The consciousness of the public in Nigeria, especially the elite, has been awakened towards medical specialties and even sub-specialties. It is not uncommon nowadays for a patient to walk into the hospital and ask to see consultant ENT surgeon or a gynaecologist. However, there are still a few specialties that are hardly sought after that commonly; not because they are not often needed, but because they are hardly known. Urology is one of them.
Nigerian Association of Urological Surgeons (NAUS) defines urology as the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Thus a urologist is a physician who specializes in diagnosis/investigation/treatment of disease/conditions that affect the urinary tract in men and women, as well as the male reproductive system. This can include diseases affecting the bladder, urethra, ureters, kidneys, and adrenal glands, along with the epididymis, penis, prostate, seminal vesicles and testes specifically in men. Urology is commonly regarded as a surgical specialty.
There were an estimated 9,500 urologists in the US in 2013. This number has been projected to fall to 7,500 by 2020. The Nigerian story is different as there are fewer urologists, and the number will most likely increase in the near future (i.e if the recurrent industrial action in the health sector allows it). In a 2012 survey of 29,025 physicians representing 25 different medical specialties in the US, urologists were found to be the third happiest with their lives outside of work, behind physicians practicing rheumatology and dermatology. Such studies are seldom in Nigeria.
Urology, the study of conditions of the urinary tract and male reproductive system, is a broad field. Although it is generally classified as a surgical specialty, urologists require knowledge of other specialties such as gynaecology and internal medicine due to the wide variety of clinical problems that they have to deal with.
To become a urologist in the Nigeria, candidates will graduate from an approved medical school and complete a urology residency program that takes a minimum of 5 years to complete in a hospital accredited by the National Postgraduate Medical College of Nigerian or West African College of Surgeons.
Common conditions treated in urology clinic include (not exhaustive):
1. Bladder prolapse: when the tissues and muscles of the pelvic floor are no longer able to support the organs in the pelvis, the organs can drop from their usual position. As well as the bladder, this can affect the urethra, rectum, cervix, vagina and uterus. This condition is more common in women than men, and can be attended to by gynaecologists when it occurs in females.
2. Cancer (bladder, kidney, prostate, testicular): Urologists also treat cancers of other organs that fall under the scope of urology.
3. Enlarged prostate: also referred to as benign prostatic hyperplasia (BPH). BPH affects around one-third of men over 50. The prostate is a male gland located just below the bladder, surrounding the urethra. In BPH, an overgrowth of cells in the central portion of the gland causes the urethra to constrict, hindering urination and making it difficult for the bladder to be emptied.
4. Erectile dysfunction: when the penis is unable to attain sufficient rigidity to fully participate in sexual intercourse. Frequently, erectile dysfunction is a symptom of a further underlying problem.
5. Incontinence: an involuntary loss of bladder control caused by part of the urinary system malfunctioning.
6. Infertility: while infertility in women is normally treated by gynaecologists, male infertility is treated by urologists. Male partners are estimated to contribute to 40% of cases of infertility within couples. The condition can be caused by damage to the male reproductive tract and a variety of sperm disorders. A third of cases are caused by varicoceles - an enlarged vein in the sac beneath the penis.
7. Interstitial cystitis/Painful bladder syndrome: a chronic inflammatory bladder condition producing discomfort at varying levels and frequencies. Although the cause is unknown, it is believed that a breakdown in the bladder's lining could be related to the disease.
8. Kidney and ureteral stones: small, hard deposits made from mineral and acid salts form in the kidneys but can pass through into the ureters.14 Stones can affect urination and cause pain, nausea and vomiting.
9. Peyronie's disease: a disorder whereby a fibrous layer of scar tissue develops beneath the skin of the penis. This growth affects the erectile tissue, leading to bending or curving in the penis during erection that can cause pain and lead to difficulties with sexual intercourse.
10. Prostatitis: infection or inflammation of the prostate (as opposed to overgrowth as in BPH) can cause painful urination or ejaculation. Prostatitis is the most common urologic condition in men under 50. Cases can be acute or chronic.
11. Undescended testes: also referred to as cryptorchidism, undescended testicle is the most common genital abnormality in men. Around 4% of males are born with the condition. In normal development, testicles form inside the abdomen and descend into the scrotum before birth. If one or both do not descend, sperm production can be impaired and the risk of injury is much higher.
12. Urethral stricture: whereby scarring of the urethra can narrow or block the path of urine flowing from the bladder. Urethral stricture can be caused by infection, inflammation or injury, leading to urinary symptoms such as painful urination and reduced output. Complications include other urologic conditions such as prostatitis and urinary tract infections.
13. Urinary tract infections (UTIs): a common complaint in women, whose lifetime risk is more than 50%. UTIs are frequently caused by the migration of bacteria from the digestive tract to the urethra. Common symptoms include abnormal urination, pain, incontinence, nausea, vomiting, fevers and chills.