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What is 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.

NKTI Urology History

The National Kidney & Transplant institute (NKTI) – Urology in 2020, a journey into excellence and to be the best in the service of the Filipino people By Dante P. Dator, MD; Chairman, Dept of Urology (2005-2013)

The creation of the National Kidney Foundation of the Philippines (NKFP), which later became the NKTI, in 1983 is closely intertwined with the birth of the section of Urology which together with Nephrology were the cornerstones of the specialty hospital dedicated to renal and urologic conditions together with transplantation.  Through the initiative of Dr. Claver Ramos, its first director, Dr. Benjamin Magsino from Makati Medical Center recruited the best and brightest urologists at that time to form the section, namely Dr. Genaro Yusi, from the UP-PGH Section of Urology and Dr Abelardo Prodigalidad, from UERM and UST  all three of them coming from training at the prestigious centers in the United States.  This triumvirate who didn’t know each other personally from the start became solid friends and professional partners laying down the foundation of the department eventually establishing the training program that became accredited by the Philippine Board of Urology in 1986. Two young GS residents were recruited, Dr. Eduardo Rivera and Dr. Nelson Patron and they successfully completed their training amidst the construction activities and birthing pains of the new Institute to become the very first graduates in 1987 and who were later absorbed to become one of the consultants of the department.  From an initial   50 bed hospital that was “carved” out from one of the wings of the Lung Center of the Philippines which was shared with the nephrology service, the growing department started the modern practice of urology equipped with the current armamentarium and tutored by the “masters” themselves. They performed the first living related kidney transplant in 1983.   

Because of the esteemed reputation, skills and professional network of the founders – the patients came from all walks of life with an exponential growth in consultations and surgeries in the years that followed.

SERVICE, TRAINING, & RESEARCH

This was the simple and powerful mantra that the young department emulated, with the intent of training the future urologists for the rest of the Philippines. And they all came – applicants from all over the country that if you fast forward today – from north to south they are heads of departments, associations, societies etc.

An alliance was formed with the UP-PGH urology section (that was later expanded to a MOA with UP Manila in 2015) which fostered greater academic interaction and camaraderie between the 2 institutions with regular case reporting and journal presentations held in various residences of the generous staff.  This was the first formal linkage between 2 PBU accredited programs at that time.

• The Growth & Expansion of the Department (the many firsts)
• The first urology group practice in the country

Emergence of sub-specialization thru recruitment and training of new faculty.

• Endourology – Dr Benjamin Mendoza was sent by the group for training in various centers abroad and the first PCNL performed in 1988.
• Urologic Oncology – Dr Reynaldo dela Cruz from  Dalhousie University, Canada
• Pediatric Urology – Dr Dante Dator, from Boston Children’s Hospital, in 1992 – formalized the subspecialty by creating and forging a partnership with Pediatric Nephrology with its own clinic and ward. The first successful closure of bladder exstrophy was one of the highlights of the subspecialty in 1993.

The first urodynamics facility in 1992 with a LifeTec machine that was set-up by Dr. Dante Dator and Dr. Eduardo Rivera, the latter also after being sent for training in Singapore. At that time, Nkti urology was the referral center for urodynamics.

• The first ESWL in the Philippines – the EDAP LT-01 machine that was initially housed at the NKTI in 1989 and eventually transferred to a private hospital because of regulatory concerns. (The core of this machine is now at display the the Urology Museum of the department, which is recognized by the William Didusch Center for Urologic History of the AUA)
• Broke the male dominated Urology specialty by graduating the first female Urologist in the Philippines, Dr. Ellen Vercelles in 1992.
• Acquisition of the latest endourologic equipment that by virtue of being a GOCC hospital (government corporation) allowed the group the leverage to acquire them in a timely manner.
• The first HIFU (high intensity focused ultrasound) – minimally invasive treatment for prostate cancer – sending Dr Genlinus Yusi for training in France in 2002.
• The Prostate Health Clinic in 2005
• Laparoscopic Urology – started upon return from training by Dr. Ernesto Gerial Jr and Dr. JV Prodigalidad who eventually honed their skills at the NKTI to establish the leadership in this subspecialty.
• The Center for Urology and Men’s Health – established when then executive director Enrique Ona completed the conversion of Wards 3E and 3F into dedicated service areas which eventually was completed during the term of exexcutive director Dante Dator when the 2^nd floors administrative areas and first floor operating room expansion and ESWL/urodynamics facility was completed in 2014.
• The first fully modular OR One (Storz) to complement the growing minimally invasive subspecialty(2014).
• One of the first to adopt the use of lasers in urology by acquiring 2 Thullium laser machines for stones and soft tissue
• Fellowship Programs were established in Urologic Oncology and Minimally Invasive Urology.
• The first lap renal donor nephrectomy in the Philippines was done on Feb 2004 by Dr. Peter Breten and Dr. Ernesto Gerial Jr.
• The Buenaventura Memorial Lectures running since 2010 and has been instrumental in bringing to the NKTI the “whos who in urology” in the world, in partnership with the PUA.
• The Donald Marshall Memorial lecture – hosting Dr Peter Carroll from the UCSF, a leading academician of the AUA for Prostate Cancer in 2012.
• Published 2 editions of clinical practice guidelines in urology
• Participated in all the DRE programs of the PUA.
• The Straight GS-URO training program was started in 2013, a unique set-up for NKTI who did not have a formal GS training program.

Today the department has fulfilled the mission vision of the founders and has remained to be the future leaders and trainors to continue the tradition, excellence, professionalism and integrity as we continue to attract the best and brightest minds in Urology, "Sakit sa Bato, Sagot Nandito …. NKTI Kaagapay Mo."  (Dante P. Dator, M.D.)

List of Past Chairmen

Dr. Abelardo M. Prodigalidad (1983 to 2001)	Dr. Reynaldo C. Dela Cruz (2001 to 2005)	Dr. Jose Dante P. Dator (2005 to 2013)

Dr. Emmanuel V. Lenon (2013 to 2016)	Dr. Nelson A. Patron (2016 to 2019)	Dr. Genlinus D. Yusi (2019 to 2021)
Dr. Carlos Ramon N. Torres Jr. (2021 to Present)

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 . 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 Chairmanships 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 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.

Services

Featured Services

• Percutaneous Nephrolithotomy (PCNL)
• Laparoscopic Urology : Minimally Invasive Puncture Incision Surgery
• Extra-Corporeal Shockwave Lithotripsy (ESWL) : Wound-Less Operation for Urinary Stones aka “Laser” Surgery for Stones
• Transrectal Ultrasonography
• Urodynamic Studies
• Endourology
• Pediatric Urology
• Renal Transplantation

General Services

In-Patient Services
The Department of Urology is capable of diagnosing and managing all forms of Urologic disease. These include operations for urinary stone disease, enlarged prostate, urinary obstruction, genito-urinary tract infection,infertility and sexual dysfunction. The Deparment is especially skilled inoperations for genito-urinary tumors, both adult and children, benign and malignant. The Deparment performs major, minor, and endourologic elective operations daily from Monday to Saturday. A typical day would mean 5 major operations with 4 to 8 minor and endourological procedures. Emergency procedures can, of course, be done 24/7.

Out-Patient Services
Private Urology Out-Patient Clinics: To provide the best Urologic care in the country, our specialists hold regular clinics at the Annex II Building. Here at least one expert Urologists is available for consultation at all times. You may schedule Urology Service Out-Patient Clinics: The Deparment holds a regular Out-Patient clinic for service patients. This clinic is composed of three distinct specialty clinics:

General Urology Clinic
This clinic is conducted four times a week. This consists of the General Urology Clinic which is on Monday and Friday at 10 am to 5 pm local time. This clinic services walk-in (new), follow-up, and post-operative Urologic patients as well as referrals from other specialties and departments.

The Prostate Health Clinic
This clinic is conducted weekly on Tuesday and Thursday at  1 pm to 3 pm. This clinic handles all patients with prostate disorders. These include, but are not limited to, patients with prostatitis, benign prostatic hypertrophy, and prostatic adenocarcinoma.

The Urologic Oncology Clinic
This clinic is conducted weekly on Tuesday and Thursday at 1 pm to 5 pm. This clinic handles all patients with Urologic Malignancies. They may be patients who have yet to be operated on, and are still on work-up. Others may have already undergone operation and consult the clinic for follow-up or adjuvant chemotherapy/radiotherapy, or even for stoma care, in the case of most radical cystectomy patients.

Services and Facilities for Urologic Conditions provided by the Institute, but are not under the Department of Urology

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

 Therapeutic Services

• 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.

Our Expert Team 

Contact Us

Training Program

Conferences
 
The Department conducts a regular weekly conference for Continuing Medical Education (CME) purposes. This conference is open to ALL Urologists free-of-charge, whether they be affiliated with the Institution or not. Participation is also encouraged to all attendees.     
       
Topics during the conference vary depending on the available clinical material or monthly assignment. Topics can be Monthly Department Census, interesting Pre- or Post-Op cases with diagnostic and/or therapeutic problems. Cases may be from the Institution’s Private or Service patients. Journal Clubs and Tumor Board conferences are usually presented once-a-month. Special Topics of Interest can arise depending on the situation
       
The conference is presented every Wednesday at 8:00 am.     
  
The Residency Training Program in Urology

REQUIREMENTS FOR THE GS-URO RESIDENCY TRAINING PROGRAM:

1. Letter of Intent addressed to:
   

   CARLOS RAMON N. TORRES Jr., MD
   Chairman, Department of Urology
   National Kidney and Transplant Institute

   THRU:        AMIHAN A. BANAAG, MD, FPCS 
                 Officer-in-Charge, Department of Surgery
                 National Kidney and Transplant Institute

2. Curriculum Vitae 2 copies with 2x2 picture
3. Original Copy Medical School Transcript
4. Verification of graduation from Medical School
5. College Diploma and TOR
6. PRC Certificate with Board Ratings
7. Valid PRC card – photocopy front and back
8. Three letters of reference from attending physicians familiar with the individual’s performance
9. Internship certificate
10. Class standing and WT Average

Basis for Evaluation of Applicants

• Written Examination covering both Urology (50%) and General Surgery (50%) will be given to all applicants.
• Personal Interview with a panel consisting of at least three Attending Consultants. The schedule for Interview is not negotiable. Failure to show up at the Interview implies disinterest in the program, thus such applicants will be dropped from the deliberation list.
• Letters of Recommendation
• Other factors (location of future Urologic practice, tie-up with a Provincial Hospital, etc.)