Page 31 - NEWSLETTER_27

ΣΥΝΈΝΤΈΥΞΗ
Tεύχος 27 | Iανουάριος - Φεβρουάριος 2024
Η ακόλουθη συνέντευξη πραγματοποιήθηκε μέσω Zoom. Απομαγνητοφώνηση & επιμέλεια κειμένου: Θεόδωρος Σπίνος, ειδικευόμενος Ουρολόγος & Φίλιππος Νικητάκης, μέλος συντακτικής ομάδας του Newsletter.
F.N.: Why did you decide to become a urologist?
P.W.: Before choosing Urology, I thought I was going to be a neurosurgeon. In those days, you did not make the decision until later in your training. As a surgical intern at the Peter Bent Brigham Hospital in Boston, I spent eight weeks on neurosurgery. During this period, I learned two things that I didn’t know. First, you were rarely involved in making the diagnosis and second, the outcomes from surgery, even in the hands of brilliant surgeons, were very disappointing. My next rotation was urology and this was much different. I learned that Urologists are the primary care physicians of the urinary tract. They take the history, perform the physical examination, order the labs, interpretate the imaging and if necessary, do endoscopy. Moreover, the outcome from surgery is much different! Patients who are symptomatic are relieved of their symptoms, making them happy. Also, I could see that this was a great field for research. So, I immediately embraced it.
F.N.: In your opinion, which are the character traits of a good surgeon?
P.W.: The essential element is someone who loves fixing things. I see many medical students who say: “I like to use my hands” and so they look at surgery as an “a, b, c” approach to things. However, anyone who has done surgery knows that oftentimes you begin with “x, y, z” before you get to “a, b, c”. Therefore, you must be interested in taking something apart and putting it back together again. And there is one other essential quality. You have to be a person who is not easily frightened. You have to be almost fearless! Because during an operation, you may think that it is going to be very simple, nevertheless, you can encounter terrible complications. You have to be the kind of person who at that time becomes very calm.
T.S.: We are sure that you are tired of being asked this question. Could you please briefly tell us the story behind the discovery of the neurovascular bundles?
P.W.: Thank you! I enjoy telling this story. The first radical prostatectomy for the cure of prostate cancer
was performed at the Johns Hopkins Hospital in 1904 by Hugh Hampton Young. However, by the time I got to Hopkins, as the Chairman in 1974, 70 years later, the operation was rarely performed anywhere, even at Johns Hopkins, because patients considered the outcomes worse than the disease. Every man became impotent and 25% of the men had no urinary control. Also, urologists did not want to do the operation because of the frightening blood loss.
I had spent the prior ten years training at excellent centers on the East and West Coast, and I had never heard anyone ever mentioning that these side effects could be avoided. It was like the price a patient had to pay for a chance to be cured. So, as one of Hugh Young’s successors (Dr. Young was Chair until 1942, Dr. Scott was Chair until 1974, and I was the third Chair of the Brady Urological Institute) I felt it was my responsibility to solve this problem. I had to figure it out. The first thing I did was review the anatomy.
It soon became very clear that these side effects occurred because we did not understand the anatomy around the prostate. There was bleeding, because the anatomy of the dorsal vein had never been charted. Impotence? No one knew exactly where the nerves were. But because every patient was impotent, everyone believed that the nerves must run through the prostate and thus the preservation of potency would be impossible. Finally, the location of the sphincter responsible for passive urinary control was not known. Why were we so ignorant? Because of the use of the adult cadaver. After death the abdominal contents compress the bladder and the prostate into a thick “pancake of tissue”. And formalin dissolves the fatty tissue planes making anatomical
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