Urology is a surgical specialty focused on diseases of the urinary tract in both men and women, as well as the male reproductive organs. That covers a broad stretch of anatomy: the kidneys, ureters (the tubes connecting kidneys to the bladder), the bladder, the urethra, and, in men, the prostate, testes, and penis. If something goes wrong with how your body makes, stores, or passes urine, or with male reproductive function, a urologist is typically the specialist you’ll see.
What Urologists Treat
The range of conditions urologists handle is wider than most people expect. Some of the most common include frequent urinary tract infections, urinary incontinence (leaking urine or feeling sudden urgency even when your bladder isn’t full), blood in the urine, kidney stones, and bladder stones. Enlarged prostate, known as benign prostatic hyperplasia or BPH, is one of the most frequent reasons older men visit a urologist. It can cause difficulty urinating, a weak stream, or a constant feeling that you need to go.
Urologists also diagnose and treat cancers of the urinary tract and male reproductive system, including bladder cancer, kidney cancer, prostate cancer, and testicular cancer. Beyond cancer, they manage erectile dysfunction, premature or delayed ejaculation, male infertility caused by low sperm production or blocked sperm ducts, urethral strictures (a narrowing of the tube that carries urine out of the body), and pelvic organ prolapse in women. Some urologists treat conditions people are born with, such as structural problems in the urinary tract that are detected in childhood.
Men’s Reproductive Health
Because urology covers the male reproductive system, urologists are often the first specialists men see for sexual health and fertility concerns. Erectile dysfunction is common and can stem from vascular, hormonal, or neurological causes. Urologists evaluate the underlying problem and offer treatment options ranging from medication to minimally invasive procedures. For male infertility, they can identify issues like blockages in the sperm ducts, varicoceles (enlarged veins in the scrotum), or hormonal imbalances that reduce sperm production.
Prostate health is a major part of urological practice. BPH affects a large share of men as they age, and urologists manage it with medications, lifestyle changes, or procedures to relieve the blockage. Prostate cancer screening, biopsy, and treatment also fall squarely within urology.
How Urologists Diagnose Problems
Urologists use a set of specialized tests to figure out what’s happening inside the urinary tract. One of the most common is cystoscopy, where a thin camera is passed through the urethra to visually inspect the bladder lining. This can reveal tumors, inflammation, or structural abnormalities.
For problems with bladder function, urologists turn to urodynamic testing, a group of tests that measure how well your bladder stores and releases urine. Uroflowmetry, for example, tracks how fast urine flows out, which can reveal whether your bladder muscles are weak or something is blocking the flow. A postvoid residual measurement checks whether urine is left in your bladder after you finish (more than about 100 to 150 milliliters suggests incomplete emptying). Cystometric testing measures how much your bladder can hold, how pressure builds as it fills, and at what point you feel the urge to go. It can also detect involuntary bladder contractions, which are a hallmark of overactive bladder.
If nerve or muscle damage is suspected, electromyography can measure the electrical signals between your nerves and the muscles controlling your bladder and pelvic floor. Video urodynamic tests combine imaging with these pressure measurements, letting the urologist watch the bladder fill and empty in real time.
Surgical and Minimally Invasive Treatments
Urology is, at its core, a surgical specialty, and the field has shifted dramatically toward minimally invasive techniques over the past several decades. For kidney stones, the most common approaches now include shockwave lithotripsy (which uses targeted energy waves to break stones into passable fragments from outside the body), ureteroscopy (a thin scope threaded up through the urinary tract to reach and fragment the stone), and percutaneous nephrolithotomy for larger stones, where a small incision in the back provides direct access to the kidney. Open surgery for stones has become rare.
Robot-assisted surgery, most commonly using the da Vinci surgical system, has become a major tool in urology. It’s widely used for prostate cancer removal, kidney tumor removal, and bladder reconstruction. The robotic platform gives surgeons magnified 3D vision and greater precision through small incisions, which generally means less blood loss, shorter hospital stays, and faster recovery compared to traditional open surgery. For complex stone cases where standard techniques aren’t feasible, robotic approaches serve as an alternative to open procedures.
Urology Subspecialties
After completing their core training, some urologists pursue fellowship training in a narrower area. Pediatric urology focuses on urinary and genital problems in children, many of which are congenital. Urologic oncology concentrates on cancers of the kidney, bladder, prostate, and testes. Urogynecology (also called female pelvic medicine and reconstructive surgery) deals with pelvic organ prolapse and complex incontinence in women. Other common focus areas include male infertility, stone disease, and neurourology, which addresses urinary problems caused by conditions like spinal cord injury or multiple sclerosis.
How Urologists Differ From Nephrologists
Both urologists and nephrologists deal with the kidneys, but in very different ways. Nephrologists are internal medicine doctors who manage kidney disease itself: chronic kidney disease, acute kidney injury, electrolyte imbalances, and conditions that damage the kidney’s filtering units. They oversee dialysis and provide long-term care after kidney transplants. They do not perform surgery.
Urologists, by contrast, handle the structural and surgical side. If you have a kidney stone that needs to be broken up or removed, a tumor in the kidney, or a blockage in the urinary tract, that’s urological territory. In practice, the two specialties often work together. A nephrologist might manage a patient’s declining kidney function while a urologist addresses a blockage that’s contributing to it.
Training and Education
Becoming a urologist requires significant training beyond medical school. The American Board of Urology requires a minimum of five clinical years of postgraduate training. The first year includes rotations in general surgery and urology, building a broad surgical foundation. The remaining four years are spent in an accredited urology residency, with at least 48 months dedicated to urology training. During the final two years, residents must complete at least 12 months as chief resident, taking on greater surgical responsibility. After residency, those pursuing a subspecialty complete an additional one to two years of fellowship training.