In the U.S. urology market, the demand side of the market continues to undergo consolidation, with hospitals acquiring outpatient facilities and expanding the reach of the group purchasing organizations (GPOs), coupled with the reimbursement cuts across the urology space, average selling prices are expected to remain under significant pressure, negatively impacting the future growth of the market.
Since NeoTract launched UroLift an implant for the treatment of BPH, in the U.S. in 2013 and in Europe in 2010, the device has been rapidly adopted by urologists, following the trend from other regions where it is available, such as Canada, Australia and more. The UroLift® procedure is minimally invasive and can be performed in a relatively short amount of time, making it an attractive treatment option for BPH. In 2017, NeoTract was acquired by Teleflex, which is expected to further drive adoption of UroLift by leveraging the large presence and sales distribution network of Teleflex.
In Europe, the adverse effects of urinary incontinence slings have been up for discussion since 2008, when the U.S. Food and Drug Administration (FDA) released warnings regarding the use of surgical mesh for stress urinary incontinence. Since then, the market for urinary incontinence slings has been on the decline. In 2018, the National Health Service (NHS) suspended the use of female urinary
Incontinence slings in NHS hospitals in the United Kingdom. This has had negative impacts on the overall urinary incontinence sling market.
Track 1: Urology
The urinary and reproductive tracts are firmly connected, and clutters of one frequently influence the other. In this way, a spectrum range of the conditions oversaw in urology exists under the area of genitourinary issue. Urologyconsolidates the administration of restorative and it is nonsurgical conditions, such as urinary tract contaminations and benevolent prostatic hyperplasia, with the administration of surgical conditions. Examples: Bladder or prostate tumor, kidney stones, genetic changes, kidney damage, and stress incontinence.
Track 2: Andrology
Andrology is the medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urological problems that are unique to men. It is the counterpart to gynaecology, which deals with medical issues which are specific to female health, especially reproductive and urologic health. Andrology covers anomalies in the connective tissues pertaining to the genitalia, as well as changes in the volume of cells, such as in genital hypertrophy or macrogenitosomia. From reproductive and urologic viewpoints, male-specific medical and surgical procedures include vasectomy, vasovasostomy (one of the vasectomy reversal procedures), orchidopexy and circumcision as well as intervention to deal with male genitourinary disorders
Track 3: Clinical andrology
Andrology is still not recognized as a surgical specialty even in the USA and seminars and workshops that include clinical rather than scientific andrology are few. Formal teaching in andrology is only occasionally included in the routine training of either the gynaecologists or even the urologists. The reliance on a wide variety of tests on semen as a means of diagnosing male infertility seems to have elevated the spermatozoon to the status of a ‘cellular patient’. In many clinics, the diagnosis of male infertility relies solely upon the findings in a semen analysis. These semen analyses are usually interpreted by a laboratory scientist who knows little or nothing of the clinical history or of the clinical findings.
Track 4: The use of multiple clinicians
This system ensures that an expert in a particular field always sees each patient, and this is a system that appears to be commonly used in the USA. In relation to male infertility one might, using this system, feel more confident that the correct diagnosis is being made and that the right treatment is being applied to the patient. However, it is the author’s experience that patients do like to relate to one clinician and do not like to be treated by ‘a committee’. Multiple doctors, especially in private practice, involve multiple appointments and multiple discussions relating to their treatment—as well as an increase in the cost of that treatment. In that situation, patient notes may need to be transferred between clinics and such a system could give rise to confusion resulting in misdirected and false information being given to the patients.
Track 5: Infertility
Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species. In humans, infertility is the inability to become pregnant after one year of intercourse without contraception involving a male and female partner. There are many causes of infertility, including some that medical intervention can treat. Estimates from 1997 suggest that worldwide about five percent of all heterosexual couples have an unresolved problem with infertility.
Track 6: Micropenis
Micropenis is an unusually small penis. A common criterion is a dorsal (measured on top) erect penile length of at least 2.5 standard deviations smaller than the mean human penis size, or smaller than about 7 cm (2 3⁄4 in) for an adult when compared with an average erection of 12.5 cm .The condition is usually recognized shortly after birth. The term is most often used medically when the rest of the penis, scrotum, and perineum are without ambiguity, such as hypospadias. Micropenis occurs in about 0.6% of males.
Track 7: Paraphimosis
Paraphimosis is an uncommon medical condition in which the foreskin of a penis becomes trapped behind the glans penis, and cannot be reduced (pulled back to its normal flaccid position covering the glans). If this condition persists for several hours or there is any sign of a lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result in gangrene.
Track 8: Phimosis
Phimosis is a condition in which the foreskin of the penis cannot be pulled back past the glans. A balloon-like swelling under the foreskin may occur with urination. In teenagers and adults, it may result in pain during an erection, but is otherwise not painful. Those affected are at greater risk of inflammation of the glans, known as balanitis, and other complications. In young children, it is normal not to be able to pull back the foreskin. In more than 90% of cases, this inability resolves by the age of seven, and in 99% of cases by age 16. Occasionally, phimosis may be caused by an underlying condition such as scarring due to balanitis or balanitis xerotica obliterans. This can typically be diagnosed by seeing scarring of the opening of the foreskin.
Track 9: Prostate cancer
Prostate cancer is the development of cancer in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, some grow relatively quickly. The cancer cells may spread from the prostate to other areas of the body, particularly the bones and lymph nodes. It may initially cause no symptoms. In later stages, it can lead to difficulty urinating, blood in the urine or pain in the pelvis, back, or when urinating. A disease known as benign prostatic hyperplasia may produce similar symptoms. Other late symptoms may include feeling tired due to low levels of red blood cells.
Track 10: Varicocele
A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum. This plexus of veins drains blood from the testicles back to the heart. The vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Varicoceles occur in around 15% to 20% of all men. The incidence of varicocele increase with age.
Track 11: Female urology
Female urology is a branch of urology dealing with overactive bladder, pelvic organ prolapse, and urinary incontinence. Many of these physicians also practice neurourology and reconstructive urology as mentioned above. Female urologists (many of whom are men) complete a 1–3-year fellowship after completion of a 5–6-year urology residency. Thorough knowledge of the female pelvic floor together with intimate understanding of the physiology and pathology of voiding are necessary to diagnose and treat these disorders. Depending on the cause of the individual problem, a medical or surgical treatment can be the solution. Their field of practice heavily overlaps with that of urogynecologists, physicians in a sub-discipline of gynecology, who have done a three-year fellowship after a four-year OBGYN residency.
Track 12: Reconstructive urology
Reconstructive urology is a highly specialized field of male urology that restores both structure and function to the genitourinary tract. Prostate procedures, full or partial hysterectomies, trauma (auto accidents, gunshot wounds, industrial accidents, straddle injuries, etc.), disease, obstructions, blockages (e.g., urethral strictures), and occasionally, childbirth, can necessitate reconstructive surgery. The urinary bladder, ureters (the tubes that lead from the kidneys to the urinary bladder) and genitalia are other examples of reconstructive urology.
Track 13: Pediatric urology
Pediatric urology concerns urologic disorders in children. Such disorders include cryptorchidism (undescended testes), congenital abnormalities of the genitourinary tract, enuresis, underdeveloped genitalia (due to delayed growth or delayed puberty, often an endocrinological problem), and vesicoureteral reflux.
Track 14: Urologic oncology
Urologic oncology concerns the surgical treatment of malignant genitourinary diseases such as cancer of the prostate, adrenal glands, bladder, kidneys, ureters, testicles, and penis, as well as the skin and subcutaneous tissue and muscle and fascia of those areas (that particular subspecialty overlaps with dermatological oncology and related areas of oncology). The treatment of genitourinary cancer is managed by either a urologist or an oncologist, depending on the treatment type (surgical or medical). Most urologic oncologists in western countries use minimally invasive techniques (laparoscopy or endourology, robotic-assisted surgery) to manage urologic cancers amenable to surgical management.
Track 15: Neurourology
Neurourology concerns nervous system control of the genitourinary system, and of conditions causing abnormal urination. Neurological diseases and disorders such as a stroke, multiple sclerosis, Parkinson's disease, and spinal cord injury can disrupt the lower urinary tract and result in conditions such as urinary incontinence, detrusor overactivity, urinary retention, and detrusor sphincter dyssynergia. Urodynamic studies play an important diagnostic role in neurourology. Therapy for nervous system disorders includes clean intermittent self-catheterization of the bladder, anticholinergic drugs, injection of Botulinum toxin into the bladder wall and advanced and less commonly used therapies such as sacral neuromodulation. Less marked neurological abnormalities can cause urological disorders as well—for example, abnormalities of the sensory nervous system are thought by many researchers to play a role in disorders of painful or frequent urination.
