Urology – Minimally Invasive and Majorly Exclusive: Chawm Ganguly

chawm gangulyThe incidence of urologic diseases is on the rise in India, some say at an alarming rate which has brought the domain in sharp focus of late. Benign prostatic hyperplasia (BPH) is an enlarged prostate, Urinary Incontinence, urinary tract infections (UTIs), kidney and ureteral stones, prostate cancer, bladder cancer, bladder prolapsed, hematuria (blood in the urine),erectile dysfunction (ED),interstitial cystitis (also called painful bladder syndrome), overactive bladder, prostatitis (swelling of the prostate gland) are all on rise which can also be established from the urology related centers of excellence that have now become the norm as opposed to an exception in almost all multi and super specialty hospitals.

Urology (from Greek οὖρον ouron “urine” and -λογία -logia “study of”), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the male and female urinary tract system and the male reproductive organs. The organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate, and penis).

There is hardly anyone who hasn’t heard the terms like “minimally invasive”, “laparoscopic surgery”, “laser assisted and robotic surgeries” or for that matter “scope guided procedures”. However, not many of us associate such almost ubiquitous terms with Urology, which has traditionally been, and continues to be that field of medicine (read surgical technology) where the cutting edge is usually the norm. Using real time ultrasound guidance, manning fiber-optic endoscopic equipment and often guided by lasers that look straight out of the domain of sci-fi, Urologists deploy minimally invasive techniques to treat a plethora of malignant and benign conditions that are often as much engineering feats as they are medical. Little wonder then, that the help of urologists are often sought for collaboration by practitioners from a variety of related fields like oncology, nephrology, gynecology, andrology, pediatrics, colorectology, gastroenterology and endocrinology.

Physiologically, as the urinary and reproductive tracts are closely linked, and disorders of one often affect the other, a major spectrum of the conditions managed in urology exists under the domain of genitourinary disorders. As a branch of medical science, urology combines the management of medical (i.e., non-surgical) conditions, such as urinary tract infections and benign prostatic hyperplasia, with the management of surgical conditions such as bladder or prostate cancer, kidney stones, congenital abnormalities, traumatic injury, and stress incontinence. Therefore, a visit to an urologist, despite their glamour as Surgical Saviors, need not necessarily lead to the operation theatre and may well be treated by the administration of medicines. As a matter of fact, the recent past has witnessed so many earth-shattering advancements in the medical (read molecular) side of treatment that surgery in certain cases of anomalies at least, is virtually being ruled out, state of the art drugs doing the trick that used to earlier call for the scissors and forceps.

We will be failing in our duties if we do not point out one peculiarity about the profession of urology. Because of the long years that are needed for a practitioner to perfect the art of surgery in the domain, the average age of the Urology Surgeons is comparatively higher that Surgeons with other specializations – a trend that is prevalent in most countries, including the advanced western ones. This means that trained Urologists cannot be co-opted into service at will in the short term, leading to near perennial shortfalls, and following the natural laws of demand and supply, premium pricing.

With India’s population demography changing the way it is, the need for trained urologists, with the necessary infrastructure for them to be effective is expected to skyrocket in the medium as well as the long terms. If current supply trends are to be projected in the future, the demand supply gap that will emerge will be extremely disturbing to put things mildly. And, if one were to factor in the fact that there is a marked shortage of trained urologists even in the United States, making the migration of at least some practitioners to foreign shores a distinct possibility, the scenario will become even more distressing. To put things in the right perspective would be to point out that the official website Urological Society of India which is the premier body of Urologists in the country (formed way back in 1961) refers to about 3100 plus Urologists in its rolls. Now compare that to the population of India, which accounts for close to 20 percent of that of the world and the picture will come into sharper focus.


General Guidelines from the AUAF for promoting good urological health in adults and children:

  • Stay hydrated
  • Drink cranberry juice to help prevent urinary tract infections (UTIs)
  • Limit the amount of salt and caffeine you consume
  • Stay within a healthy weight range
  • Choose a smoke-free lifestyle
  • Strengthen the muscles of the pelvic area with Kegel exercises
  • Encourage children to urinate immediately before bed
  • Limit fluid intake in the nighttime hours
  • Purchase athletic “cups” for young boys to help prevent injury
  • Instruct young girls to use a front-to-back motion to wipe the genital area after using the washroom