The urologist and his craft-A A +A
The Urology Corner
Tuesday, October 15, 2013
A UROLOGIST is a "physician and surgeon" who is trained in this branch of surgery and is the expert in diagnosis and treatment of disorders of the adrenal glands, kidneys, ureters, and urinary bladder in males and females of any age as well as the male reproductive and genital tract (testes, epididymis, vas deferens, seminal vesicles, prostate and penis).
To become a urologist, one undergoes a four year training program in an accredited institution after completing at least two years of an accredited general surgery training. After completing the four years, one may pursue further subspecialty training or may go into private practice.
The Philippine Board of Urology is the body authorized to certify the graduates from each training program. Three examinations, written, oral and practical have to be passed in order to become a diplomate or a board certified urologist.
Urology is mainly a surgical specialty and urologic procedures can either be done via the traditional open surgery, endoscopic approach and minimally invasive and laparoscopic urologic surgery which is slowly being the gold standard in most cases.
Although the trend is gearing towards minimally invasive surgery, open surgery still plays an important role in the management of urologic disorders and all urologists still know how to perform them.
Some common conditions which are approached via open surgery include: 1) kidney stones three centimeters (cm) or more, stones in the middle and lower ureter two centimeters or more; urinary bladder stones more than two centimeters 2) cancer surgery -- kidney more than seven centimeters, diagnosed bladder cancer, prostate cancer, testicular cancer 3) reconstructive surgery especially in the pediatric age group -- urethroplasty, orchidopexy, hypospadias repair, ureteral reimplantation.
Urologists are also endoscopic surgeons as many urologic procedures are done using operating telescopes. A cystoscope is an instrument used to visually examine the urethra and the urinary bladder and there are instrument ports for use of forceps and tubes.
Since the bladder is a part of the urinary tract, cystoscopy is a purely urologic procedure. Aside from visualization of the urethra and urinary bladder, common procedures done with a cystoscope include insertion of tubes called stents for urinary drainage, resection of the prostate and of bladder tumors, and incision of scar tissues in the urethra.
A ureteroscope is another operating telescope for the visualization of the ureter as well as addressing problems in the ureter such as stones and tumors by using a lithotripter or laser (depending on availability in the institution).
Minimally invasive procedures and laparoscopy also plays an integral role in management of urologic problems. For kidney stones less than three cms, extracorporeal shockwave lithotripsy (ESWL) can be offered. This procedure fragments the kidney stones by means of shockwaves and the patient will pass out the stone fragments through the urine.
For bigger stones, if the intruments are available in the institution, percutaneous nephrostolithotomy (PCNL) can be performed. This is done by inserting a telescope in the kidney called a nephroscope, then the stone is fragmented using a lithotripter or laser if these are available in the institution.
Laparoscopic procedures are also performed for urologic conditions. Commonly done laparoscopic urologic procedures include: removal of a cyst in the kidney, removal of a non functioning kidney (nephrectomy), removal of a kidney with a tumor (radical nephrectomy), removal of a tumors less than 4cm in the kidney (partial nephrectomy), removal of the adrenal gland with a tumor (adrenalectomy), kidney retrieval for transplant (donor nephrectomy), repair of an obstructed part of the kidney (pyeloplasty), and prostate cancer surgery (radical prostatectomy).
Although there are many treatment options for urologic conditions, the type of approach still depends on the following factors: 1) availability of instruments and equipment in the institution, 2) indications for the surgery, 3) best option for the patient, and 4) best treatment success rates and outcomes.
About the Author: Dr. Latayan is a Diplomate of the Philippine Board of Urology and a Fellow of the Philippine Urological Association and of the Philippine College of Surgeons. He had his training in urology at National Kidney and Transplant Institute. The scope of training included Adult And Pediatric Urology; Endourology, Minimally Invasive And Laparoscopic Urology; Transplant Urology (Donor). For inquiries/questions, kindly send email at firstname.lastname@example.org.
Published in the Sun.Star Davao newspaper on October 15, 2013.