Coining a new term-Urovesicology: advancing towards a mechanistic understanding of bladder symptoms

When patients present with lower urinary tract symptoms (urgency, frequency, nocturia, slow stream, hesitancy, sense of incomplete emptying, post-void dribbling), urinary incontinence (stress and urge), urinary retention, dysuria, and/or bladder pain, the urologist would be the most appropriate specialist to evaluate and treat these patients. These symptoms will be collectively labeled as “urovesicologic” symptoms, the reason which will become apparent. Because these symptoms usually have no known cause, empiric (trial-and-error) treatments directed at ameliorating symptoms, but not at the underlying pathophysiology, are the usual recourse. Within the field of urology, there are numerous appellations given to those who treat urovesicologic symptoms. These appellations, to date, include female urologist, female pelvic medicine and reconstructive surgeon, urogynecologist, neurourologist, urodynamicist, and probably a few more. Why so many? Of course, there are specific reasons. Labels with the words “female” or “gyn” imply that these subspecialists focus only on female patients. The use of the words “medicine” and “surgeon” imply that the physician has both intellectual and technical skills. The label “neuro” implies expertise in treating urologic issues in patients with concomitant neurologic diagnoses such as spinal cord injury, multiple sclerosis, post-cerebrovascular accident (stroke), Parkinsons, and Alzheimers, which can adversely affect bladder function. The term “urodynamicist” implies an expert in urodynamics with the further implication that urodynamics can objectively determine the etiology of the urovesicologic symptoms and/or prognosticate treatment outcomes. Ultimately, how do these numerous labels help patients with these urovesicologic symptoms? Do we even need these many labels? The critical issue is the lack of understanding of how physiologic function/dysfunction translates into symptoms. We should not be so focused on a specific gender, treatment modalities (medicine versus surgery), distinct concomitant disease (neurogenic versus non-neurogenic) or ability to do specialized testing (urodynamics). The urologists should be the specialty that seeks knowledge about the pathophysiologic mechanisms underlying urovesiciologic symptoms. Therefore, I propose a new term, “urovesicology” (uro=urine + vesic=bladder + ology=study of) which would be a discipline that studies basic pathophysiologic mechanisms that lead to bladder symptoms. Urovesicology will not be limited to mechanisms based on a gender (male or female), a specific treatment method (medical or surgical), a specific cause (neurologic injury or degeneration) nor a specific testing modality (urodynamics), but rather, urovesicology would be defined by development and implementation of new treatments and/or diagnostic tests for urovesicologic symptoms based on ability to measure, detect, and/or quantify specific pathophysiologic mechanisms. Future treatments will therefore be driven by mechanistic principles rather than the current paradigm of empirical symptoms-based treatment. This editorial will present what the future in urovesicology might hold.