S/P: Urology

Another rotation down.

I spent the last 2 weeks learning about Urology, a field I have professed interest in since day 1 of medical school when I casually announced to my anatomy dissection group on our first meeting that I would love to handle the dissection of our cadaver's nether region. When the day came, I wielded my scalpel with a degree of avidity that no one who was nearby has forgotten (no really, they remind me whenever the topic re-surfaces). I then spent a few mornings of the following summer shadowing a urologist in a community hospital back home. Though I only saw the clinical side of her practice (urology is in fact a surgical field), my interest was still piqued and I sought out the Urology rotation as my Number 1 (and No. 2, actually, to reinforce the seriousness of my choice!) preference for the surgery rotation.

Skip ahead to approximately 2 weeks ago. Reviews from my classmates who had done the Urology rotation prior to me gave mediocre reviews of their experience and I had just come off of a rather excellent month of Surg Onc (though admittedly, my mood had sunk considerably by the end of the month too). Maybe we are all just tired. Let's face it, surgery is pretty physically demanding from the long hours to the standing around an operating table to the not peeing or drinking fluids or eating on a regular schedule (or sometimes at all) to the not exercising...It's easy to see how one's spirits might be crushed by this sort of lifestyle. Anyhow, I found myself less enthusiastic than I anticipated going into the Urology rotation.

At the start of my rotation I quickly learned that I had chosen a bad time to be on urology. Several attendings would be on vacation and the service was slow as molasses. Good for hours. Bad for urologic experience. The majority of my first week was spent in clinic seeing kids with voiding dysfunction (a general condition of irregular bowel and bladder emptying) or vesicoureteral reflux (the back flow of urine from the bladder into the ureters or kidneys, predisposing the kiddos to urinary tract infections) and adults with kidney stones, benign prostatic hypertrophy (BPH) and prostate cancer. Not to complain too much, but I did come here to see surgery! On the bright side, I did get to improve my clinical skills somewhat.

Week 2 had a bit more surgery on the schedule so I spent much less time in clinic. However, the majority of the cases I saw were "under water" (aka cystoscopy, where the surgery is performed through a rigid scope inserted into the urethra) or robotic (where the surgeon operates at a console that controls laparoscopic instruments inside the patient). Not much for a lowly medical student to do but sit in the corner on a stool and watch the monitors. Since I was not standing at the operating table, I was generally forgotten and not much teaching happened during these cases as is typically done during an open surgery. Dare I say, this was a tad boring.

I am hesitant to discount Urology as a potential career, even though I didn't have an ideal experience. The residents and attendings were extremely like-able, the patient population is varied (male/female, young/old), and there is a good balance of clinic and procedures. I guess we'll just have to see how the rest of this year goes!