What is Urology?

Urologists are physicians that diagnose and treat diseases of the urinary tract in men and women and treat conditions involving the reproductive tract in men.

Urology is likely one of the oldest medical specialties and likely dates to the time of ancient Egyptians and Greeks. There is evidence that suggests urology existed over 4000 years ago in ancient Egypt when surgical instruments used to treat urethral stricture were found at burial sites of the pharaohs. In ancient Greece, doctors who could be considered early urologists frequently examined urine’s colour, odour, and texture, looking for bubbles, blood, and other signs of disease.

Today, urology has evolved substantially from its ancient origins and is a rapidly developing medical specialty focusing on the health of the urinary system and male genital system.

These videos are a look at who urologists are, what we do, how we do it and why you should consider becoming a urologist as a rewarding career. This is made with input from many different urologists from across Canada.

Urologists are surgeons. Many of the diseases we treat have surgical options. For example, we frequently surgically remove cancers of the genitourinary system, such as prostate, kidney, testes, and bladder, and also commonly surgically repair blockages of the urinary tract, such as in the case of kidney stones, urethral strictures, or an enlarged prostate.

Although urology is a surgical specialty, urologists also have knowledge of internal medicine, pediatrics, gynecology, and other specialties because of the wide variety of clinical problems we encounter. Many urologic conditions have medical treatments, including erectile dysfunction, urinary tract infections, bladder dysfunction, and prostate enlargement, to name a few.

The urinary tract is the organ system that creates, stores, and removes urine from the body. Urologists treat all parts of the urinary system, including the:

• Kidneys (the organs that filter waste out of the blood and produce urine)
• Ureters (the tubes through which urine flows from the kidneys to the bladder)
• Bladder (the hollow muscular sac that stores urine prior to urinating)
• Urethra (the tube through which urine travels from the bladder out of the body)
• Adrenal glands (the glands located on top of each kidney that release various hormones)

Urologists also treat all parts of the male reproductive system, including the:

• Penis
• Prostate
• Testicles

Urologists treat a wide variety of conditions that affect the urinary system of both genders, as well as the male reproductive system.

Urology patients run the entire spectrum, with patients of all ages, gender, and socioeconomic status affected by urologic conditions. It is an inclusive range of patients.

In men, urologists commonly treat:

• Cancers of the bladder, kidneys, penis, testicles, adrenal and prostate glands
• Prostate gland enlargement known as benign prostatic hyperplasia
• Erectile dysfunction
• Male infertility
• Interstitial cystitis and other bladder disorders
• Kidney diseases and kidney stones
• Prostatitis, which is inflammation of the prostate gland
• Urinary tract infections
• Varicoceles, or enlarged veins in the scrotum
• Urethral stricture

In women, urologists often treat:

• Urinary incontinence
• Bladder prolapse, or the dropping of the bladder into the vagina
• Cancers of the bladder, kidneys, and adrenal glands
• Bladder conditions, such as interstitial cystitis and overactive bladder
• Kidney and ureteral stones
• Urinary tract infections

In children, urologists commonly treat congenital diseases that cause urinary blockage, infection, or difficulties urinating.

To accurately diagnose patients with urologic disease, urologists perform a variety of tests, including:

• Imaging, such as CT scan, MRI scan, PET scan, or ultrasound
• Contrast studies (“dye tests”) commonly of the bladder (aka cystogram), urethra (aka urethrogram), or kidneys (aka pyelogram)
• Cystoscopy using a specific thin endoscope called a cystoscope to see inside the urethra and bladder
• Studies of the bladder and lower urinary system called urodynamics to assess function of these structures
• A variety of blood and urinary tests, some of which are unique to our specialty

Urologists are trained to perform different types of surgery. This often includes: 

• Biopsies of the bladder, kidneys, or prostate
• Cystectomy, which involves removing the bladder to treat cancer
• Nephrectomy to remove kidneys for cancer or infection
• Extracorporeal shock wave lithotripsy, which involves breaking up kidney stones so they can remove them more easily
• Kidney transplants to replace a diseased kidney with a healthy one
• Procedures to open urinary blockages to the urethra, bladder, and ureter
• Repair of damage due to trauma
• Repair of urinary organs that don’t develop properly
• Prostatectomy, which involves removing all or part of the prostate gland to treat prostate cancer; this is often done robotically
• Sling procedures to support the urethra and treat urinary incontinence
• Transurethral resection of the prostate, which involves removing excess tissue from an enlarged prostate
• Ureteroscopy, which involves using a scope to remove stones in the kidneys and ureter
• Vasectomy to ligate the vas deferens as contraception to prevent pregnancy

• Urologists work in a variety of settings, including hospitals (operating rooms), clinics, and ambulatory care centers.
• Approximately 65% of urologist in Canada work in a community-based setting while the remaining 35% or urologists work primarily in an academic or university-based environment.
• Work Week: Urologists have a varied clinical work week, spending approximately equal time in the operating room, clinics, and ambulatory care centres performing procedures under local anesthetic (cystoscopy or shockwave treatment of urinary stones). According to the 2017 Canadian Medical Association (CMA) Workforce Survey, urologists worked on average 56 hours per week (excluding call), which includes direct patient care, administrative duties, research and teaching.
• Gender: ~90% of urologists in Canada are male, however the proportion of female urologists has been steadily increasing since 2003. Currently ~20% of the urologist under age 44 are female.
• Income: According to the 2017 CMA Workforce Survey, 61% of urologists in Canada are remunerated through a fee-for-service model and the remainder are remunerated through contracts, salaries or blended models.  In 2015/2016, the average gross clinical earnings for Canadian Urologists remunerated using a fee-for-service model (for those earning at least $60,000) was $462,688.  The average overhead expenses for urologists in Canada in 2017 was reported at 25% of total income.
• Satisfaction: As a result of great patients, effective surgeries, healthy income and great colleagues, surveys report that urologist have a very high job satisfaction rate and are happy with their career choice.
• As the population ages and the prevalence urologic conditions increase, there will be an increasing demand for urologists in Canada, which bodes well for future job prospects and opportunities throughout the country. Although supply and demand are variable across the country, many job opportunities do exist for urologists in Canada.

After completion of medical school, to become a urologist in Canada requires a minimum of 5 years of Royal College-approved training. This period must include 2 years of core training in surgery and 3 years of approved residency training in urology, one of which is as a senior resident.

Senior residency is defined as a year in which the resident is regularly entrusted with the responsibility for preoperative, operative, and postoperative care, including the most difficult problems in urology.

The senior resident must be in charge of a urological unit with no other resident intervening between the senior resident and the attending staff urologist.

At the end of their training, urologists must pass the specialty certification exam for urologists. The Royal College of Physicians and Surgeons of Canada certifies residents after successful completion of the exam.

Some urologists decide to do a year or two of additional fellowship subspecialty training. During this time, you gain skills in a subspecialty area.

After residency training, urologists may pursue 1-2 years of subspecialty training known as a fellowship. Some of the subspecialties in urology are:

• Pediatric urology
• Urologic oncology, which focuses on cancers of the urinary system, including the bladder, kidneys, prostate, adrenal, and testicles
• Renal transplant
• Male infertility, which focuses on problems that prevent a man from conceiving a baby with his partner
• Endourology/calculi, which deals with the closed manipulation of the urinary tract most commonly for urinary stones. The field has grown to now include minimally invasive surgical procedures. Procedures are carried out using endoscopes inserted into the urinary tract and examples include prostate surgery, stone removal surgery, and simple urethral or ureteral surgeries
• Female urology, which focuses on conditions of a woman’s reproductive and urinary tract
• Neurourology, which focuses on the nervous system’s control of genitourinary organs
• Reconstructive urology, which focuses on restoring both structure and function to the genitourinary tract