As a discipline that involves the study of many organs and physiological systems, urology can be broken down into subdisciplines. At larger centers and especially university hospitals, many urologists specialize within a particular subdiscipline of urology.
Endourology is the branch of urology that deals with minimally invasive surgical procedures. As opposed to open surgery, endourology is performed using small cameras and instruments inserted into the urinary tract. Transurethral surgery has been the cornerstone of endourology. Most of the urinary tract can be reached via the urethra, enabling prostate surgery, surgery of tumors of the urothelium, stone surgery, and simple urethral and ureteral procedures.
Laparoscopy is a rapidly evolving branch of urology and has replaced some open surgical procedures. Robot-assisted surgery of the prostate, kidney, and ureter has been expanding this field. Today, many prostatectomies in the United States are carried out by robotic assistance. This has created controversy, however, as the machines are very expensive, require a dedicated surgical team and have high maintenance costs.
Urologic oncology concerns the surgical treatment of malignant genitourinary diseases such as cancer of the prostate, adrenal glands, bladder, kidneys, ureters, testicles, and penis. The medical treatment of advanced genitourinary cancer is managed by either a urologist or an oncologist depending on the cancer.
Neurourology concerns nervous system control of the genitourinary system, and of conditions causing abnormal urination. Neurological diseases and disorders such as a stroke, multiple sclerosis, Parkinson’s disease, and spinal cord injury can disrupt the lower urinary tract and result in conditions such as urinary incontinence, detrusor overactivity, urinary retention, and detrusor sphincter dyssynergia. Urodynamic studies play an important diagnostic role in neurourology. Therapy for nervous system disorders includes clean intermittent self-catheterization of the bladder, anticholinergic drugs, injection of Botulinum toxin into the bladder wall and advanced and less commonly used therapies such as sacral neuromodulation. Less marked neurological abnormalities can cause urological disorders as well—for example, abnormalities of the sensory nervous system are thought by many researchers to play a role in disorders of painful or frequent urination (e.g. painful bladder syndrome, formerly known as interstitial cystitis).
Pediatric urology concerns urologic disorders in children. Such disorders include cryptorchism (undescended testes), congenital abnormalities of the genitourinary tract, enuresis, underdeveloped genitalia (due to delayed growth or delayed puberty, often an endocrinological problem), and vesicoureteral reflux.
Andrology focuses on the male reproductive system. It is mainly concerned with male infertility, erectile dysfunction and ejaculatory disorders. Since male sexuality is largely controlled by hormones, andrology overlaps with endocrinology. Surgery in this field includes fertilization procedures, vasectomy reversals, and the implantation of penile prostheses. Vasectomies may also be included here, although most urologists perform this procedure.
Reconstructive urology is a highly specialized field of urology that restores function to any of various structures of the genitourinary tract. Prostate procedures, full or partial hysterectomies, trauma (auto accidents, gunshot wounds, industrial accidents, straddle injuries, etc.), disease, obstructions, blockages (e.g., urethral strictures), and occasionally, childbirth, can necessitate require reconstructive surgery. The urinary bladder, ureters (the tubes that lead from the kidneys to the urinary bladder) and genitalia are other examples of reconstructive urology. Often, plastic surgeons assist in these procedures, although purely cosmetic procedures such as penis enlargement do not fall under the rubric of reconstructive urology.
Urogynecology is a branch dealing with overactive bladder, pelvic organ prolapse, and urinary incontinence. Thorough knowledge of the female pelvic floor together with urodynamic skills are necessary to diagnose and treat these disorders. Depending on the cause of the individual problem, a medical or surgical treatment can be the solution.