep) and truly help improve patients' quality of life.
Urology is a surgical subspecialty focusing on the urinary tract of men and women, as well as the reproductive system of men. A common perception of urologists is that they operate on men's “private parts” and, well, that is about it. Although urologists do in fact operate on the male genitalia (penis, testicles, and scrotum), there is much more to the practice of urology than the penis. They are experts on the diagnosis and management of diseases involving the kidney, ureters, prostate, bladder, urethra, and male genitalia.
Urologists are masters of everything that has to do with the passage of urine, from its production in the kidney to its release through the urethra. They surgically correct problems such as obstructing posterior urethral valves in newborn boys or bladder outlet obstruction caused by benign prostatic hypertrophy (BPH) in elderly men. Urinary tract infections (UTIs), which affect every age group and can be quite destructive, make up a large proportion of cases seen by urologists, especially if it progresses to a worrisome infection of the kidney itself (pyelonephritis). These UTIs could actually represent serious underlying problems of the urinary system. Urologists, therefore, make use of sophisticated testing (laboratory urine analysis, urodynamic flow studies, cystoscopy) to make diagnoses and begin formulating treatment plans.
In the pediatric population, the focus is on male and female congenital abnormalities. The urinary tract is affected by nonfatal congenital anomalies more than any other organ system. This means undescended testicles (cryptorchidism), ureters poorly implanted into a bladder such that urine refluxes back to the kidneys (vesicoureteral reflux), bladder exstrophy, and the technically difficult arenas of cloacal malformation and disorder of sexual differentiation. Certainly, a general practice urologist will feel comfortable treating some of the more minor conditions, but will likely refer the more complex cases to specialists in pediatric urology.
Kidney stones (nephrolithiasis), which form in both women and men, fall under the expertise of the urologist. Some nephrologists also have an interest in treating patients who form stones, but once a stone is obstructing the urinary system, it is up to the urologist to take it out. Stone surgery dates back to some of the medical writings of Hippocrates. Certainly, a lot has changed since then; with the recent advent of endoscopic technology, minimally invasive techniques can be used to fragment stones ...