Urology is the surgical specialty involving disorders of the genitourinary tract and the adrenal glands. Specialists in this discipline must demonstrate knowledge, skill, and understanding of the basic medical sciences relevant to the genitourinary tract and the adrenal glands as well as possess the people skills needed to counsel patients on personal and sensitive topics.
Residency education in this specialty is designed to educate physicians in the clinical aspects of diagnosis, medical and surgical therapy, and the prevention and reconstruction of urologic diseases, neoplasms, deformities, disorders, and injuries. Common procedures include open, endoscopic and robotic surgeries for both benign and malignant conditions meaning that urologists must be familiar and facile with a broad range of both disease processes and surgical approaches.
Five years of postgraduate education are required, but some residency programs may include a sixth year for research. As found in the American Board of Urology’s (ABU) Information for Applicants and Candidates handbook for certification, an applicant for certification by the ABU must:
The ABU mandates a minimum of five clinical years of postgraduate medical training. The training must include:
- 48 months in an ACGME-approved urology program
- Three months of general surgery in an ACGME-approved surgical program
- Three months of urology in an ACGME-approved program
- Three months of other surgical training (e.g., intensive care unit, trauma, vascular surgery, cardiac surgery, etc.) in an ACGME-approved surgical program
- Three months of other rotations, not including dedicated research time, in an ACGME- or RCPS(C)-approved core surgery program
Every single rotation listed above is not part of core urology training and each program’s director is responsible for designing the residency curricula. As part of the core urology training, the candidate must have completed at least 12 months as a chief resident in urology with the appropriate clinical responsibility and under supervision in institutions that are part of an ACGME-approved program.
For more information, visit the American Board of Urology and the American Urological Association.
The description of this surgical specialty was adapted from a description set forth by the American Board of Medical Specialties (ABMS).
Urology as a Career
Urology is a surgical specialty with a wide spectrum of opportunities, ranging from office practice to minimally invasive endoscopies and from robotic to major open surgical procedures. This variety is a particularly attractive feature for practicing urologists and can be molded and evolve over time to match ones career goals and priorities. Urologists are the prime caretakers of the male genitourinary tract and the female urinary tract and operate on the kidneys, ureters, bladder, prostate, urethra, testes, etc. Furthermore, for many patients with prostate conditions, kidney stones (nephrolithiasis), and incontinence, urologists are the primary physicians. Most urologists in private practice will see between 50 and 100 patients a week and perform additional cystoscopies, prostate biopsies, vasectomies, and other minor office-based procedures. They will also perform a range of both minor and major surgical procedures including ureteroscopy, urologic implantation and nephrectomy in ambulatory surgery centers and hospital settings. While a urology practice can be primarily surgical with three to four days a week spent in the operating room, most urologists operate only about one to two days a week.
Although most urologists in private practice are generalists and see a spectrum of diseases ranging from benign prostatic enlargement (BPH), urinary stones, incontinence, and cancer, there are recognized areas of subspecialization within urology, especially at the academic centers and in large group practices. These include urologic oncology, pediatric urology, stone disease, infertility, urologic reconstruction, female urology and incontinence, and minimally-invasive surgery. There are clinical fellowships in these fields that range from one- to three-years long. A fellowship appointment requires completion of an accredited residency program.
For many students, their initial exposure to urology is on their third-year rotations in surgery. Unfortunately, at many institutions, most students are never exposed to urology and never get a chance to consider it as a career choice. Those students who become interested in urology generally take an elective fourth-year urology rotation for four to six weeks to gain a better understanding of the specialty and to get letters of recommendation to apply for a residency position. As a surgical specialty, urology is quite competitive and continues to attract some of the best and brightest medical students. There are a total of about 150 programs and 400 residency positions in urology filled through the match each year. It should be noted that urology is an early match, so medical students should prioritize attaining mentorship and preparing their application as soon as they suspect that urology is the right career for them.
Urology is interesting and exciting in that one can adapt the field to his or her own talents and circumstances. If performing major surgical procedures is a priority, it is possible to construct such a practice in a number of urologic subspecialties. If performing endoscopies and office-based practice are priorities, those can also be easily pursued. As an example, a young surgeon may elect to perform major oncologic, pediatric, or reconstructive procedures while the same surgeon 20 years later may elect to perform minor surgical procedures or even have primarily an office practice. Both of these kinds of practices exist in almost every practice setting. Urologists are often friendly and have wide-ranging interests outside of medicine. With the aging population and the continued rise in the number of patients with BPH, prostate cancer, incontinence, erectile dysfunction, and infertility, urologists are poised to be in high demand with a great deal of career autonomy for the foreseeable future.
George Koch, MD
Columbus, OH
July, 2026
