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Department of Urology

About Urology
 
Urology is a surgical specialty which deals with diseases of the male and female urinary tract and the male reproductive organs. Although urology is classified as a surgical specialty, a knowledge of internal medicine, pediatrics, gynecology, and other specialties is required by the urologist because of the wide variety of clinical problems encountered. In recognition of the wide scope of urology, the American Urological Association has identified seven subspecialty areas:

  • Pediatric Urology
  • Urologic Oncology (cancer)
  • Renal Transplantation
  • Male Infertility
  • Calculi (urinary tract stones)
  • Female Urology (urinary incontinence and pelvic outlet relaxation disorders)
  • Neurourology (voiding disorders, urodynamic evaluation of patients and erectile dysfunction or impotence).


Historically, the subject which clearly established the specialty of urology as being distinct from general surgery was the treatment of obstructive uropathy. This treatment ranges from the correction of obstructing posterior urethral valves or ureteropelvic junction obstruction in the infant to the correction of bladder outlet obstruction from benign prostatic hyperplasia in the older male. Through the decades, we have witnessed a tremendous increase in our general understanding of the diverse functional disorders of urine transport associated with various overt and covert forms of neuromuscular dysfunction. The rapidly evolving discipline of urodynamics has established itself as a major resource in the diagnosis and therapy of such disturbances.

Stone disease of the urinary tract has always provided a substantial portion of general urologic practice. The recent introduction of rigid and flexible ureteroscopy has greatly improved the capacity of the urologist to deal with the problem while the management of stones in the kidney has been revolutionized twice in the immediate past: first with the introduction of percutaneous methods for stone disintegration and extraction, and secondly by the application of extracorporeal shockwave lithotripsy. Collectively these techniques have largely rendered open surgical procedures for dealing with kidney and ureteral stones obsolete. These new technologies remain under urological stewardship. In addition, advances in the diagnosis and metabolic management of recurrent nephrolithiasis allow urologists to reduce the risk of recurrent stone formation.

Another area of major urologic concern is that of congenital anomalies. The urinary tract is affected by congenital anomalies more than any other organ system. These congenital abnormalities run the gamut from the relatively common problem of cryptorchidism to the complex area of intersexuality. Most urologists do surgically repair many congenital anomalies in children, but the more complex problems are often referred to urologists with specialized training in pediatric urology.

Involvement of the urologist in the problems of renal insufficiency and end-stage renal disease has been necessitated by an enormous increase in the number of patients on dialysis and requiring transplantation. In a number of centers, urologists are the prime surgical arm for renal transplantation and, in others, serve as members of the surgical team. This practice has tended to increase the experience of the urologist in vascular surgery which has been beneficially incorporated into other areas such as renal vascular reconstruction and in the new microvascular surgical procedures performed for certain cases of impotence. The enhanced communication between nephrologist and urologist often leads to involvement in the general area of hypertension and adrenal disorders.

The treatment of malignant disease is a very large portion of urologic practice. Some of the most encouraging results in the medical and surgical management of solid tumors have involved genitourinary tumors, namely testis tumors and Wilms' tumors. The development of multimodal therapy, in which chemotherapy, radiation therapy, and surgical treatment are used in conjunction, will hopefully improve the results of the treatment of other genitourinary malignancies. Newer diagnostic methods for the detection of prostate cancer have recently emerged and currently the diagnosis and treatment of prostate cancer occupies much of many urologists' time.

Urinary tract infections affecting every age group in both sexes comprise a significant fraction of urological practice. While urinary tract infection may be the obvious and definitive clinical symptom at presentation, it may also reflect other disorders of the urinary tract such as obstructive uropathy. Much recent interest has been focused on the characterization of pathogenic bacteria that are particularly prone to cause persistent urinary tract infections, specifically pyelonephritis. Bacteriuria is such a common clinical problem that there is inevitably a large cross-disciplinary approach to this problem. Urologists often interact with internists, pediatricians and gynecologists in the management of patients with bacteriuria.

The importance of urologic problems seen primarily in women (stress urinary incontinence, interstitial cystitis, urethral diverticuli, etc.) is being increasingly recognized. The diagnosis and therapy of urinary incontinence constitute a significant portion of most urology practices. New therapies, both surgical and non-surgical, are being constantly developed. The number of female patients treated by urologists is substantial, and urologists need to understand gender differences in the medical and surgical approaches to these patients.

Male sexual dysfunction and infertility have become virtual subspecialties. The management of impotence has been revolutionized first and foremost by the introduction of prosthetic devices in urology. The area of prosthetics in urology has gradually expanded to encompass not only the various forms of penile prostheses, but also the use of the artificial urinary sphincter. The management of infertility in the male has generally focused on the surgical correction of various acquired and congenital obstructions within the genital system, and increasingly sophisticated efforts to diagnose and treat the problem of coexisting male subfertility and varicocele. Continued improvements in the medical management of male infertility require a high level of expertise in the area of reproductive physiology and endocrinology.

Trauma to the genitourinary system involves the urologist as one member of the trauma team during the initial evaluation of the multiply-injured patient. Recent improvement in imaging techniques for the evaluation of renal trauma and standardization of approaches to the problem of lower urinary tract trauma have significantly improved the care of such patients. There are a vast number of operative approaches to the problem of the late correction of injuries to the lower urinary tract which fall under the general heading of reconstructive surgery.

The specialty of urology is constantly changing. Much of this change has been the result of improved technology. Refinements in the area of ureteral and renal endoscopic surgery have already revolutionized the therapy of urinary tract stones and, working in conjunction with the new generation of extracorporeal lithotriptors, many of the traditional surgical and even endoscopic approaches to the problem of renal and ureteral calculi are now largely obsolete. Other traditional urologic procedures, specifically vasovasostomy and hypospadias repair have improved results in selected cases with the use of the surgical microscope. Skill and experience using the surgical microscope will undoubtedly be an important part of urologic practice in the future. Lasers are in their infancy, but will influence the practice of urology in the management of neoplasms and, in a somewhat different context, the management of ureteral calculi. Much recent research effort has evolved in the area of laparoscopic surgery. Many urologic operations which have been done by open surgery in the past can now be performed through the laparoscope. The development of new cancer chemotherapeutic agents has significantly altered therapy for some urologic cancers. In summary, urology is a rapidly changing and exciting area of medicine which requires practicing urologists to be actively involved in continuing education.

Exerpted from "What Is Urology: Information for Medical Students and Prospective Urology Residents", prepared by the AUA Graduate Medical Education Committee. Found at 
http://www.auanet.org/content/about-us/what-is-urology.cfm

In addition, Urology is one of the 1st specialties to branch out from the mains-tream medical profession. In fact, it is even mentioned in the original greek version of the Hippocratic Oath, wherein specific prohibitions are contained for physicans against cutting "persons labouring under the stone" and to leave it to those who are practioners of this work. Urologic diseases has been describedas far back as the ancient Egyptians who did routine perineal cystolithotomies on patients with urinary retention for bladder stones or enlarged prostates.
 
 
About the Department

 
The NKTI Department of Urology was established in 1983 at the same time as the NKTI, formerly known as the National Kidney Foundation of the Philippines, by Drs. Benjamin C. Magsino, Abelardo M. Prodigalidad, and Genaro M. Yusi. Dr. Magsino, in his capacity as Chairman of the Department was tasked to find suitable specialists who will spearhead what will eventually be the premier Urological training and healthcare program in the country. Although he could have chosen colleagues who were already at the peak of their careers in this country, he instead chose two young and dynamic consultants who were trained in the United States and who can best modernize the practice of Urology in the Philippines. He chose Dr. Genaro M. Yusi, who trained in the University of Iowa, and Dr. Abelardo M. Prodigalidad who trained in Memorial Sloan-Kettering in New York. Together, these three formed the so-called "triad" of Urology in the NKFP who worked closely with the Department of Transplantation to perform the first successful Kidney Transplants in Asia. The triad also succeeded in performing much of the milestones in this country's Urologic history.

After the events of the 1986 February People Power Revolution, the position for Chairman was passed down to Dr. Abelardo M. Prodigalidad. Dr. Prodigalidad was Chairman for 15 years. Much of what the Department, its Training Program, and Vision is today is largely due to the legacy of Dr. Prodigalidad. In 2001, after Dr. Prodigalidad?s retirement from government service, Dr. Reynaldo C. Dela Cruz was appointed Chairman. At this time, the Chairmanship?s term was set at 3 years. Under the aegis of Dr. Dela Cruz, the Department?s administrative structure was upgraded, in order to comply with ISO9001 standards.

Since then, the Department's admissions has grown at an almost exponential rate with a mere 46 patients in 1983 to a whopping 3,274 for 2004. This is also reflected in the number of operative procedures done with only 90 major and minor operations in 1983 compared to xxxx in 2004.

Unlike many other government hospitals in the country, the Department of Urology has a healthy balance between private and service (aka charity) patients. In addition, the Department has the most number of both active and visiting Urology consultants in the country, thus as far as training purposes are concerned, residents-in-training have to opportunity to see not only many different urology cases, but also the styles peculiar to each consultant. The Department also boasts of having among the most number of Urologic procedures per day, both open and endourological.

The Institute also offers some of the most advanced diagnostic and therapeutic facilities available for Urologists.

Diagnostic Services

  • Urodynamic Studies
  • Advanced Immunological and Molecular Biological Studies Studies such as Fluorescence In-Situ Hybridization (FISH) for the diagnosis of cytology and surgical specimens.
  • Diagnostic Catheter Angiography (for Renal Vascular Disease)
  • Transrectal Ultrasound of the Prostate (TRUS) with or without Biopsies
  • Radionuclide Imaging Studies such as bone, renal, adrenal, and testicular scans
  • Color Doppler Imaging for vascular involvement of renal tumors or vascular defects
  • Spiral CT (Computed Tomographic) Scans with 3D reconstruction
  • MRI (Magnetic Resonance Imaging) with or without contrast


Therapeutics

  • Trans-urethral Endourological Procedures including Ureteroscopies with EMI lithotripsy, ultrasonic lithotripsy, or pneumatic lithotripsy.
  • \Percutaneous procedures under Ultrasonic or Flouroscopic Guidance in the kidney or other organs like Percutaneous Nephrolithotomies or Nephrostomies, renal biopsies or percutaneous renal cyst aspirations.
  • Special ancilliary surgical equipment such as ultrasonic dissector, argon beam coagulation, operating microscopes for microsurgery.
  • Laparoscopic Urology: Nephrectomy, Pyeloplasty, Ureterolithotomy, Prostatectomy, Adrenalectomy
  • Extra-corporeal Shock Wave Lithotripsy (ESWL)
  • High-Intensity Focused Ultrasound (HIFU) using the EDAP Ablatherm for prostatic CA
  • Cadaver and Living-Related Kidney Transplantation
  • Interventional Catheter Angiography (for minimally-invasive treatment of renal vascular diseases, such as stenting of renal artery stenosis, selective renal arterial embolization, etc.


 
 
Departmental Organization
 
The Department is divided into 8 sections, reflecting the sub-specializations of Urology. These are:

Section of General Urology

General Urology is defined as the subsection of Urology that deals in, but is not limited to, the Urological conditions, disorders and therapies not classified under the other sub-specialties.

Section of Endourology


Endourology is the branch of Urology that endeavors to diagnose and treat various Urologic conditions with the least possible invasiveness. Minimally-invasive Urologic Surgery is within the scope of the section.

Section of Female Urology


The section aims to evaluate, characterize, describe and treat all urological abnormalities, including voiding dysfunction, affecting women.

Section of Laparoscopic Urology

Laparoscopic Urology is the section that aims to diagnose and treat intraabdominal or retroperitoneal urologic conditions via the use of basic and advanced laparoscopic techniques.

Section of Pediatric Urology

Pediatric Urology aims to diagnose and treat urologic conditions that affect the pediatric age group (0 to 18 years of age).

Section of Urologic Oncology


Urologic Oncology is the section that deals with the evaluation, diagnosis, medical and surgical management of all malignancies that may affect the Genito-Urinary Tract.

Section of Renal Transplantation

The section aims to provided the basic knowledge and skills required for the care of both kidney donor and recipient.

Section of Neurourology, Infertility and Sexual Dysfunction

Neurourology is based on the complex nerve supply to the urinary bladder, urethra, pelvic floor, and therefore any disease that may alter the micturation process.

Although a certain case may be treated under one section, most disease conditions in Urology are dealt with by two or more sections. Example:

Patient with Renal Cell cancer treated with laparoscopic radical nephrectomy would be handled by both the section of Urologic Oncology and the section of Laparoscopic Urology.