Urology is the field of medicine that focuses on the urinary tracts of males and females, and on the reproductive system of males. In men, the urinary system overlaps with the reproductive system, and in women the urinary tract opens into the vulva. In both sexes, the urinary and reproductive tracts are close together, and disorders of one often affect the other. The organs covered by urology include the kidneys, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate and penis).

The discipline combines management of medical (i.e., non-surgical) problems such as urinary infections, and surgical problems such as the correction of congenital abnormalities and the surgical management of cancers. Such abnormalities within the genital region are called genitourinary disorders.

Urologists are also involved in the assessment and treatment of incontinence. Urodynamics is the study of the pressure within the urinary system and urologists often use diagnostic techniques such as flow cystometry or ambulatory urodynamic profiles to determine the best method of treatment for the patient. This could include medical prescription (e.g. oxybutynin or multiple alpha-blockers) or surgical intervention (e.g. urethral suspension/slings).

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Urologist needed within a half hour from Boston, MA!!! --Easy potential of 300K+ :: Massachusetts :: CompHealth Inc
Job 918340 Employed position - Salary plus incentives - Great Benefits Hospital Employee - great stability with this independent, financially stabile facility! Practice general, bread and butter Urology.
Solo Opportunity for Urologist in Iowa to join Multi-Specialty Group :: Iowa :: CompHealth Inc
Job 916885 Solo general urology opening in Multi-Specialty Group Busy from the start from referring physicians Patients are currently being sent to outreach areas that are 60-100 miles away Have two
Urologist needed to join a great practice in Northern California :: California :: CompHealth Inc
Job 919056 Multiple opportunities in and around Sacramento - 1 yr track to partnership Join respected, established practices Nice mix of clinic and surgeries, as well as strong referral network Hospital

Urology / Nephrology News From Medical News Today

Drug Side Effects A Key Factor In Reduced Quality Of Life For Kidney Transplant Patients
Tue, 24 Nov 2009 02:00:00 -0800
People who have kidney transplants need longer-term support than most friends, relatives or even healthcare professionals realise, according to a study of 160 patients published in the December issue of the UK-based Journal of Advanced Nursing. Researchers surveyed 55 patients who had undergone surgery in the last year, together with 105 who had had surgery in the last one to three years at the Vanderbilt Transplant Center in Tennessee, USA.
Proteon Initiates Second Phase 1/2 Clinical Study Of PRT-201 In Hemodialysis Patients
Tue, 24 Nov 2009 01:00:00 -0800
Proteon Therapeutics, Inc., has initiated a Phase 1/2 human clinical study of its lead product, PRT-201, in end-stage renal disease (ESRD) patients undergoing surgery for arteriovenous graft (AVG) creation. The AVG study represents Proteon's second human clinical study in hemodialysis patients, previously announcing the initiation of a Phase 1/2 study of PRT-201 in ESRD patients undergoing surgery for arteriovenous fistula (AVF) creation earlier this year.
Study Assesses Neuropathic Pain Risk For Breast Cancer Patients
Tue, 24 Nov 2009 01:00:00 -0800
Breast cancer patients treated with the chemotherapy drug Taxol (paclitaxel) are more likely to develop chronic neuropathic pain, according to research published in The Journal of Pain, the peer review publication of the American Pain Society. Researchers from the University of Texas MD Anderson Cancer Center conducted a survey of breast cancer patients who participated in clinical trials of Taxol from 1994 to 2001. There were 240 respondents.

BMC Urology - Latest Articles

Treatment success for overactive bladder with urinary urge incontinence refractory to oral antimuscarinics: a review of published evidence
Jonathan CampbellKatharine GriesJonathan WatanabeArliene RaveloRoger DmochowskiSean Sullivan Fri, 20 Nov 2009 00:00:00 -0000
Background: Treatment options for overactive bladder (OAB) with urinary urge incontinence (UUI) refractory to oral antimuscarinics include: botulinum toxin type A (BoNTA), sacral neuromodulation (SNM), and augmentation cystoplasty (AC). A standard treatment success metric that can be used in both clinical and economic evaluations of the above interventions has not emerged. Our objective was to conduct a literature review and synthesis of published measures of treatment success for OAB with UUI interventions and to identify a treatment success outcome. Methods: We performed a literature review of primary studies that used a definition of treatment success in the OAB with UUI population receiving BoNTA, SNM, or AC. The recommended success outcome was compared to generic and disease-specific health-related quality-of-life (HRQoL) measures using data from a BoNTA treatment study of neurogenic incontinent patients. Results: Across all interventions, success outcomes included: complete continence (n=23, 44%), >=50% improvement in incontinence episodes (n=16, 31%), and subjective improvement (n=13, 25%). We recommend the OAB with UUI treatment success outcome of >=50% improvement in incontinence episodes from baseline. Using data from a neurogenic BoNTA treatment study, the average change in the Incontinence Quality of Life questionnaire was 8.8 (95% CI: -4.7, 22.3) higher for those that succeeded (N=25) versus those that failed (N=26). The average change in the SF-6D preference score was 0.07 (95% CI: 0.02, 0.12) higher for those that succeeded versus those that failed. Conclusions: A treatment success definition that encompasses the many components of underlying OAB with UUI symptoms is currently not practical as a consequence of difficulties in measuring urgency. The treatment success outcome of >=50% improvement in incontinence episodes was associated with a clinically meaningful improvement in disease-specific HRQoL for those with neurogenic OAB with UUI. The recommended success definition is less restrictive than a measure such as complete continence but includes patients who are satisfied with treatment and experience meaningful improvement in symptoms. A standardized measure of treatment success will be useful in clinical and health economic applications.
Percutaneous nephrolithotomy in horseshoe Kidneys: is rigid nephroscopy sufficient tool for complete clearance? a case series study
Mohamed El GhoneimyAhmed KoderaAshraf EmranTamer OrbanAhmed ShabanMohamed El Gammal Mon, 16 Nov 2009 00:00:00 -0000
Background: this study represents a case series to evaluate how successful is the rigid percutaneous nephroscopy as a tool for clearance of all stones in various locations in horseshoe kidneys. Methods: Between 2005 and 2009, we carried out PCNL (percutaneous nephrolithotomy) for calculi in horseshoe kidneys in 21 renal units (17 patients) in our department. The indications were large stone burden in 18 units and failed SWL( shock wave lithotripsy) in 3 renal units. All procedures were done under general anesthesia; using fluoroscopic guidance for localization and standard alkan dilatation followed by rigid nephroscopy and stone extraction with or without stone disintegration. We analyzed our results regarding the site and number of the required access, the intra and postoperative complications, the presence of any residual stones, as well as their location. Results: The procedure was completed, using a single access tract in 20 renal units, with the site of puncture being the upper calyx in nine units and the posterior middle calyx in eleven units. Only in one renal unit, two access tracts (an upper and a lower calyceal) were required for completion and a supracostal puncture was required in another case. There was no significant intraoperative bleeding and no blood transfusion was required in any patient. A pelvic perforation occurred in one case, requiring longer PCN (percutaneous nephrostomy) drainage. One patient with infection stones suffered urosepsis postoperatively which was successfully managed. Three cases had residual stones, all located in the renal isthmus, all residuals were un approachable with the rigid instrument; resulting in a overall stone-free rate of 85.7 % at discharge. Conclusion: Percutaneous nephrolithotomy is generally safe and successful in the management of stones in horseshoe kidneys. However, location of the stones in these patients is crucial to decide the proper tool for optimal stone clearance result.
Pharmacologic attenuation of pelvic pain in a Murine model of interstitial cystitis
Charles RudickAnthony SchaefferDavid Klumpp Thu, 12 Nov 2009 00:00:00 -0000
Background: Interstitial cystitis/painful bladder syndrome (IC/PBS) is a bladder disease that causes debilitating pelvic pain of unknown origin, and IC/PBS symptoms correlate with elevated bladder lamina propria mast cell counts. Similar to IC/PBS patients, pseudorabies virus (PRV) infection in mice induces a neurogenic cystitis associated with bladder lamina propria mast cell accumulation and pelvic pain. We evaluated several drugs to determine the effectiveness of reducing PRV-induced pelvic pain. Methods: Neurogenic cystitis was induced by the injection of Bartha's strain of PRV into the abductor caudalis dorsalis tail base muscle of female C57BL/6 mice. Therapeutic modulation of pelvic pain was assessed daily for five days using von Frey filament stimulation to the pelvic region to quantify tactile allodynia. Results: Significant reduction of PRV-induced pelvic pain was observed for animals treated with antagonists of neurokinin receptor 1 (NK1R) and histamine receptors. In contrast, the H1R antagonist hydroxyzine, proton pump inhibitors, a histamine receptor 3 agonist, and gabapentin had little or no effect on PRV-induced pelvic pain. Conclusion: These data demonstrate that bladder-associated pelvic pain is attenuated by antagonists of NK1R and H2R. Therefore, NK1R and H2Rrepresent direct therapeutic targets for pain in IC/PBS and potentially other chronic pain conditions.
Donor site morbidity in oral mucosa graft urethroplasty: implications of tobacco consumption
Rahul Janak SinhaVishwajeet SinghS SankhwarDivakar Dalela Mon, 21 Sep 2009 00:00:00 -0000
Background: The purpose of this prospective study was to evaluate the donor site morbidity in patients who have undergone oral mucosa graft urethroplasty for stricture of the urethra. The impact of smoking and oral consumption of tobacco and/or paan masala on the donor site was also assessed. This study is probably the first of its kind where the affect of smoking, paan masala and tobacco chewing on the donor site morbidity has been documented. Methods: Forty-eight patients suffering from stricture of the urethra underwent oral mucosa graft urethroplasty between July 2005 and December 2007. The patients were divided into two groups (users or non-users) based on tobacco consumption and oral hygiene. The donor site was evaluated at frequent intervals for pain, swelling, numbness, bleeding, salivation and tightness of mouth. Results: Donor site morbidity was more in users with poor oral hygiene. Pain scores were higher amongst the users and the morbidity persisted longer in the users compared to non-users with good oral hygiene. Conclusion: Patients who consume tobacco and have poor oral hygiene should be warned regarding poorer outcomes after oral mucosa graft urethroplasty.
A systematic review of the diagnostic accuracy of prostate specific antigen
Philip HarveyAmman BasuitaDeborah EndersbyBen CurtisAphrodite IacovidouMary Walker Thu, 10 Sep 2009 00:00:00 -0000
Background: Prostate cancer is the fourth commonest cancer in the UK, and the incidence is rising. The reference standard for diagnosing this condition is prostate biopsy, an invasive procedure.This study systematically reviews recent literature on tPSA accuracy. The time period was restricted to ensure that the estimates referred to contemporary tPSA tests and prostate cancer reference standards. The focus of this review was restricted to European populations as tPSA levels are known to vary by population group. Methods: Medline was searched (from 01/1998 to 01/2008) and Embase (from 01/1998 to 01/2008), which returned 3087 citations. These were assessed by 6 reviewers, who shortlisted 54 of possible relevance. 2 reviewers assessed each using the following inclusion criteria: data collection between 1998-2008; tPSA measurements for all participants; histological confirmation of the diagnosis; samples from a European population and sufficient data to calculate 2 × 2 tables. The final set of 10 included studies represented 5373 participants. Quality of the included studies was assessed in duplicate using criteria suggested by the Cochrane Collaboration. Review Manager 5.0 software was used to analyse the data, including plotting a series of summary receiver operator curve spaces (SROC). Results: tPSA sensitivities ranged from 0.78 to 1.00 and specificities from 0.06 to 0.66. Positive likelihood ratios ranged from 0.83 to 2.90 and negative likelihood ratios ranged from 0.00 to 3.75 Conclusion: tPSA has a role to play as one of several indicators for prostate biopsy along with abnormal digital rectal examination and urinary symptoms. However, tPSA test has a high false positive and significant false negative rate. It is important that clinicians understand these limitations.
Commentary: the role of cytologic analysis of voided urine in the work-up of asymptomatic microhematuria
Deep TrivediEdward Messing Thu, 10 Sep 2009 00:00:00 -0000
Microscopic hematuria is a common finding in patients presenting to both primary care doctors as well as urologists. Sources of microscopic hematuria include infection, stones, inflammatory disorders as well as cancer of the genitourinary tract, particularly urothelial cancer. A primary focus in the urologic workup of hematuria is to rule out cancer. This is done using radiographic studies as well as procedures such as cystoscopy and bladder biopsy. As the authors state in their article titled "The utility of serial urinary cytology in the initial evaluation of the patient with microscopic hematuria", cytologic analysis of voided urine, though attractive due to its noninvasive nature, has been found to have the neither the sensitivity, cost-effectiveness, nor the ease of administration necessary to replace more invasive diagnostics in the evaluation of microscopic hematuria.

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