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So next, we have about who will be talking about a career in urology. She's a registrar working in the specialty and great, everything's already in a way. So the floor is yours whenever you're ready. Thanks. You know, are you able to hear me and see the lights? Yeah, that sounds good. All right, perfect. So welcome everyone. So today I'm going to talk about a cardio in urology. I am. I've just started as an ST three in North London in urology. And uh I'm also the asset rep for bow section of trainees, which is the urology branch of trainees. So welcome everyone. It is one of the best and the friendliest specialty. We just don't um have a particular subspecialty that is um more popular. I think there's loads of subspecialties, lots of choice even within urology. So as you can see on this, there's stones, but there's also loads other subspecialties to choose from. Ok. So what is urology? Um We do both medical and surgical management of male gender urinary system as well as female urinary system. Um It has evolved significantly over the years. So back in say late 19th century, you're still doing a lot of open surgeries, a lot of herbal treatments for urological diseases. However, it's moved down from that to um keyhole procedures and uh lots of advancements have happened since then. So my part to urology, I did my med school um finished it in 2017. I did, did uh an F one volunteer outside of the UK. And then I started working in the UK since um 2020 which was during COVID. Um I did a standalone program where I had a surgical uh rotation. And then I went on to do another surgical specialty as a junior clinical fellow after which I got into court training, which was urology themed. And then here I am uh starting as a urology trainee this year. So, in general, what do urologists do? So there is um heavy emphasis on co urology and emergency urology. And then every consultant would have their own special interest within the specialty. So that ranges from endourology, which is um stones, PCNL S um uh laser trips and things like that. There's oncology which is divided into upper tract and lower tract. So kidney cancers, upper tract um transitional cell carcinoma, ureters, things like that. Lower tract is mainly bladder cancers, prostate cancers. Um There's also a branch of female and functional urology. Um There, there's interesting stuff like corpus suspension S NS modulators which is um no modulators for uh neurogenic bladders. Um And then there's urology which is another subspecialty which also deals with fertility. Um There's advanced general urology which is um co urology with more advancements within these procedures. And then uh if you have a special interest in pursuing transplant or pediatric urology, then this is an option as well. So, co urology, um this is mainly the bread and butter of urology. This involves um if, if you can see the image on the left which is um bladder tumor resection, it's all endoscopic procedure. There's um uh the image to the right where you can see a stone which is impacted in the ureter. So that in an emergency situation, this would involve uh unblocking the system which is passing a stent through. And then we bring the patient back in a few weeks time to manage the stone uh uh in itself before we take the stent out. Um then prostate procedures where it's blocking the ureter and uh urethra and then we have channel opening, which is TU RP and there's lots of other procedures as well um to achieve this goal. Um And then there's scrotal, you know, scrotal procedures which involve circumcisions and uh management of uh testicular torsion as an emergency, um other emergency urology procedures. So, testicular to torsion is there um in some situations, unfortunately, this leads to an orchidectomy. Um It could be a late presentation. Um And as you can see on the left image that testicle doesn't look healthy, so that unfortunately needs to be taken out. Um The one next to it is what we call a penile fracture, um which looks like an a and there's an image next to it which tells us exactly where the fracture has happened or the um discontinuity of the corpora has happened. So it helps us to repair the area and plan further steps. Um The X ray at the bottom is showing a foreign object and then catheters which um have different uses and there are different sizes as you can see um endourology. So this is uh currently what I am doing. Uh It's one of the rotations within urology um that I have been allocated to. So this involves stones, um stones can be various sizes, various components, locations are different and patient complexity is something to be um taken into consideration. So um most procedures are endoscopic. There's also the percutaneous nephrolithotomy where the tract is made through the back, which goes straight into the renal pelvis. And then the scopes are inserted through there to find where the stones are to clear it out. So that's the image at the bottom. Then there's oncology. So we've moved more from an open procedure to um laparoscopic and robotic procedure which you can see at the top. And it's also moved from radical nephrectomy for renal cancers to more nephron sparing, which is um what you can see as partial nephrectomy. That's on the image. There's also bladder cancer procedures where um there's a cystectomy and an ileal conduit, which is a part of the bubble that has been connected and brought up as a stoma. There's one image on the left corner and then there's um prostatectomy. So most procedures are now done robotically uh female functional urology. Um This is quite um it's quite interesting, quite complex patient cohort is different. Um However, the procedures are quite cool. So if you see on the left uh top, this is a Mitrofanov procedure where a part of the bowel is augmented to um the dome of the uh the bladder and that is to increase capacity and to improve symptoms. Um There's also procedures where it can be brought up as a stoma. So an ileal conduit, but this is a benign indication for an ileal conduit, there's also Botox andrology and fertility. So, a lot of microvascular micro um procedures done in this situation um especially in tertiary centers which are um heavy on andrology, uh patient cohort as well as um tertiary centers with andrological experience. Um The image at the left bottom is showing a peron plaque. So it involves um removal of this plaque and um straightening of the penis, advanced uh urology. So, as I mentioned earlier, um so these are procedures for the prostate, which is, which has moved from traditional Turp S to procedures such as urolith, which is at the right top corner. Um The one at the left bottom corner is the resume where there's steam um injected into the prostate and it, there's apoptosis that happens over the next few weeks and that helps improve symptoms. There's also green light laser for uh procedures on the prostate and then there's other possible subspecialties. Um These are not really incorporated in the urological training. However, there is a possibility to do a fellowship here. If you're interested in pursuing kidney transplant or pediatric urology, we do have um at least six months of pediatric urology, which is part of our training. However, if you want to subspecialise in it, um then there sh there is a possibility to do a fellowship in the UK. Um And then just generally why choose urology. So vast, vast range of procedures, lots of things to do. It can be, it ranges from open endoscopic laparoscopic and robotic. It's one of the fast moving specialties as well. There's also minor procedures and diagnostic procedures like urodynamics where um it it is an invasive procedure, but it gives us a lot of information and helps us to plan further. Um There's a lot of medical emphasis before we actually move on to surgical uh management for uh common procedures, generally an excellent work-life balance. So, and we are very quick to embrace new technology. Lots of advancements in the last few years have happened. There's also a lot of broad scope for uh academia within urology and we just generally friendly and happy uh surgeons. Um and then what does a typical week look like? So this is a um try and but two examples of my general week. So there's usually two or three theater list which are elective um half day of flexible cystoscopy. And these can be either hematuria clinics where we are trying to see if anyone's got cancer or whether we can discharge them. And there could be other reasons for the hematuria or sometimes they come in for flexible cystoscopy with um recurrent uti s or lower tract symptoms, which have not got better. So that's flexible cystoscopy. Then there's a half day admin to catch up on all the paperwork. There's a half day outpatient clinic and the diagnostic clinic and then there's a MDT which is half day. So we triage patients in the morning and then discuss them in the MDT and then there's teaching um for half of the day. Um Another example would be an MDT with the clinic in the afternoon, couple of theater lists during the week and also diagnostics clinic and teaching as well. And then in terms of the pathway to become a urologist. So after medical school, there's foundation training. So year one and year two followed by co surgical training and specialty training, which is ST three to ST seven. and then there's consultancy after that, if you're interested in having an academic component that can be a run through program after foundation training from ST one to ST seven. Um And then, so that's until you become a consultant um in terms of foundation training. So it's a two-year program as you might be already aware of with a mixture of specialties. Um you will have a surgical rotation if you're interested in urology at an early stage, having a urology rotation always helps. Um Otherwise, when you're doing other surgical specialties, there is on call cover where you possibly could cover urology as well, especially in DGH. If not, if you're really interested, you can always approach um a consultant or a senior registrar in urology. And I'm sure we are very happy to help uh support your career in terms of course, surgical training. So it's a two-year program again, usually themed. So mine was a urology themed surgical specialty. Um If it'll be good if you get at least six months of urology experience, um other allied specialty experiences um within surgery would be also useful. So general surgery, pediatric surgery or transplant surgery in some regions, especially in DG HS your um in your CT two year, you get to act up, you get allocated to the registrar rota and you sort of have um some experience of stepping up rather than going straight from CT two to T three, which can be a big leap and then in co surgical training to be signed off for your ACP, uh mrcs is expected by the end of the program, academic Clinical Fellows. So this is where you um get a research um component as part of your clinical work. So it's a 7525 in most um most denies or you can have a day of your week, which is allocated for research work and there's an assigned academic supervisor. So in terms of tips for application, um I would say plan ahead, it's um changing every year. So lots of um new components are brought into the portfolio and a lot of things are taken away. So you need to find a balance not to miss out on um getting your application through, check the portfolio requirements early on. Um try and have sort of uh what when I was um applying for ST three or even go surgical training, I had a spreadsheet with all the, the the components that I had already achieved and what else I could improve on and how my score would improve from there on. And it was all about trying to achieve those um while also trying to balance a busy job. Uh But I would say that it is possible um try and link up with urology, registrars and consultants in your hospital or in your area in your dry. Um They are usually very useful and very helpful in providing guidance on how to get into training and how to get into the subspecialty um that you're interested in and in terms of procedures. So as an ST three, you are expected to have co urological procedures at level four. So level four is where you can do them independently. You're able to deal with any unexpected complications when the patient is on table. And even for your T three application, you need level four signed off before you even start your ST three. So the four procedures that they need level fours are cystoscopy, which can be a rigid or flexible cystoscopy, scrotal procedures. So torsion fixation, orchidectomy, any hydrocele repair, those kind of procedures, stents, emergency procedures involving insertion of stent to unblock and uh for an infected obstructed system and circumcision. So these are the co procedures that you're expected. And then if you're interested in urology as a medical student or foundation doctors, you can join the BO um there's a BFIC conference coming up next year in June, which is in Manchester. And I would highly recommend um if you, if it, it's, it's an a fantastic opportunity to network, get to know the team. It's a small subs, some small sub uh specialty which where people know each other. And it's it's really close specialty. So very good hands on experience as well as well as good guidance from uh from mentors. Um This is the B page. So if you're interested in urology, I would recommend visiting the page, it's free for uh medical students to join and there's lots of events and lots of courses um to help build your portfolio as well as your interest in urology. And that's me. So if anyone has any questions, I'm happy to answer them and you can also follow me on Twitter. Um Any questions I'm happy to answer them now as well. Well, thank you so much for taking the time to talk about that. Um I can't see any questions in, in the chat at the moment, but I'm very curious. Was there a particular moment in, in your career that you were just like? No, this, this is the defining reason why I want to do urology. So that's very interesting because I, when I started my co training um which was urology themed. I had no urology experience other than the, the the moments where I had to cover emergency urology while covering say from orthopedics. So, but I wanted to try it. And I think having a good mentor and a good department is probably the defining moment. So when I did one of my rotations in ct one, that's when I said, OK, this looks like a good specialty. You're expected to be independent, but you're also supported to get there. Um There's a lot of expectation in terms of preparing your for the portfolio, but I will say that it's not impossible. So I've come straight from C D2 to ST three and I did 16 months of urology during my co training. Um I would say eight months before applying for ST three. But I think having that supportive team was very, very important and I think most teams that I've worked with in urology have ha have have provided that support to further my career. Um Yeah, excellent. Well, thank you so much for taking the time to, to a career in urology. I really appreciate it for those of you in the chat. Be sure to give some more followers uh on X. That's future urologist, pop, pop her an email. If, if you've got any more questions, you, you're too sure. There's someone asking about pathway into renal transplant with urology training. Yes. So this renal transplant would be a fellowship year after completing ST seven or T in urology. Um There might be consultants in tertiary centers who are cross covering urology and renal transplant. I would encourage you to speak to um them because they will be able to give you a better idea. But I'm pretty sure post fellowship in renal transplant will get you them. Excellent. Thank you. Thank you. Sorry, we don't have any more time for any more questions, but thank you so much for your time. Really. Appreciate it. No problem. Thank you.