What is Urology?

موضوع: What is Urology? الأحد مارس 24, 2019 3:37 pm

What is Urology?
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Urology is a part of health care that deals with diseases of the male and female urinary tract (kidneys, ureters, bladder and urethra). It also deals with the male organs that are able to make babies (penis, testes, scrotum, prostate, etc.). Since health problems in these body parts can happen to everyone, urologic health is important.

Urology is known as a surgical specialty. Besides surgery, a urologist is a doctor with wisdom of internal medicine, pediatrics, gynecology and other parts of health care. This is because a urologist encounters a wide range of clinical problems. The scope of urology is big and the American Urological Association has named seven subspecialty parts:

(Pediatric Urology (children's urology
(Urologic Oncology (urologic cancers
Renal (kidney) Transplant
Male Infertility
(Calculi (urinary tract stones
Female Urology
(Neurourology (nervous system control of genitourinary organs

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موضوع: رد: What is Urology? الإثنين مارس 25, 2019 4:17 pm

Glossary

Acute
Refers to conditions that happen suddenly and last a short time. Acute is the opposite of chronic, or long lasting

Albuminuria
A condition in which the urine has more than normal amounts of a protein called albumin. Albuminuria may be a sign of kidney disease.

Amino Acids
The basic building blocks of proteins. The body produces many amino acids and others come from food, which the body breaks down for use by the cells. See protein.

Antibiotic
A medicine that kills bacteria.

(Antidiuretic Hormone (ADH
A natural body chemical that slows down the production of urine.
Some children who wet the bed regularly may lack normal amounts of antidiuretic hormone.
Also called vasopressin.

Anuria
A condition in which the body stops making urine.

Artificial Bladder
A bladder grown in a laboratory and transplanted into a patients pelvis to replace a diseased bladder.
The term is also occasionally used to describe a bladder substitute.

(Artificial Urinary Sphincter (AUS
An implanted device for men that keeps the urethra closed until the wearer is ready to urinate.
The device consists of a cuff that fits around the urethra, a small balloon reservoir placed in the abdomen, and a pump placed in the scrotum.

Autoimmune Disease
A disorder of the bodys immune system in which the immune system mistakenly attacks and destroys body tissue it believes to be foreign.

Bacteria
Tiny organisms that cause infection or disease.

Bacteriuria
A condition in which the urine contains bacteria.

Balloon Dilation
A treatment for benign prostatic hyperplasia or prostate enlargement.
A tiny balloon is inflated inside the urethra to make it wider so urine can flow more freely from the bladder.

(Benign Prostatic Hyperplasia (BPH
An enlarged prostate not caused by cancer.
BPH can cause problems with urination because the enlarged prostate squeezes the urethra at the opening of the bladder.
Biofeedback
A way of training a patient to control muscles such as the bladder control muscles with the use of electronic devices that monitor muscle and nerve impulses.
The electronic devices convert nerve impulses into sound or visual signals so the patient knows when he or she is performing the correct action.

Biopsy
A procedure in which a tiny piece of tissue, such as from the kidney or bladder, is removed for examination with a microscope.

Bladder
The balloon- shaped organ inside the pelvis that holds urine.
.
(Bladder Outlet Obstruction (BOO
Any blockage at the urethra or the opening of the bladder.

Bladder Substitute
A urinary diversion in which urine is stored in an internal pouch made from the patients bowel.
The pouch is connected to the patients urethra rather than a stoma.
Also called a neobladder.
.
Bladder Training
A strategy for making the bladder able to hold more urine for longer periods of time using timed voiding and Kegel exercises.

(Blood Urea Nitrogen (BUN
A waste product in the blood that comes from the breakdown of protein.
The kidneys filter blood to remove urea.
As kidney function decreases, the BUN level increases.

Bulking Agent
A substance injected into the urethra around the opening of the bladder to treat stress urinary incontinence. Bulking agents include collagen, silicon, and Teflon.

Calcium
A mineral the body needs for strong bones and teeth.
Calcium may form stones in the kidney.

Calcium Oxalate Stone
A kidney stone made from calcium and oxalate.

Catheter
A thin, flexible tube inserted through the urethra to the bladder to drain urine.
Placement of the catheter is called catheterization.

Chronic
Refers to disorders that last a long time, often years.
Chronic kidney disease may develop over many years and lead to end-stage renal disease.
Chronic is the opposite of acute, or brief.

Chronic Prostatitis
Inflammation of the prostate gland that develops slowly and lasts a long time.

Clean Catch Urine Specimen
A urine sample obtained after the area around the opening of the urethra has been cleaned. A clean catch specimen is taken in the middle of the urine stream so any remaining bacteria are flushed away. See midstream urine collection

Collagen
A threadlike protein in humans and animals, sometimes used as a bulking agent to treat urinary incontinence.

Continence
The ability to control the timing of urination or a bowel movement.

Continent Cutaneous Reservoir
A urinary diversion in which urine is stored in an internal pouch made from a portion of the patients bowel.
Urine is removed by inserting a catheter through the stoma to drain the urine.
Different kinds of continent cutaneous reservoirs include the Indiana pouch and the Kock pouch.

Cryptorchidism
Undescended testicles.
In most boys, the testicles descend from the abdomen into the scrotum during fetal development.
This condition is rare.

Cyst
An abnormal sac containing gas, fluid, or a semisolid material.
Cysts may form in the kidneys or in other parts of the body.

Cystine Stone
A rare form of kidney stone consisting of the amino acid cystine.

Cystinuria
A condition in which urine contains high levels of the amino acid cystine.
If cystine does not dissolve in the urine, it can build up to form kidney stones.

Cystitis
Inflammation of the bladder, causing pain and a burning feeling in the pelvis or urethra.

Cystocele
A fallen bladder.
A bladder that falls or sags from its normal position down to the pelvic floor can result in either urinary leakage or urinary retention.

Cystometrogram
A line graph that records urinary bladder pressure at various volumes.

Cystoplasty
Surgery to reconstruct a damaged urinary bladder.

Cystoscop
A tubelike instrument used to look inside the urethra and bladder.
The procedure is called cystoscopy.

Cystourethrogram
An x-ray image of the urinary tract taken during urination.

Desmopressin
A synthetic form of antidiuretic hormone used to treat enuresis and diabetes insipidus.
(Also called (1-deamino-8-D-arginine vasopressin, abbreviated DDAVP
Desmopressin is a man-made form of vasopressin and is used to replace a low level of vasopressin. This medication helps to control increased thirst and too much urination due to these conditions, and helps prevent dehydration. Desmopressin is also used to control nighttime bedwetting in children.

Detrusor Muscle
A muscle that pushes a liquid or substance out of an organ.
The muscle in the bladder wall is a detrusor muscle.

Diabetes
A condition characterized by high blood glucose, resulting from the bodys inability to use blood glucose for energy.
In type 1 diabetes, the pancreas no longer makes insulin, and therefore glucose cannot enter the cells to be used for energy.
In type 2 diabetes, either the pancreas does not make enough insulin or the body is unable to use insulin correctly.

Diabetes Insipidus
A condition characterized by frequent and heavy urination, excessive thirst, and an overall feeling of weakness. This condition may be caused by a defect in the pituitary gland or the kidney.
In diabetes insipidus, blood glucose levels are normal. See nephrogenic diabetes insipidus.

(Digital Rectal Examination (DRE
A procedure in which the examiner inserts a lubricated, gloved finger into the patients rectum to feel the prostate, ovaries, or other internal organs.

Diuretic
An oral medicine that lowers blood pressure by aiding the kidneys in removing fluid from the blood.

Dysfunctional Voiding
A persons inability to relax the appropriate muscles when trying to urinate
or the inability to control spasms and leakage when trying to hold urine in the bladder.
This condition is most common in children.
Dysfunctional voiding may be caused by nerve damage, but it is often the result of poor voiding habits, such as delaying a trip to the bathroom because the child is engaged in an enjoyable activity.

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موضوع: رد: What is Urology? الإثنين مارس 25, 2019 4:19 pm

Ectopic Kidney
A birth defect in which a kidney is in an abnormal position.

Ejaculation
The sudden release of semen through the penis during sexual climax.

Electrical Stimulation
he use of a mild electrical current applied to the nerves that control the bladder to treat urinary and fecal incontinence.

(End-stage Renal Disease (ESRD
Total and permanent kidney failure.
When the kidneys fail, the body retains fluid.
Harmful wastes build up.
A person with ESRD needs treatment to replace the work of the failed kidneys.

Endoscope
Any tubelike instrument used to look inside the body.
Endoscopes used for urologic exams include the cystoscope and the ureteroscope.

Enuresis
Urinary incontinence not caused by a physical disorder.
The term enuresis is usually used as a synonym for bedwetting, although the term can also be used to describe daytime incontinence.
Daytime incontinence is called diurnal enuresis.
Bedwetting, or nighttime incontinence, is called nocturnal enuresis.

(Erectile Dysfunction (ED
The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence.

Erection
Enlargement and hardening of the penis caused by increased blood flow into the penis and decreased blood flow out of it as a result of sexual excitement.
.
(Extracorporeal Shock Wave Lithotripsy (ESWL
A nonsurgical procedure using shock waves to break up kidney stones.

Functional Incontinence
Incontinence caused by physical disability, external obstacles, or problems in thinking or communicating that prevent a person from reaching a toilet in time.

Genitals
Sex organs, including the penis and testicles in men and the vagina, vulva, and uterus in women.

Glucose
One of the simplest forms of sugar.

Hematuria
Blood in the urine, which can be a sign of a kidney stone or other urinary problem.

Hormone
A natural chemical produced in one part of the body and released into the blood to trigger or regulate particular body functions.
Antidiuretic hormone tells the kidneys to slow down urine production.

Hydronephrosis
Backup and buildup of extra urine within the kidney and renal pelvis, usually because something is blocking urine from flowing into or out of the bladder.

Hydroureter
Backup and buildup of extra urine within the ureter, usually because something is blocking urine from flowing into or out of the bladder.

Hypercalciuria
Abnormally large amounts of calcium in the urine, leading to kidney stones.

Hyperoxaluria
Unusually large amounts of oxalate in the urine, leading to kidney stones.

Hyperplaysia
Growth of cells that do not lead to cancer in an organ or other tissues. See benign prostatic hyperplasia.

Hypospadias
A birth defect in which the opening of the urethra, called the urinary meatus, is on the underside of the penis instead of at the tip.

Ileal Conduit
A kind of urostomy in which a section of the bowel is surgically removed from the digestive tract and repositioned to serve as a passage for urine from the kidneys and ureters to a stoma.

Immune System
The bodys system for protecting itself from viruses and bacteria or any foreign substances.

Immunosuppressant
A drug given to stop the natural responses of the bodys immune system.
Immunosuppressants are given to prevent organ rejection in people who have received a transplantfor example, a kidney transplantand to people with certain autoimmune diseases, such as lupus.

Incontinence
Loss of bladder or bowel control; the accidental loss of urine or stool.

Indwelling Urinary Catheter
A catheter placed in the bladder and urethra to release and collect urine over long periods of time.

Inflammation
Swelling and redness that results from injury to tissue.

Insulin
A hormone that helps the body use glucose for energy.

(Intermittent Catheterization (IC
Short-term use of a catheter to release and collect urine.
The catheter is removed as soon as the bladder is completely empty.

(Interstitial Cystitis (IC
A disorder that causes the bladder wall to become swollen and irritated, leading to scarring and stiffening of the bladder, decreased bladder capacity, and, in rare cases, ulcers in the bladder lining.
IC is also called painful bladder syndrome.

Intravenous Pyelogram
An x ray of the urinary tract. A dye is injected into a vein in the patients arm, travels through the body to the kidneys, and makes urine visible on the x ray and to show any blockage in the urinary tract.

Irrigation
Flushing the bladder or a continent cutaneous reservoir using a stream of water delivered through a catheter.

Kegel Exercises
Tightening and relaxing the muscles that hold urine in the bladder and hold the bladder in its proper position. These exercises can improve a persons ability to hold in urine.
Also called pelvic muscle exercises.

Kidney
One of the two bean-shaped organs that filter wastes from the blood. The kidneys are located near the middle of the back, one on each side of the spine. They create urine, which is delivered to the bladder through tubes called ureters.

Kidney Stone
A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. Kidney stones include calcium oxalate stones, cystine stones, struvite stones, and uric acid stones. See nephrolithiasis.

Lithotripsy
A method of breaking up kidney stones by using shock waves or other means.

Lower Urinary Tract Symptoms (LUTS
Urinary symptoms such as urinary frequency and urgency, difficulty starting a stream, and incomplete voiding that suggest urinary problems, such as benign prostatic hyperplasia, urinary tract infection, or kidney stones.

Micturition
The act of urinating.

Midstream Urine Collection
A method used to obtain a clean catch urine specimen.
The patient starts a stream of urine into the toilet, and then catches the urine in a sample cup as the stream continues.

Mixed Urinary Incontinence
A combination of different types of incontinence, usually stress urinary incontinence and urge urinary incontinence.

MRI-Fusion Biopsy
A diagnostic technique where an MRI image is superimposed upon an Ultrasound image in order to direct a biopsy needle with great precision.

Nephrectomy
Surgical removal of a kidney.

Nephritis
Inflammation of the kidneys.

Nephrogenic Diabetes Insipidus
Constant thirst and frequent urination because the kidney tubules cannot respond to antidiuretic hormone.
The result is an increase in urine formation and excessive urine flow.

Nephrolithiasis
The condition of having kidney stones.

Nephron
A tiny part of the kidneys. Each kidney is made up of about 1 million nephrons, which are the working units of the kidneys, removing wastes and extra fluids from the blood.

Nephropathy
Disease of the kidneys.

Nephrotic Syndrome
A collection of symptoms that indicate kidney damage.
Symptoms include high levels of protein in the urine, lack of protein in the blood, and high blood cholesterol.

Neurogenic Bladder
Loss of bladder control caused by damage to the nerves controlling the bladder.

Nocturia
Frequent urination at night.

Nuclear Scan
A test of the structure, blood flow, and function of the kidneys.
The doctor injects a mildly radioactive solution into a patients arm vein and uses x rays to monitor its progress through the kidneys.

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موضوع: رد: What is Urology? الإثنين مارس 25, 2019 4:19 pm

(Overactive Bladder (OAB
A condition in which the patient experiences at least two of the following conditions:
urinary urgency
urge urinary incontinence
urinary frequency defined for this condition as urination eight or more times a day or more than twice at night

Overflow Urinary Incontinence
Unexpected leakage of small amounts of urine because of a full bladder.

Oxalate
A chemical that combines with calcium in urine to form calcium oxalate stones, the most common type of kidney stone.

Pancreas
An organ that makes insulin and enzymes for digestion.
The pancreas is located behind the lower part of the stomach and is about the size of a hand.

Pelvic Floor Muscles
Muscles that support the bladder, bowel, and uterus.

(Pelvic Organ Prolapse (POP
Sinking of the bladder, bowel, and uterus out of their normal positions.

Pelvis
The bowl-shaped bone that supports the spine and holds up the digestive, urinary, and reproductive organs. The legs connect to the body at the pelvis.

Penis
The male organ used for urination and sex.

Percutaneous Nephrolithotomy
A method for removing kidney stones via surgery through a small incision in the back.

Pessary
A specially designed object worn in the vagina to hold the bladder, rectum, or uterus in its correct position and prevent leakage of urine.
Pessaries come in many shapes and sizes.

Peyronies Disease
A plaque, or hardened area, that forms on the penis, preventing that area from stretching.
During erection, the penis bends in the direction of the plaque, or the plaque may lead to indentation and shortening of the penis.

Pituitary Gland
A pea-sized gland at the base of the brain that regulates the bodys balance of hormones.

Polyuria
Overproduction of urine by the kidneys, resulting in excessive urination.

(Posterior Urethral Valves (PUV)
A birth defect in boys in which an abnormal fold of tissue in the urethra keeps urine from flowing freely out of the bladder.

(Postvoid Residual (PVR
Urine that remains in the bladder after urination.
A post-void residual urine greater than 50 ml is a significant amount of urine and increases the potential for recurring urinary tract infections. In adults older than 60 years, 50-100 ml of residual urine may remain after each voiding because of the decreased contractility of the detrusor muscle.

Priapism
A persistent, often painful erection of the penis not caused by sexual desire.

Prostate
In men, a walnut-shaped gland that surrounds the urethra at the neck of the bladder.
The prostate supplies fluid that goes into semen.

(Prostate-specific Antigen (PSA
A protein made only by the prostate gland.
High levels of PSA in the blood may be a sign of prostate cancer.

Prostatectomy
Removal of the entire prostate gland.

Prostatitis
Inflammation of the prostate gland.
Chronic prostatitis means the prostate gets inflamed repeatedly.
The most common form of prostatitis is not associated with any known infecting organism.

Protein
1. one of the three main nutrients in food.
Foods that provide protein include meat, poultry, fish, cheese, milk, dairy products, eggs, and dried beans. 2. proteins are also used in the body for cell structure, fighting infection, and other functions.
After the bodys cells use protein, it is broken down into waste products containing nitrogen that must be removed by the kidneys.
The blood absorbs amino acids and uses them to build and mend cells.

Proteinuria
A condition in which the urine contains large amounts of protein, a sign that the kidneys are not functioning properly.

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موضوع: رد: What is Urology? الإثنين مارس 25, 2019 4:20 pm

Pus
Thick yellow or white fluid containing white blood cells and other tissues.

Pyelogram
An x ray using injected dye that shows the urinary tract, including the kidneys, ureters, bladder, and urethra.

Pyelonephritis
An infection of the kidneys, usually caused by a germ that has traveled up through the urethra, bladder, and ureters from outside the body.

Pyuria
Pus in the urine, often a sign of a urinary tract infection or other condition.

Renal
Of or relating to the kidneys.
A renal disease is a disease of the kidneys.
Renal failure means the kidneys have stopped working properly.

Renal Pelvis
The area where urine formed by the kidneys is collected and excreted before it travels to the ureters and bladder.

(Sling Procedure (sling
A surgical procedure to treat female stress urinary incontinence in which a strip of material is wrapped around the urethra for support.

Sphincter
A round muscle that opens and closes to let fluid or other matter pass into or out of an organ. Sphincter muscles keep the bladder closed until it is time to urinate.

Stent
A small tube placed inside a passage, such as the urethra or a blood vessel, to keep that passage open.

Stoma
A surgically created opening in the abdomen that allows passage of urine or stool.
Urinary stomas must be covered at all times by a pouch that collects urine.

Stool
The solid waste that passes through the rectum as a bowel movement.
Stool is undigested food, bacteria, mucus, and dead cells.
Also called feces.

Stress Test
A simple test in which the patient coughs to see if the internal stress of that action causes urine to leak from the bladder.

(Stress Urinary Incontinence (stress
Leakage of urine caused by actions such as coughing, laughing, sneezing, running, or lifting that place pressure on the bladder from inside the body.
Stress urinary incontinence can result from either a cystocele or weak sphincter muscles.

Stricture
Narrowing of a bodily passage, such as a ureter or the urethra.

Struvite Stone
A type of kidney stone caused by infection.

Testicles
The two male glands below the penis that make sperm.

Timed Voiding Or Toileting
The practice of urinating or taking someone to the bathroom at set times to increase the bladders capacity to hold more urine for longer periods of time.

Transient Incontinence
Incontinence that lasts a short time.
Transient incontinence is usually caused by a temporary condition, such as a urinary tract infection.

Transurethral
Through the urethra.
Several transurethral procedures are treatments for benign prostatic hyperplasia

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موضوع: رد: What is Urology? الإثنين مارس 25, 2019 4:21 pm

: PVP) photoselective vaporization of the prostate)
destruction of excess prostate tissue interfering with the exit of urine from the body by using a controlled laser beam inside the prostate.

: TUIP) transurethral incision of the prostate)
widening of the urethra by making a few small cuts in the bladder neck where the urethra joins the bladder and in the prostate gland itself.

TUMT (transurethral microwave thermotherapy) : procedure that destroys excess prostate tissue interfering with the exit of urine from the body by using a probe in the urethra to deliver microwaves.

TUNA (transurethral needle ablation) : technique that destroys excess prostate tissue with electromagnetically generated heat by using a needle like device in the urethra.

TURP (transurethral resection of the prostate) :r emoval of the excess prostate tissue using an instrument with an electrical loop.

Ultrasound
A technique that bounces safe, painless sound waves off organs to create an image of their structure.

Urea
A waste product found in the blood that results from the normal breakdown of protein in the liver.
Urea is normally removed from the blood by the kidneys and then excreted in the urine.

Ureterocele
A birth defect in which a ureter swells where it empties into the bladder, often blocking the flow of urine from the kidney.

(Ureteropelvic Junction (UPJ
The point where a ureter joins the kidney.

Ureteropelvic Junction Obstruction
Blockage of urine at the ureteropelvic junction, causing the kidney to swell.

Ureteroscope
A tool for examining the bladder and ureters and for removing kidney stones through the urethra. The procedure is called ureteroscopy.

Ureterostomy
A form of urostomy in which the ureters are directly connected to the stoma.

Ureters
Tubes that carry urine from the kidneys to the bladder.

Urethra
The tube that carries urine from the bladder to the outside of the body.

Urethral Obstruction
A blockage in the urethra.
A kidney stone is the most common cause.

Urethritis
Inflammation of the urethra.

Urge Urinary Incontinence
Urinary leakage when the bladder contracts unexpectedly.

Uric Acid Stone
A kidney stone that may result from a diet high in animal protein.
When the body breaks down this protein, uric acid levels rise and can form stones.

Urinalysis
A test of a urine sample that can reveal many problems of the urinary tract and other body systems.
The sample may be observed for color, cloudiness, concentration; signs of drug use; chemical composition, including glucose; the presence of protein, blood cells, or bacteria; or other signs of disease.

Urinary Diversion
A way to release urine from the body when the bladder does not function properly.
Urinary diversions include urostomy, continent cutaneous reservoir, and bladder substitute, or neobladder.

Urinary Frequency
Urination eight or more times a day.

(Urinary Incontinence (UI
Loss of bladder control; the accidental loss of urine.

Urinary Retention
The inability to empty the bladder completely.

Urinary Tract
The system that takes wastes from the blood and carries them out of the body in the form of urine.
The urinary tract includes the kidneys, renal pelvises, ureters, bladder, and urethra.

Urinary Tract Infection (UTI
An illness caused by harmful bacteria growing in the urinary tract.

Urinary Urgency
Inability to delay urination.

Urinate
To release urine from the bladder to the outside of the body.

Urine
Liquid waste product filtered from the blood by the kidneys, stored in the bladder, and expelled from the body through the urethra by the act of voiding or urinating. See urinate and void.

Urodynamic Tests
Tests that measure the bladders ability to hold and release urine.

Uroflow Test
Measurement of the rate at which urine flows out of the body.
A lower than normal rate can indicate blockage.

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موضوع: رد: What is Urology? الإثنين مارس 25, 2019 4:21 pm

Urogynecologist
A doctor who is trained in urology and gynecology and specializes in female urinary problems.

Urolithiasis
The condition of having stones in the urinary tract.

Urologic
Pertaining to urology. See urology

Urologist
A doctor who specializes in urinary problems.

Urology
The medical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract.

Urostomy
An opening through the skin into the urinary tract to allow urine to drain when voiding through the urethra is not possible.

Uterus
Female organ, located in the pelvis, where a baby develops before birth. Also called a womb.

Vagina
The tube in a womans body that runs beside the urethra and connects the womb, or uterus, to the outside of the body. Sometimes called the birth canal.

Vesicoureteral Reflux
An abnormal condition in which urine backs up into the ureters, and occasionally into the kidneys, raising the risk of infection.

Void
To urinate; to empty the bladder.

(Voiding Cystourethrogram (VCUG
An x-ray image of the bladder and urethra taken during voiding.
The bladder and urethra are filled with a special fluid to make the urethra clearly visible.

Vulva
The outer part of the female genitals.

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موضوع: رد: What is Urology? الإثنين مارس 25, 2019 4:22 pm

What do I want from my urology training?

Abstract
Introduction
The basic aims of a urology trainee are broadly similar, with the need to be trained to a competent level of surgical and clinical skill being a general theme.

Aim
In this article I provide a short list of what I felt were and are the most important elements in my training as I enter my final 5 years of specialist registrar training, having completed 3 years of research for an MD, 3 years as a surgery/urology Senior House Officer, a year as a House Officer and 6 years in medical school. Some of the points will, of course, be more personal, but hopefully this will give some perspective to the exciting early years in a young urologist’s career.

Abbreviations: SHO, Senior House Officer; SpR, specialist registrar
Keywords: Urology training, Registrar, Academic urology
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Introduction
Urology training and training in general in the UK, has changed significantly since I embarked on a surgical career. I am a final-year trainee in urology from the London Deanery, and the trainee representative for the North Thames on the Specialist Training Committee. My path is very typical of urology registrars before me, but I was part of the last batch of trainees to be interviewed for a specific region (e.g. London) in a variant of the Calman training programme, rather than for national/pan-UK selection [1,2]. In addition, the introduction of a ‘run-through’ system from Senior House Officer (SHO) to specialist registrar (SpR) meant that the conventional ‘bottleneck’ of entry to ‘numbered’ SpR training was shifted to the SHO (now called FY2) level, with doctors expected to decide in their second year of training what specialty to apply for [3,4]. Appendix 1 shows the current path for urology trainees. Also, the introduction of academic ‘numbers’ to facilitate research during training, and the further reorganisation of training and service provision as a whole within the National Health Service, expected soon, have made the training landscape very different from when I began my SpR posts [5,6]. However, the needs of a urology trainee remain broadly the same, and this is a retrospective personal opinion (i.e., probably below level-5 evidence) of what I aimed to achieve by the end of my training, and how I planned for this to happen.

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Aiming for excellence
My primary aim was to work to the highest standards of clinical, academic and surgical practice for the good of my patients. In short, I wanted to become a surgeon to whom I could be confident to refer my own family. I felt it was a privilege to be in such a competitive training programme, and that I needed to make the best use of what it had to offer, and reciprocate in kind. I knew I had to reach certain milestones, e.g., the FRCS (Urol) examinations at the end of my training, as well as the annual assessments of competency that allow trainees to progress to the next year of training. The latter includes a quota of computer-based assessments, mainly by the trainers, about the clinical examination, problem solving, communication and operative skills. I also knew that I had 5 years of core urology training, and the acquisition of any skill and knowledge had to be a constant process. For this I felt that we had an outstanding teaching schedule that helped us, i.e., a ‘teaching’ day for all London trainees every alternate Friday at University College London during term time, and that dovetailed into our clinical work. Equally as beneficial were the simulation training courses at the Royal London Hospital, which were time-tabled into our training, to allow us to refine our endoscopic, laparoscopic and open procedures (robotics was nascent when I started!). These courses were a direct result of our progressive programme director at the time, observing and gathering feedback from his SpRs in what skills we felt we needed to be trained. This combination of a dedicated trainer-mentor and a strong academic department, that encouraged constant feedback on the quality of training, meant that the opportunities for learning were well supplied.

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Mentors and colleagues
In terms of the surgical skill set, I knew I needed core operative competencies (now formalised into a target number, depending on procedure) before progressing to subspecialty surgery. I took every opportunity available to observe, operate and then (when competent) to teach a procedure, and I learnt from errors, appreciating and soliciting feedback. Again I was grateful that I had good trainee mentors, but I was also fortunate to have had excellent senior and junior colleagues who understood that we were basically working towards the same goal. Having access to a simulation centre was a great help, but again, a strong, motivated faculty that encouraged training opportunities was priceless. Remember the anaesthetist who attempted to hurry you through all your learner cases (‘You have five minutes to do this circumcision’)? Did your trainer intervene? If he or she did, how? All these questions provide an insight into the mindset of the faculty for which you are working.

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Learning from trainers
I wanted to be trained well, and in turn, I aimed to be a good trainee. I knew that my fellow trainees were also individuals who had formed opinions that might differ from mine. The diplomacy, courtesy and respect you display often reflect how you want to be treated. From each of my trainers, I wanted to acquire an outstanding part of their non-surgical skills: How to manage a team of highly skilled individuals, how to resolve high-level conflict, how to deal with an impending human resource issue, how to organise a regional meeting of urologists; commonplace things that are often a part of your role as a consultant. So I was happy to volunteer when opportunities arose that I felt would add to my skills, like organising regional debating forums, running departmental audits and helping to revamp a medical publication, i.e., things I felt were interesting but allowed me to learn alternative skills. ‘Can you organise a conference room please? For 200 delegates? Tomorrow?’ refers to a particularly challenging situation that used this alternative but vital skill set and that can be universally applied to any profession.

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Clinical research: ‘Inject the methylene blue there!’
I had completed an MD in urological research before getting my ‘number’, but I still wanted to be a part of active relevant urological research. So, knowing the academic interests of the departments I work in was essential; there will always be an outstanding question or topic that needs an SpR to investigate! I wanted to continue presenting at regional and national conferences, and generate publications, so I approached the consultants whose research I felt was most relevant to my interests, often continuing research work with them after leaving the post. For example, I helped to compile the penile cancer database at St George’s Hospital in my first SpR post, now one of the largest in the penile cancer community, as part of my interest in andrology. This included contributing to landmark papers on sentinel-node biopsies that are now amongst quoted guidelines (hence the methylene blue). These opportunities are present everywhere, but the hard part is doing something you find interesting and rewarding; otherwise you might eventually resent its imposition on your clinical work. So know what you want (roughly), and seek out the research, if you are so inclined.

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Leadership and communication
Communication and ‘people skills’, contrary to what many believe, can and should be acquired [7]. To know and understand how it feels on the other side of the consultation table might not seem like the ‘Eureka moment’ of your career, but it might be one of the most important. The combination of professionalism and empathy is a true skill to hone. By accepting difficult situations (both with patients and co-workers) as challenges, you learn very fast how to react to the most stressful of situations. This adaptive skill was something I knew I needed, and my urology training allowed me opportunities to help both colleagues and patients beyond just the obvious issue. Never underestimate the impact that a simple ‘thank you’ has; sincere gratitude, from and to patients and colleagues alike, can make even the toughest days into good ones. It also helped me to gain confidence in my abilities to lead and manage a team. There are leadership and management courses that offer these excellent adjuncts to traditional training, and I see this as being an integral part of future urology training [8].

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Training, the law and the future
There are a few other things I wanted from my training, most of which I have sought in some form. I wanted to successfully address the training needs of the urology SpRs who I am representing; I wanted to know more about the details of medico-legal law in this increasing litigious era, something in which many pre-consultants feel they lack training [9], and most of all I wanted to enjoy a singularly exciting profession that has allowed me an opportunity to develop at my pace whilst working with the most inspiring individuals. In the first, I am currently actively involved in various forms; the second, I am starting to delve into, and the third… well I would not be here typing this if it were not the case.

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