As the only doctor in my family, I had no idea what a urologist was or the types of procedure they performed. For a while I thought I’d be a pediatrician because I always wanted kids of my own. Then I realized that I don’t like treating sick kids . . . who aren’t of my DNA . . . nor their parents.
One day while on a surgery rotation in my 3rd year of medical school, a urology resident (doctor in training) asked if I wanted to come observe a kidney stone removal. Always the overachiever, I jumped at the opportunity. The attending urologist, in his early 60’s, still had the enthusiasm of a child who just ate their first Krispy Kreme donut.
When the kidney stone was snatched he yelled “YES! GREAT JOB!”. At that moment, I said to myself, “if this guy still loves urology after 30 years of practice, then this is the job for me.” And from that moment on, I became the penis and scrotum doctor.
But, we’re not all about the pork and beans. Urologists take care of kidney cancer, lady business issues and make sure the population doesn’t get out of hand with vasectomies.
Let’s review the types of procedures a urologist performs by both types of procedures and the body parts we work on. This way you can be better prepared for whether a urologist is the right doctor for you.
Male Anatomy
Scrotum, testicles, and vas deferens - oh my!
Let’s start with the lowest hanging fruit. The ball sac and its contents (sorry this is how guys talk . . . it’s totally professional in a urology discussion). Any ailments of the scrotal contents require the help of a urologist.
The most common procedures a urologist performs on the scrotal contents include:
- Vasectomy
- Hydrocele repair (hydrocelectomy)
- Testicular torsion repair (orchidopexy)
- Testicle removal for cancer (radical orchiectomy)
- Cyst removal (spermatocelectomy)
- Infertility surgery (sperm retrieval, vasectomy reversal)
Whether it’s a scrotal skin problem (e.g. sebaceous cyst) or something more internal (e.g. testicular cancer) a urologist will be the right man or woman for the procedure.
One confusing area is a hernia. Groin (inguinal) hernias can bulge into the scrotum and cause swelling. Unless this is an issue since birth (congenital hernia), then the correct doctor for this issue is a general surgeon.
In the cosmetic space (yes men are vain about their balls), a urologist may place a testicular prosthesis if a testicle was previously removed or even inject Botox to smoothen the skin. Yes . . . “Scrotox” is a thing.
Overall scrotal surgeries are safe and completed as an outpatient. A vasectomy is routinely performed in an office setting with local anesthesia and sedation.
Penis
My son looked at me the other day and said “penises Dad? . . . really?!” I reminded him that penises will partially cover his college expenses while quickly pivoting to a discussion about baseball.
We actually don’t operate on penises very often, but the more common penile procedures a urologist performs include:
- Circumcision
- Genital wart removal
- Penile prosthesis for ED
- Penile straightening for curvature (Peyronie’s disease)
- Cancer removal (yes you can get d@*! cancer . . . don’t worry it’s rare)
Penis procedures are usually performed as an outpatient in an office or surgery center. Prosthesis placement is typically done in a hospital.
Prostate
The prostate is a walnut to grapefruit sized organ which sits behind the pubic bone in men. It is part of the urinary tract and is also partially responsible for semen production. Prostate procedures are usually performed for problems urinating or prostate cancer.
With recent advances in prostate medications, along with more conservative prostate cancer guidelines, these procedures are not as routine but still commonly performed by most urologists.
A urologist performs endoscopic, open and robotic procedures on the prostate such as:
- Prostate biopsy
- Urolift implant
- Transurethral resection of the prostate (TURP or “roto-rooter”)
- Laser resection or enucleation of the prostate (HoLAP, HoLEP, Greenlight laser)
- Radical prostatectomy for cancer (robotic or open)
- Prostate seeds, HIFU or cryoablation for cancer
These surgeries vary greatly in their side effects and recovery timeframe.
Female anatomy
Although OB/GYNs are the main lady business doctors, urologists also perform vaginal surgeries for women. To brush up on the difference between a urologist vs. a urogynecologist, please check out our previous blog post on the subject.
The types of vaginal procedures that a urologist perform may include:
- Mid-urethral sling (for stress incontinence)
- Pelvic prolapse repair
- Urethral diverticulum removal
- Pelvic mesh removal
- Repair of a vaginal fistula
Many general urologists will perform sling surgeries to treat leakage with coughing, sneezing and laughing. The other procedures are typically performed by fellowship trained female pelvic medicine and reconstructive specialists.
Male and female urinary tract
Enough about our differences, now lets focus on the urinary tract procedures that a urologists performs on men and/or women.
Urethra
The pee channel runs from the bladder to the outside world. It’s a short muscular tube in women. In men it runs the length of the penis (to varying lengths of course), under the scrotum and through the prostate.
The various urethral procedures performed by a urologist are:
- Cystoscopy
- Urethral dilation
- Treatment of urethral stricture
- Artificial urinary sphincter (stress incontinence in men after prostate surgery)
- Urethral bulking (mainly incontinence in women)
- Urethroplasty (reconstruction of the urethra)
A cystoscopy is the most common procedure performed by urologists. It is typically done in an office setting for the evaluation of any urethral or bladder issue. In order to treat the upper parts of the urinary tract (e.g. bladder, ureter, kidney) a cystoscopy through the urethra is necessary.
Bladder
If you have bothersome problems in the bathroom, then a bladder procedure with a urologist is likely in your future. Bladder procedures can be performed via a cystoscopy or in a more invasive fashion. This may involve:
- Urinary catheter placement
- Bladder cancer diagnosis and removal
- Lithotripsy of bladder stones
- Botox injections of the bladder (for incontinence not wrinkles)
- Sacral neuromodulation (a bladder pacemaker for incontinence that technically does not involve surgery of the bladder itself)
- Bladder stretching (hydrodistention)
A urinary catheter placement is technically a procedure so we included it in this list. Most urinary catheters are placed by non-urologists in a hospital setting before surgery or if someone is unable to urinate on their own.
Ureter
The ureter is the urinary tube connecting the kidney to the bladder. Ureter procedures by a urologist include but are not limited to:
- Stone removal (stone was formed in the kidney and is “passing” down the ureter)
- Lithotripsy (breaking up the stone with sound waves or a “freakin laser”)
- Cancer removal
- Repair or scar tissue (ureteral stricture)
- Stent placement
Stone surgery makes up 99% of ureteral procedures a urologist performs. Ureteral stents are very commonly placed after a ureteral surgery is completed to prevent a blockage. They are removed via a string or cystoscopy in the office.
Kidney
As we finish our journey back up the urinary tract, we finally reach the kidney. Urologists perform surgeries on the kidneys while nephrologists deal with kidney dysfunction (click here to learn more).
Many of the aforementioned procedures of the ureter and bladder, are performed by a urologist on the kidney including:
- Kidney cancer removal (partial or radical nephrectomy)
- Kidney cancer destruction (cryoablation or radiofrequency ablation)
- Stone removal and lithotripsy (ESWL, PCNL, laser)
- Repair of scar tissue (pyeloplasty)
- Kidney trauma or bleeding
Some kidney procedures are not performed by the urologist. A kidney biopsy is usually performed by a nephrologist or interventional radiologist. Occasionally a trauma surgeon will fix a kidney injury if they are doing an exploration for other internal organ injuries.
Endoscopy procedures
An endoscopy can be performed of the:
- Urethra (urethroscopy)
- Bladder (cystoscopy)
- Ureter (ureteroscopy)
- Kidney (nephroscopy)
These procedures usually are performed from the bottom up. However, you can make a small incision in the back and gain direct access to the kidney (most commonly for a PCNL or percutaneous nephrolithotomy).
Robotic-assisted or laparoscopic procedures
Laparoscopic procedures entail inflating the abdomen with air, making small incisions, and performing surgery with narrow instruments guided with a camera.
When we utilize a robotic system for remote access to the instruments, this now becomes robotic-assisted laparoscopic surgery. The most common procedures a urologist performs with either of these approaches are for kidney cancer, prostate cancer and urinary reconstruction.
Open procedures
Alright! Now we’re talking, good old-fashioned, “pass the scalpel” surgery. This is what most people think of when they talk about “a surgery.”
However, many open procedures a urologist performs are still minimally invasive.
A no-needle, no scalpel vasectomy is technically an open surgery performed through a tiny poke in the scrotal wall. Repair of swollen testicular veins (varicocele) can be done through a 3-4 cm incision in the groin area with aid of a microscope.
On the other hand, major cancer surgeries, especially for large tumors, can involve incisions across the entire abdominal wall and are associated with long recovery periods.
Conclusions
Hopefully you have a better appreciation of the breadth of procedures that a urologist performs. Although my son still thinks I’m just a “penis and ball” doctor, you can see we also perform procedures on the kidneys, prostate and lady business.
Maybe don’t tell him that I’m a lady business doctor as well. He’s 13 years old and that will be a more difficult one to explain.
