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Technically, urology is a surgical subspecialty, but because of the broad range of clinical problems they treat, urologists also have a working knowledge of internal medicine, pediatrics, gynecology, and other specialties.
Common medical disorders that urologists routinely treat include prostate cancer, testicular cancer, bladder cancer, stone disease, urinary tract infections, urinary incontinence, and impotence. Less common disorders include kidney cancer, renal (kidney) disease, male infertility, genitourinary trauma, and sexually transmitted diseases (including AIDS).
The management and treatment of malignant diseases constitute much of the urologist's practice. Prostate cancer is the most common cancer in men and the second leading cause of cancer deaths in men. If detected early, prostate cancer is treatable, but once it has spread beyond the prostate it is difficult to treat successfully.
Testicular cancer is the leading cause of cancer in young men between the ages of 15 and 34. Major advances in the treatment of this cancer, involving both surgery and chemotherapy, now make it the most curable of all cancers. Bladder cancer occurs most frequently in men age 70 and older, and treatment for it also has a high success rate.
Young and middle-aged adults are primarily affected by stone diseases, which represent the third leading cause of hospitalizations in the United States. Kidney stones, composed of a combination of calcium and either oxalate or phosphate, usually pass through the body with urine. Larger stones, however, can block the flow of urine or irritate the lining of the urinary system as they pass. What has become standard treatment today is called extracorporeal shock wave lithotripsy (ESWL). In ESWL, high-energy shock waves are used to pulverize the stones into small fragments that are carried from the body in the urine. This procedure has replaced invasive, open surgery as the preferred treatment for stone disease.
Urologists also consult on spina bifida cases in children and multiple sclerosis cases in adults, as these diseases involve neuromuscular dysfunctions that affect the kidneys, bladder, and genitourinary systems.
The scope of urology has broadened so much that the American Urological Association has identified the following subspecialties: pediatric urology, male infertility, urologic oncology (cancer), renal transplantation, calculi (urinary tract stones), female urology, and neurourology (voiding disorders, erectile dysfunction or impotence, and other disorders).