Detective John McClane

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Hi everyone, I’ll make this short. I’ve had a number experiences in urology, some of which I love, others that I enjoy less. I’m trying to figure out if the things I dislike preclude me from being a urologist.

Things I love: PCNL, NephU tube placement, TURPs, TURBTs, stents, Ureteroscopy

Things I like: The robot, interstim placement, slings and other continence surgeries

No strong feelings: Fertility

Do not enjoy: Partial/full nephrectomies, conduits and neobladders, large scale open cases in general.

I recognize that my experience thus far has been limited and I’m here for advice. Is this list concerning for someone interested in applying for urology?
 

Cyphix

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Sounds like you're very into endoscopic procedures - see Endourology. I'd also give Interventional Radiology a try to see what you think - there's a bit of procedural overlap in a way.
 

Detective John McClane

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Sounds like you're very into endoscopic procedures - see Endourology. I'd also give Interventional Radiology a try to see what you think - there's a bit of procedural overlap in a way.

I actually took a look into IR and if Urology doesn't work out, it's what I'll go for. I'm mainly trying to figure out what residency is going to look like for me. If I spend 90% of my time doing stuff in the "no strong feelings" to "stuff I love category" I think I'll be happy. I would even say a circ was borderline enjoyable for me. The issue is, if I spend 50% of my life as a resident doing things like open partials, neobladders and conduits to name a few, I don't know if I'll survive. Let me know if you have any insight into this.
 
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DoctwoB

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I actually took a look into IR and if Urology doesn't work out, it's what I'll go for. I'm mainly trying to figure out what residency is going to look like for me. If I spend 90% of my time doing stuff in the "no strong feelings" to "stuff I love category" I think I'll be happy. I would even say a circ was borderline enjoyable for me. The issue is, if I spend 50% of my life as a resident doing things like open partials, neobladders and conduits to name a few, I don't know if I'll survive. Let me know if you have any insight into this.

Just out of curiosity, what don’t you like about open cases? Many med students hate long open cases because standing around and cutting the occasional suture while barely understanding what you’re seeing (or not seeing because only 2 people can see into the pelvis) isn’t that exhilarating. The better question then if you enjoy it is whether you would see yourself enjoying it if you were the attending or resident.

There are many urology programs that are so heavy on robotics their open case volume is pretty low, but I’d argue that’s a weakness not a strength. You’re training to be a surgeon, not a technician, and that means being able to use the best tool for the job. Many times in urology that is endoscopic or robotic, but often it isn’t. Once done with residency you can tailor your practice as you like or do a endourology fellowship and specialize in that direction and never to an open cystectomy or partial again. But when you disrupt a upj endoscopically or get into bleeding you can’t control lap or robotically or get called intraop to assess a ureteral injury you’ll be glad you had well rounded training.
 

cpants

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Agree with above. After residency, you will certainly be able to limit your practice to the procedures you like.
 

startswithb

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I also encourage medical students to consider their clinic experiences in surgical subspecialties as many urologists spend only 1.5-2 days a week in the OR. Surgical clinic days can be long. What type of patients do you want to take care of? Do any disease processes interest or not interest you? Also, think of the worst aspect of all specialties and find the lesser evil. This really helped me decide between a few specialties and I have no regrets.
 

Detective John McClane

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Which the big open cases I definitely feel less drive to be the one who’s actually operating, although boredom sometimes may play into it. I just seem to want to be the one actually doing the procedure when it’s endo type stuff.

It’s hard to tell if I’d be absolutely miserable doing open cases, but I probably wouldn’t enjoy it if >50% of the stuff I do was open.
 

Detective John McClane

Yippee-ki-yay
5+ Year Member
Aug 17, 2014
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Nakatomi Plaza
I also encourage medical students to consider their clinic experiences in surgical subspecialties as many urologists spend only 1.5-2 days a week in the OR. Surgical clinic days can be long. What type of patients do you want to take care of? Do any disease processes interest or not interest you? Also, think of the worst aspect of all specialties and find the lesser evil. This really helped me decide between a few specialties and I have no regrets.

I actually enjoy Uro clinic quite a bit. The disease processes interest me and I love how many options each issue has for treatment, both medical and surgical, and that the urologist manages both routes. Marathon clinic with35+ patients can be brutal though.
 

Seph

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I'm in the opposite situation, I love open and lap cases, hate endoscopy ... since most of urology today is endoscope based, I'm actually thinking of leaving residency altogether because of it.
 

DoctwoB

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I'm in the opposite situation, I love open and lap cases, hate endoscopy ... since most of urology today is endoscope based, I'm actually thinking of leaving residency altogether because of it.

If you really hate cysto you can tailor your career to avoid it, though it’s not easy. Do an onc or robotics fellowship and focus on kidney or prostate. Do peds, which has relatively fewer (but more painful) cysto fares. You probably can’t escape it all together, but it could be minimized.
 
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Seph

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If you really hate cysto you can tailor your career to avoid it, though it’s not easy. Do an onc or robotics fellowship and focus on kidney or prostate. Do peds, which has relatively fewer (but more painful) cysto fares. You probably can’t escape it all together, but it could be minimized.

Thanks for the suggestion but I'm not based in the US. Socialized health care is arguable unforgiving on personal aspirations. I’m afraid a tailored practice is almost impossible to achieve. I’ll have to do what needs be done, which entails a lot of pipe and scope work with a couple of open/lap cases in between. Urology is quite competitive and I feel I might have shot myself in the foot choosing it over other surgical subs with more "classical" approaches to pathology. It has been a tough couple of months... Sorry for the vent.

To the OP, if you love endo work, there is no field like urology!
 
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