The Profession of Urology
Curiously, neither my Oxford nor Macquarie dictionaries gave a definition for urology – However, Wikipedia defines urology as – “the branch of medicine that focuses on the surgical and medical diseases of the male and female urinary tract system and the male reproductive organs”. The organs under the domain of urology include the kidneys, adrenal glands, urinary bladder, urethra, and the male reproductive organs including the testes, epididymis, vas deferens, seminal vesicles, prostate and penis [interestingly, the pelvic floor muscles were not mentioned].
One of the most respected and established fields of medicine; urology involves the care of many organs and physiological systems. In Australia, as in the United States, urologists undergo rigorous post graduate surgical training periods of up to six years. At the conclusion of the study period, including various internships required to meet the standard, the urologist has had as much as ten years of intense academic training and hands on experience in this very specific area of medicine.
Some say that a fully trained urologist is essentially a surgical specialist rather than a medical specialist, and it’s here where I think traditional diagnosis has the potential to be confused in regards to Chronic Pelvic Pain Syndrome and Chronic Prostatitis. In general, my feeling is that as doctors become more specialized in an area of the body or in a specific organ, the less they seem to appreciate the human being that is the host to all those things emotional, behavioral and social combined.
Treatment for Chronic Pelvic Pain and Chronic Prostatitis has been traditionally based on our concept of Prostatitis, and therefore centered on infection, inflammation or cancer of the prostate gland, and hence the most common therapies were antibiotics, anti-inflammatories, or surgical intervention. It would seem entirely plausible for an urologist to treat Prostatitis symptoms and pain with drugs including anti-inflammatories, analgesics, antidepressants, alpha-blockers, and for life threatening situations, surgical intervention.
This course of action is consistent with the teachings of the profession and therefore explains quite reasonably the actions and conclusions of the urologist. However, one specific issue remains – why go down the path of prescribing antibiotics when there is no proof that this approach would be clinically effective for patients with a non bacterial diagnosis of Prostatitis?
Could the answer be as simple as the urologist having less understanding in the structure and complexities of the pelvic floor muscles? I wonder whether this question is tempting the ridiculous or asking the obvious? Could it be that these finely and acutely tuned medical surgeons are so skilled in so many other life saving and pain preventing ways that the function of the pelvic floor muscles may have sliped through the cracks of their extensive and intensive nature of study and experience? And is it in the urologists’ professional scope of expertise to know about the functioning and the intricacies of the pelvic floor muscles?
During the course of conducting my research for this book I had the pleasure of meeting professor James Best – Head of the Medical School at Melbourne University. Coincidentally a sufferer of Chronic Pelvic Pain himself, Professor Best indicated to me that in Victoria [my home state in Australia], all students who wish to pursue urology must do so via a stream of medicine that takes them into and ultimately through the College of Surgeons Institute. That admission by Professor Best told me a lot more than I ever knew about the profession of urology, and the high caliber of medical professionals produced by the system of education and training in my home state.
It also made me wonder whether urology as a profession, or the urologist as a consequence, have been unfairly burdened with having the responsibility for providing us with the answers, the diagnosis, the drug therapies, the reassurance, and ultimately the redemption one seeks from a life inflicted with this mysterious and painful condition known as Chronic pelvic Pain, especially given that quite possibly, the urologist may never have studied, nor ever been exposed to, any part of the condition during their academic and/or professional life.
Hence some understandable skepticism exists on the topic of Chronic Pelvic Pain amongst the established medical fraternity and particularly old school urologists who could think – “didn’t study it, can’t see it – mustn’t be there”. In addition, are these finely tuned surgical professionals willing to deal in the maze of issues associated with pain, chronic pain, long term neuropathic pain or central sensitization? As highly skilled surgeons, urologists would be more suited to performing surgery, therein lies their primary ambition, as a surgeon one’s status and reputation is enhanced, as a surgeon self esteem and sense of worth is important business – and besides, people can die from prostate related issues without the right surgery but no one dies from pain alone – do they?
Even so, Professor Best hopes to make some changes to the urological curriculum at his medical school at Melbourne University to incorporate study into Chronic Pelvic Pain – an important step in the process of acknowledging the condition in its own right and educating our future urologist to this very real medical phenomenon.
This story details the life journey of one individual and is not intended to be a substitute for competent medical advice and or professional treatment.
Some of the medical information contained in this story is not the original work of the author. As best as possible, original sources and web sites have been credited and referenced.
Other than the personal account, this story has been adapted from information which is freely available to the general public.