Why Urology is the Coolest Specialty

Why Urology is the Coolest Specialty

“Urology” (uro – “urinary tract” and logos – “study of”) is the branch of medicine that deals with diseases of the urinary tract in males and females and of the reproductive tract in males. The urinary organs in the “domain” of urology include the kidneys, the ureters (tubes connecting the kidneys to the urinary bladder), the urinary bladder, and the urethra (channel that conducts urine from the bladder to the outside).  These body parts are responsible for the production, storage, and release of urine.

The male reproductive organs in the “domain” of urology include the testes, epididymis, (structures above and behind the testicle where sperm mature and are stored), vas deferens (sperm ducts), 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.

Does this group of urologists look happy or what?

Urology is akin to plumbing, a highly mechanical vocation that deals with problems ranging from leaks to obstructions, and one of the beauties of the specialty is that urologists have the capacity to cure or vastly improve most problems of the urinary tract that are often mechanical in nature.

One of the greatest appeals of urology to me is that it is and has always been on the cutting-edge (no pun intended) of surgical advancements.  From the ability to scrutinize and operate on the entirety of the urinary tract with minimally invasive, tiny fiberoptic endoscopes to the extensive use of lasers and shock wave lithotripsy to the use of laparoscopic and robotic technology via keyhole incisions to the use of prosthetic implantable devices, urology is at the forefront of technical innovation.

It has been exciting to be a part of the dramatic progress in urology.  For example, when I started out in practice, prostate biopsies were finger-guided and were only done when there was an abnormality that could be felt on physical exam.  This became vastly refined with the advent of PSA testing and ultrasound-guided biopsies. Subsequently, sophisticated imaging techniques became available – multiparametric MRI and micro-ultrasound – capable of identifying lesions suspicious for prostate cancer and guide biopsies, truly a remarkable revolution in the diagnosis of prostate cancer. 

Another major appeal of urology is that it is a balanced specialty -- we treat men and women, young and old, and 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.  The field of urology is broad enough so that urologists can customize their practice to suit their talents and interests and subspecialize in the particular areas of what interests them the most. My interests are voiding dysfunction (the whole range of issues ranging from urinary frequency to incontinence to difficulty voiding to inability to void), female urology (incontinence, prolapse, urinary infections), prostate cancer, and male sexual dysfunction. The license plate on my car reads RUPNOK, which succinctly expresses my area of interest in urology!

Urology is particularly attractive to me because it allows instant intimacy with patients, often involving very personal issues.  Developing a good relationship, collaborating with patients on their journey to health and maintaining wellness, and providing interventions that can often make a meaningful difference in their quality and quantity of lives is unique and special.

And, while not all issues are curable, what many patients seek is not a cure, but simply validation, empathy, education, and assurance that their issue is not a serious problem.  Providing this acknowledgement to patients that is often as therapeutic as cure is intensely rewarding.

My path to urology was 4 years college, 4 years medical school, 2 years general surgery residency, 4 years urology residency and 1 year specialty fellowship in pelvic medicine and reconstructive urology.  I started practicing at age 33.  Board certification is the equivalent of passing the bar exam for lawyers. Urologists may be “boarded” in general urology, pediatric urology, and female pelvic medicine and reconstructive surgery.  I am board certified in both general urology and female pelvic medicine. 

Urologists are the male counterparts to gynecologists and the go-to physicians when it comes to expertise in male pelvic health.  Because of my fellowship training in female pelvic medicine, I also treat many female patients with urinary incontinence (stress incontinence and overactive bladder), pelvic organ prolapse and recurrent urinary tract infections.

Urology is one of the most cancer-centric specialties, with urological cancers accounting for 40% of all newly diagnosed cancers in men in 2024. It is highly gratifying to be able to save lives by diagnosing and treating urological cancers.  Prostate cancer is the most common cancer in men accounting for almost 30% of new cases; bladder cancer is number four accounting for 6% of cases; and cancer of the kidney and renal pelvis (the inner part of the kidney that collects the urine) is number six accounting for 4% of cases.  Urologists are also the specialists who treat testicular cancer. Developing long-term relationships with urological cancer survivors is extremely meaningful and rewarding.

There is overlap in what urologists do with other medical and surgical disciplines, including nephrology (medical diseases of the kidney); oncology (medical cancer specialists); radiation oncology (radiation cancer specialists); radiology (imaging); gynecology (female specialists); and endocrinology (hormone specialists).

Common reasons for a referral to a urologist include blood in the urine, whether visible or discovered on a urine test; an elevated or an accelerated PSA (Prostate Specific Antigen); prostate enlargement; irregularities of the prostate on digital rectal examination; and urinary difficulties ranging the gamut from urinary leakage to the inability to urinate (urinary retention). Urologists manage a variety of other issues. It is extremely fulfilling and satisfying to be able to quell the pain of a patient suffering with a kidney stone, manage the misery of a patient with a urinary tract infection, help patients on their pathway to fertility (or infertility with vasectomies), and treat men with sexual issues that rob them of their masculinity.

Wishing you the best of health,

Andrew Siegel, MD