What is urology?
Urology has as its anatomical sphere of action the kidney and its adjacent structures, the urinary tract and the male genital apparatus, attending to the dysfunctions of the following organs and structures: adrenal gland, kidney (morphological aspects and obstructive alterations), retroperitoneum and lumbar region , ureter, bladder, prostate, seminal path, urethra, pelvic floor structures, penis, scrotum, testicle and epididymis. The treatment of the corresponding diseases can be medical, with the use of all types of drugs, and surgical, including open procedures, laparoscopy, endoscopy and radiological methods. Urology is a medical-surgical specialty that deals with the diagnosis and treatment of renal morphological diseases and those of the urinary and retroperitoneal systems that affect both sexes; as well as diseases of the male genital tract, with no age limit.
The main urological diseases are tumors (benign and cancerous) and injuries of each of the aforementioned organs, urinary tract infection, lithiasis (stones or stone formation), stenosis (narrowing of the urinary ducts), malformations renal and urinary tract (absence of kidney, renal ectopia, polycystosis, pyeloureteral junction syndrome, megaureter, ureterocele, urethral valves, hypospadias-epispadias, cryptorchidism, intersex states), urinary incontinence and other urinary disorders , problems of the prostate (cancer, hyperplasia and prostatitis), erectile dysfunction (formerly called impotence), infertility (previously called sterility) as well as other male genital problems (penile surgery, hydrocele, varicocele) and certain soil problems female pelvic (cystocele).
The urologist knows precisely the anatomy, physiology, physiopathology, etiology, clinical expression, nosology, methods of diagnostic recognition, therapeutic, medical and surgical procedures, of the organs, apparatuses and systems described above, within the scientific, medical and legal scope of the specialty of Urology.
The development of Urology during the twentieth century has been extraordinary. The exploratory cystoscope was immediately transferred to the panendoscope as an element of surgical work, especially in the pathology of bladder and prostate tumors, which is currently in force today, with the addition of important advances in optical, mechanical, electrical and laser technology. Endoscopic techniques have been applied to the renal and ureteral level since the 70s, and urological surgical equipment has served for the development of laparoscopic surgery, with applications in the adrenal territory, kidney, ureter, retroperitoneal space, bladder, prostate and urethra. Many specialties, among which are digestive surgery, thoracic surgery, gynecology, orthopedics, and ENT have benefited from the technological advances achieved by Urology.
The current urology can approach from an integral point of view, medical and surgical, all the ailments of its area of anatomical influence (organs, apparatuses and systems) and nosological (diseases, syndrome, symptoms and clinical signs), being able to respond to problems of their patients, from a deep and complete knowledge of the specialty.
Urologists have a medical and surgical vision of diseases of the urinary system of men and women and of the genital system in men. They are trained to approach surgical pathology using classic open surgery methods for the kidneys, the retroperitoneum and the pelvis, through incisions in the lumbar region (lumbotomy), abdominal (laparotomy, and extraperitoneal accesses) and perineal that are being replaced by Laparoscopic and endoscopic approaches (minimally invasive surgery) in almost all indications, achieving important advances in terms of safety and efficacy.
At present only some complex cases or specific procedures impossible to perform by endoscopy are reserved for open surgery, although it is presumable that any intervention will be handled in the first instance by laparoscopy or robotics. Classic procedures such as nephrectomy, cystectomy and prostatectomy can already be addressed with these new techniques. On the other hand, urologists have a deep knowledge of medical therapeutics of their specialty. For this, they use multiple drug therapies in both urological cancer (chemotherapy and local immunotherapy, hormone therapy), urinary infection (antibiotic therapy), incontinence and bladder dysfunction (inhibitors of bladder function), prostate dysfunction (adrenergic inhibitors, antiandrogens) , urolithiasis (dietetics, citrates, alkalinization and urinary acidification, diuretics) and andrology (androgen therapy, precursors of erection and modulators of ejaculation). They also know the rehabilitative therapies of the urinary system, pelvic floor and sexual function.
Future of Urology
The technological future in urology swings between medical and surgical options, both aimed at treating the patient in a minimally invasive way. With the help of gene therapy solutions for the various forms of urological cancer will be obtained. In the diagnostic field, the endoscopy obtained by tomodensitometric or magnetic resonance reading will allow to reconstruct with light the urinary tract; and the new tumor markers will allow early detection of the disease and follow it with great precision. All these sections are already an incipient reality today that is giving way to new biotechnological expectations. Future expectations are renewing at great speed and now it is time to talk about projects more related to bioengineering than with the branches of pure biology. Aspects such as robotics, telemedicine, nanotechnology and tissue engineering are reviewed, just at this moment when they are breaking into the urological specialty.