November 13, 2024 • 17 mins
What do cliff diving, The Cure, and a career in urology have in common? Join us as Dr. Randall Dooley shares how his unexpected journey into urology became a life-changing experience, all thanks to a canceled plastics rotation. This episode offers a captivating glimpse into the mind of a urologist who has mastered the art of balancing a demanding medical career with an array of exhilarating hobbies. Dr. Dooley discusses how his passion for continuous learning and the discipline required for both surgery and hobbies like playing guitar, Krav Maga, and chess fuel his daily life. Listen as he recounts the joy of teaching his young son chess, fostering a love for the game and the rapid development of a child's mind.
Moreover, Dr. Dooley sheds light on the unique camaraderie and humor that define the world of urology, sharing stories from his practice at St. Luke's Hospital. He speaks candidly about urologists' diverse roles and the importance of teamwork in handling complex cases. With gratitude, he emphasizes the ongoing growth of his practice and the comprehensive care offered to patients. So whether you're a medical enthusiast or simply curious about the passions that drive professionals beyond their careers, Dr. Dooley's multifaceted journey will inspire and entertain, proving that life's unexpected paths often lead to the most rewarding destinations.
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Transcript
Episode Transcript
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Speaker 1 (00:00):
Welcome to Doc Discussions.
I'm Jason Edwards and this isthe world's best medical podcast
where we have discussions withphysicians to discover who they
are and what they do.
I am honored today to be joinedby Dr Randall Dooley.
Dr Dooley is a urologist hereat St Luke's Hospital.
Randall, welcome, Glad to behere.
Thanks for having me.
(00:20):
You bet, and so you know I wantto come right out of the gate.
You're an interesting guy, youplay guitar, you practice Krav
Maga and you are a urologist Isthere a common theme between
(00:42):
these three disciplines?
Speaker 2 (00:46):
Well, are the sensors available?
I mean, I think that if you gointo any sort of surgical
specialty, there's a little bitof it takes a little bit of
cojones if you will, and soyou're often a more baseline.
Have a higher threshold ofexcitation, okay, often a more
baseline, have a higherthreshold of excitation, okay.
(01:06):
So the combat sports jumpingoff cliffs in the ocean, riding
motorcycles, doing all thesesorts of things yeah.
Speaker 1 (01:13):
Playing a band yeah, we're always looking for a
thrill right the thrill yeah, goaround once yeah, you know, I
mean when I you know, being aurologist is a it.
It's a difficult specialty toget into and the surgical
specialties and many otherspecialties are kind of a
difficult go.
As far as the things you haveto do on a day-to-day basis
(01:39):
Playing the guitar, practicingmartial arts, being a physician,
all of these things are, it's acertainly delayed gratification
.
I mean the first day on theguitar, you're not great.
Speaker 2 (01:48):
The first day at golf practice.
Speaker 1 (01:50):
It's not, you know, you get beat up, but they all
kind of take this long-termdiscipline too Sure.
And do you enjoy that?
Do you enjoy that process?
Speaker 2 (02:03):
Well, it drives my wife a little nuts because I get
obsessive about things that Iget interested in.
So I recently decided to teachmyself to play chess.
Okay, and so I play chess.
Like I have 15 games going onsimultaneously on my phone at
any given time and I'm in theseinternational tournaments.
I started in November or so of2023 teaching myself to play
(02:24):
chess.
So I will get involved insomething and I will put a whole
so of 2023 teaching myself toplay chess.
So I will get involved insomething and I will put a whole
bunch of time into it, to apoint that other people might
find a little obsessive, butI've always enjoyed.
I'm fluent in Spanish.
I've been teaching myself alittle German.
I like to do things to expandthe mind and to put challenges
(02:44):
in front of myself to that aredifficult, just to see if I can
do it, sort of thing.
Speaker 1 (02:48):
So I've I've been down the chest pathway before
and um and it you know, um, Ithink it's good for the mind, Um
, and it's also like it's alsonot scrolling on social media,
it's also not, you know, smokingcigarettes or drinking at the
bar.
It's, it's, it's a um, and it'salso not, you know, smoking
cigarettes or drinking at thebar.
(03:08):
It's, it's, it, it's a uh andit's a, and it's a social thing
too, or it can be.
You know, obviously we have thenational, or the uh was the
world chess museum.
Here we have something,something here.
Speaker 2 (03:14):
That's a big deal central west end.
Speaker 1 (03:16):
Yeah, um and so the chess club, um and so um, and
boy you can get.
I use chesscom, which is howyou use.
Speaker 2 (03:26):
I use chesscom and there's another one called chess
Royale that I use.
Yeah, and I play on a board too.
So I do that too.
Yeah, and I play against bots,I play against friends, I play
against my family.
Yeah, and I'm teaching mylittle guy, who's almost eight
Awesome, and he's becoming alittle obsessive.
Speaker 1 (03:45):
Well, I'm teaching my little guy who's almost eight,
awesome, and he's becoming alittle obsessive.
Kids can be really good.
I mean I've played some youngchildren Like I.
Actually, two or three weeksago I played one of our friends.
They had an eight-year-oldchild and I mean I could beat
him but you had to pay attentionto what you're doing, and so I
think the child's mind canreally develop that a lot faster
(04:07):
than you know me and you areprobably a little past our prime
as far as that kind of thinking.
Speaker 2 (04:13):
It's interesting because I read a quote from a
chess master a grandmaster andhe said that being able to play
chess well is the mark of agentleman.
Being a grandmaster in thechess is the mark of having
wasted one's life.
Yeah, there is a sweet spothere, there definitely is.
Speaker 1 (04:32):
Yeah, I think you know doing things like this too.
There's the element of mastery.
You can get into a flow statewith music, sports, certainly
chess, where it's just kind of anice place to be.
You know, mentally Um and andand I, I I would assume that you
(04:53):
know surgeries, you know thatyou've done many times and
you're proficient at.
You can kind of reach a flowstate too.
Do you ever feel any of that?
Speaker 2 (05:00):
Oh, absolutely.
My favorite time doing my jobis when I'm in the operating
room and I'm just in my zone.
Yeah, plus, you get to pick themusic.
That's part of the reason I goto surgery you get to choose the
music, which has always been.
I'm a little bit dictatorialabout no, no, no, we're not
listening.
This is why I'm in the surgery.
Speaker 1 (05:15):
Well, the surgeon is the captain of the ship.
Yeah, and then you have afavorite band.
Speaker 2 (05:28):
Who's your favorite band?
My favorite band of all time isthe Cure, and I've seen them.
I've traveled all over theworld to see them play.
I saw them play in a medievalfortress on an island on the
Danny River.
I've seen them play in Pragueand Budapest and I saw them play
outside Copenhagen in the Irishcountryside.
So lots of really interestingvenues, yeah, and it leads to
(05:50):
meeting people that are localand then that leads to different
experiences than an averagetraveler gets, yeah.
So, yeah, I've been a big worldtraveler seeking out the, and
it all happened just on a justkind of a crazy whim of a buddy
of mine who was awake at 2o'clock in the morning, couldn't
sleep, was scrolling theInternet and he found this
(06:10):
festival in the Irishcountryside and the Cure was
headlining it.
That's awesome.
And he bought tickets on a whimand he called me up and said,
hey, we have to go to this.
Speaker 1 (06:17):
So now— I agree with you.
We have to go the OR nurses geta healthy dose of the Cure.
That's right.
Speaker 2 (06:24):
Well, you know, it's another form of benefiting their
expanding brains.
Speaker 1 (06:29):
It's helping them, and so what are some of the
common surgeries that you do inyour practice?
Speaker 2 (06:37):
So I would say that the most common procedures that
I do are related to stonedisease or BPH.
Okay, and then there's a fairbit of cancer surgery as well
and that sort of thing, and BPHis benign prostatic hyperplasia
right, so I do a ton of BPHrelated surgery.
Speaker 1 (06:58):
And can you explain, like, how, what's like the one
minute explanation of how thatsurgery takes place?
Speaker 2 (07:04):
Well, so there are actually several different
procedures, and the selection ofwhich depends on what the end
goal is and also what thepatient's tolerance for
different side effects oftreatment are, because the
procedures that have the bestoutcomes, the most durable
outcomes as far as improvingvoiding symptoms, also come with
some risk of potential sexualside effects and that sort of
(07:26):
thing, whereas if your real bigpriority is preservation of
sexual function, then that maylead down a different.
Got you Different?
Because some are ablative oractually removing tissue, some
are more manipulating tissue outof the way, or there's a
procedure I do where I injectsteam into the tissue that
causes a delayed breakdown andreabsorption of tissue.
So there's everything from theold school TURP that's been
(07:50):
around for 100 years to lasersand steam and implants.
Yeah, sometimes the old schoolstuff still works.
Speaker 1 (07:57):
Yeah, and just for kind of a backup just a bit.
Of course you know this, butthe urethra is a tube that comes
from the bladder and then, youknow, for the man out through
the penis but it goes throughthe prostate and if the
prostate's larger it can kind ofcrimp the urethra a little bit
(08:17):
and make it difficult to urinate.
Speaker 2 (08:19):
So there's a static component and there's a dynamic
component.
So the static component isbasically characterized by the
fact that there's just tissuethere that's just obstructive,
so it's just mechanicallycausing obstruction, and the
other component is the fact thatthe tissue is densely enriched
with smooth muscle thatmaintains a tone.
Got you and that and that'sinvoluntary.
(08:39):
So, additionally, it's supposedto be part of your continence
mechanism and your ejaculatorymechanism.
But what happens when itovergrows is you become sort of
hyper-con and obstructed.
Yeah, and so you know, we havemeds to treat the dynamic
component, we have meds to treatthe static component, got you.
So the procedures?
I mean, you're sort of, ifyou're removing tissue, you're
sort of eliminating both.
(09:02):
One of the things that's beenunfortunate with the advent of
some of the medications is that,well, there have come to light
some fairly serious long-termconsequences, side effects of
the medications.
We have discovered a linkbetween Tamsulosin or Flomax,
(09:25):
which is commonly used to treatthe dynamic components of alpha
blocker, with increased risk ofdementia.
There seems to be a link.
And then with finasteride,there seems to be an increased
risk of depression in theelderly.
Okay, so in addition, there's alitany of other potential side
effects, but they also don'treally prevent deterioration of
(09:47):
bladder function over time, andwhat really does do that is
procedures, and so the pendulumis swung a little bit towards
earlier intervention versuswaiting until they fail, medical
therapy and this sort of thingwhich has been yeah.
Speaker 1 (10:02):
And then you have organ dysfunction Right yeah,
how about that?
And so you know what other?
And then you do prostatectomies, where you remove prostates in
patients who have prostatecancer.
Speaker 2 (10:16):
Well, I don't personally do that much anymore
because I've done hundreds ofprostatectomies, but they're all
open Okay.
But actually I've been able tosuccessfully recruit a partner
and we're hoping to get anotherone as well.
And the partner that I haverecruited, who's going to be
starting first week of September, he's robotically trained, so
(10:36):
he'll do robotic.
Speaker 1 (10:37):
Okay, yes, and I've met this physician and he seems
like a great guy, yeah, comingstraight out of Wash U.
Yeah, and he's Venezuelan.
I believe he is.
Speaker 2 (10:48):
He's Venezuelan, yeah , so it's interesting because I
speak Spanish fluently and he'sfrom Venezuela, I train at Grav
Maga and he's Israeli Hisparents live in Israel, so we
sort of have these weirdcommonalities.
Speaker 1 (11:04):
So this is a weird thing.
So he was telling me that hewas Israeli, from Venezuela.
Yes, and I know one personexactly who's Jewish and from
Venezuela.
I don't know her personally,but her name is Steffi Cohen and
she's a world champion powerlifter.
And so I just said, hey, do youknow Steffi Cohen?
(11:26):
Yeah, I know her.
He said she was at my weddingand so I thought how crazy is
that?
But he seems like a great guyand I also have another mutual
friend with him, um, who'surologist?
But I've only heard good things, and so I think he was.
Speaker 2 (11:39):
he was on the um Venezuelan national water polo
team, really so he traveledaround the world competing.
How about?
Speaker 1 (11:45):
that Crazy, I think.
The urology department's in therunning for the most
interesting department I try tobe and then you have Dr Naughton
and Dr Scully as partners aswell.
Yes, correct, yeah.
Was there anything thatinspired you initially to go
into urology?
Speaker 2 (12:03):
Actually, when I was in college I had a good buddy
and we're still close friendsand his uncle is a now retired
urologist, okay, and we used togo to his house because he had
this sweet pad in san diego,where I'm from, and he always
had this really great musiccollection and he always had top
shelf liquor that he wouldserve us and he was growing up
(12:24):
steaks and everything and um, hewould hang out with us and
listen to music and everythingand he's this really interesting
, great guy.
But I but I always was askingmy buddy like what's wrong?
Why did he go into urology?
Like what's wrong with him?
And he anyway, but I alwaysreally liked the guy.
But when I went to med school Isaid the last thing I would ever
(12:44):
do is urology.
Okay, but I was on generalsurgery as a third-year med
student and we had a mandatoryspecialty rotation and I was
scheduled to do plastics, whichappealed to me because of the
artistic sort of aspect, and soI was scheduled to do plastics
and the week before thescheduled rotation I got a page
(13:07):
because we had pagers back thenfrom the secretary of the
department who told me that theprofessor who was going to be
overseeing.
My rotation was actually goingto be on vocation for two of the
four weeks so they had tocancel the rotation.
So I was scrambling for aspecialty.
So I talked to the chiefresident I was on trauma surgery
at the time and he said youshould do urology.
(13:28):
I said urology, why would Iwant to do that?
He said, first of all, you needa rotation and they'll take you
.
Second of all, coming off ofgeneral surgery and rotating on
urology, you will find it's likenight and day.
Those guys are so much happier,they enjoy their job so much
more.
They do these big cancer casesand then they do all these
minimally invasive cases andthey can tailor the practice to
(13:50):
however they want to practice.
They just don't seem to be allcases and they can tailor the
practice to however they want topractice.
They, um, they just they don'tseem to be all stressed out all
the time.
They have very busy daytimeschedule.
In the evenings they don't goin as much as a general
surgeon's orthopods or othersurgeons do.
So it's a really great work,work, life balance.
And so, worst case scenario,you learn about an organ system
(14:11):
that most other physicians don'tknow much about.
Speaker 1 (14:13):
Yeah.
And so I rotated on it, therest is history right, that's
where it came from.
Speaker 2 (14:18):
It really was night and day.
I mean, you went in there andyou're joking around and telling
dirty jokes.
Speaker 1 (14:22):
Yeah, I actually had to do a year of general surgery
and I did a month of urology andI actually found it enjoyable.
I mean it's a nice niche wherethere's not a lot.
Speaker 2 (14:33):
I mean, I'm sure in some areas people are
encroaching on it, but it waslike you know, like we got
called from the Gynocs and theywould have us, you know put in
(14:56):
urethral stents and things likethat, because you have a
cervical cancer, that's, youknow, pinching off the kidneys,
and it's kind of surprising kindof how many areas of the
hospital that the urologistswere involved with.
Oh right, we're always gettingcalled in by other surgeons to
help them, help them all.
Speaker 1 (15:02):
Yeah, yes, yeah yeah.
Somebody accidentally nicks theureter and then, all of a
sudden, you're involved.
Speaker 2 (15:09):
Or sometimes they just have a patient on the table
.
They can't get a catheter in.
Yeah, I mean, or it's involved.
Or sometimes they just have apatient on the table.
They can't get a Catherine.
Yeah, I mean, or it's right orthe inadvertent bladder injuries
, the funny thing.
Speaker 1 (15:18):
So that was like my job when I was like the, the
radonc intern who was doing amonth in urology, and they would
be like we can't get aCatherine, and you know, buck,
who was my chief, would say,jason, get a Kude and put some
gel down there and just shove itin.
And I was like I'm going to theICU and there's like this is
(15:40):
not at this hospital, but Iwould go to the ICU.
There's like a nurse who's putin like 1,000 catheters and I've
put in three and I'm taskedwith getting the job done.
But in surgery you do have thiskind of gung ho mindset of like
you know, come hell or highwater, I'm going to get the job
done.
And so I think I got them allin, but um, but it.
But it was an enjoyable monthand you know they were all
(16:02):
really funny guys and I I don'tknow what it is, but most
urologists are are fun guys totalk to and they have a good
sense of humor and there's kindof a good atmosphere there.
Speaker 2 (16:12):
You sort of have to do the job.
It's a requirement.
It comes with the territory,but it's funny.
What they say about surgeons isthat they're usually right but
never in doubt.
That's how you have to be,randall.
No one wants a wishy-washysurgeon, right?
Speaker 1 (16:28):
Yeah, that's right.
That's right.
Yeah, you need to be decisiveright in the operating room.
There's not much room for kindof futzing around.
Yeah Well, randall, Iappreciate you joining us here
on the podcast.
I'm glad to work with you hereand I'm happy that you and your
team are here at St Luke'staking care of our mutual
(16:50):
patients.
Speaker 2 (16:53):
We're glad to be here and we just keep expanding, so
can they get a full complementof us?
Yeah, very good, Because Tomwill retire one of these days
and we need to keep it going.
Speaker 1 (17:02):
Yeah, all right.
Well, thanks so much.
Speaker 2 (17:05):
Well, thanks for having me.
Welcome to Doc Discussions.
I'm Jason Edwards and this isthe world's best medical podcast
where we have discussions withphysicians to discover who they
are and what they do.
I am honored today to be joinedby Dr Randall Dooley.
Dr Dooley is a urologist hereat St Luke's Hospital.
Randall, welcome, Glad to behere.
Thanks for having me.
(00:20):
You bet, and so you know I wantto come right out of the gate.
You're an interesting guy, youplay guitar, you practice Krav
Maga and you are a urologist Isthere a common theme between
(00:42):
these three disciplines?
Speaker 2 (00:46):
Well, are the sensors available?
I mean, I think that if you gointo any sort of surgical
specialty, there's a little bitof it takes a little bit of
cojones if you will, and soyou're often a more baseline.
Have a higher threshold ofexcitation, okay, often a more
baseline, have a higherthreshold of excitation, okay.
(01:06):
So the combat sports jumpingoff cliffs in the ocean, riding
motorcycles, doing all thesesorts of things yeah.
Speaker 1 (01:13):
Playing a band yeah, we're always looking for a
thrill right the thrill yeah, goaround once yeah, you know, I
mean when I you know, being aurologist is a it.
It's a difficult specialty toget into and the surgical
specialties and many otherspecialties are kind of a
difficult go.
As far as the things you haveto do on a day-to-day basis
(01:39):
Playing the guitar, practicingmartial arts, being a physician,
all of these things are, it's acertainly delayed gratification
.
I mean the first day on theguitar, you're not great.
Speaker 2 (01:48):
The first day at golf practice.
Speaker 1 (01:50):
It's not, you know, you get beat up, but they all
kind of take this long-termdiscipline too Sure.
And do you enjoy that?
Do you enjoy that process?
Speaker 2 (02:03):
Well, it drives my wife a little nuts because I get
obsessive about things that Iget interested in.
So I recently decided to teachmyself to play chess.
Okay, and so I play chess.
Like I have 15 games going onsimultaneously on my phone at
any given time and I'm in theseinternational tournaments.
I started in November or so of2023 teaching myself to play
(02:24):
chess.
So I will get involved insomething and I will put a whole
so of 2023 teaching myself toplay chess.
So I will get involved insomething and I will put a whole
bunch of time into it, to apoint that other people might
find a little obsessive, butI've always enjoyed.
I'm fluent in Spanish.
I've been teaching myself alittle German.
I like to do things to expandthe mind and to put challenges
(02:44):
in front of myself to that aredifficult, just to see if I can
do it, sort of thing.
Speaker 1 (02:48):
So I've I've been down the chest pathway before
and um and it you know, um, Ithink it's good for the mind, Um
, and it's also like it's alsonot scrolling on social media,
it's also not, you know, smokingcigarettes or drinking at the
bar.
It's, it's, it's a um, and it'salso not, you know, smoking
cigarettes or drinking at thebar.
(03:08):
It's, it's, it, it's a uh andit's a, and it's a social thing
too, or it can be.
You know, obviously we have thenational, or the uh was the
world chess museum.
Here we have something,something here.
Speaker 2 (03:14):
That's a big deal central west end.
Speaker 1 (03:16):
Yeah, um and so the chess club, um and so um, and
boy you can get.
I use chesscom, which is howyou use.
Speaker 2 (03:26):
I use chesscom and there's another one called chess
Royale that I use.
Yeah, and I play on a board too.
So I do that too.
Yeah, and I play against bots,I play against friends, I play
against my family.
Yeah, and I'm teaching mylittle guy, who's almost eight
Awesome, and he's becoming alittle obsessive.
Speaker 1 (03:45):
Well, I'm teaching my little guy who's almost eight,
awesome, and he's becoming alittle obsessive.
Kids can be really good.
I mean I've played some youngchildren Like I.
Actually, two or three weeksago I played one of our friends.
They had an eight-year-oldchild and I mean I could beat
him but you had to pay attentionto what you're doing, and so I
think the child's mind canreally develop that a lot faster
(04:07):
than you know me and you areprobably a little past our prime
as far as that kind of thinking.
Speaker 2 (04:13):
It's interesting because I read a quote from a
chess master a grandmaster andhe said that being able to play
chess well is the mark of agentleman.
Being a grandmaster in thechess is the mark of having
wasted one's life.
Yeah, there is a sweet spothere, there definitely is.
Speaker 1 (04:32):
Yeah, I think you know doing things like this too.
There's the element of mastery.
You can get into a flow statewith music, sports, certainly
chess, where it's just kind of anice place to be.
You know, mentally Um and andand I, I I would assume that you
(04:53):
know surgeries, you know thatyou've done many times and
you're proficient at.
You can kind of reach a flowstate too.
Do you ever feel any of that?
Speaker 2 (05:00):
Oh, absolutely.
My favorite time doing my jobis when I'm in the operating
room and I'm just in my zone.
Yeah, plus, you get to pick themusic.
That's part of the reason I goto surgery you get to choose the
music, which has always been.
I'm a little bit dictatorialabout no, no, no, we're not
listening.
This is why I'm in the surgery.
Speaker 1 (05:15):
Well, the surgeon is the captain of the ship.
Yeah, and then you have afavorite band.
Speaker 2 (05:28):
Who's your favorite band?
My favorite band of all time isthe Cure, and I've seen them.
I've traveled all over theworld to see them play.
I saw them play in a medievalfortress on an island on the
Danny River.
I've seen them play in Pragueand Budapest and I saw them play
outside Copenhagen in the Irishcountryside.
So lots of really interestingvenues, yeah, and it leads to
(05:50):
meeting people that are localand then that leads to different
experiences than an averagetraveler gets, yeah.
So, yeah, I've been a big worldtraveler seeking out the, and
it all happened just on a justkind of a crazy whim of a buddy
of mine who was awake at 2o'clock in the morning, couldn't
sleep, was scrolling theInternet and he found this
(06:10):
festival in the Irishcountryside and the Cure was
headlining it.
That's awesome.
And he bought tickets on a whimand he called me up and said,
hey, we have to go to this.
Speaker 1 (06:17):
So now— I agree with you.
We have to go the OR nurses geta healthy dose of the Cure.
That's right.
Speaker 2 (06:24):
Well, you know, it's another form of benefiting their
expanding brains.
Speaker 1 (06:29):
It's helping them, and so what are some of the
common surgeries that you do inyour practice?
Speaker 2 (06:37):
So I would say that the most common procedures that
I do are related to stonedisease or BPH.
Okay, and then there's a fairbit of cancer surgery as well
and that sort of thing, and BPHis benign prostatic hyperplasia
right, so I do a ton of BPHrelated surgery.
Speaker 1 (06:58):
And can you explain, like, how, what's like the one
minute explanation of how thatsurgery takes place?
Speaker 2 (07:04):
Well, so there are actually several different
procedures, and the selection ofwhich depends on what the end
goal is and also what thepatient's tolerance for
different side effects oftreatment are, because the
procedures that have the bestoutcomes, the most durable
outcomes as far as improvingvoiding symptoms, also come with
some risk of potential sexualside effects and that sort of
(07:26):
thing, whereas if your real bigpriority is preservation of
sexual function, then that maylead down a different.
Got you Different?
Because some are ablative oractually removing tissue, some
are more manipulating tissue outof the way, or there's a
procedure I do where I injectsteam into the tissue that
causes a delayed breakdown andreabsorption of tissue.
So there's everything from theold school TURP that's been
(07:50):
around for 100 years to lasersand steam and implants.
Yeah, sometimes the old schoolstuff still works.
Speaker 1 (07:57):
Yeah, and just for kind of a backup just a bit.
Of course you know this, butthe urethra is a tube that comes
from the bladder and then, youknow, for the man out through
the penis but it goes throughthe prostate and if the
prostate's larger it can kind ofcrimp the urethra a little bit
(08:17):
and make it difficult to urinate.
Speaker 2 (08:19):
So there's a static component and there's a dynamic
component.
So the static component isbasically characterized by the
fact that there's just tissuethere that's just obstructive,
so it's just mechanicallycausing obstruction, and the
other component is the fact thatthe tissue is densely enriched
with smooth muscle thatmaintains a tone.
Got you and that and that'sinvoluntary.
(08:39):
So, additionally, it's supposedto be part of your continence
mechanism and your ejaculatorymechanism.
But what happens when itovergrows is you become sort of
hyper-con and obstructed.
Yeah, and so you know, we havemeds to treat the dynamic
component, we have meds to treatthe static component, got you.
So the procedures?
I mean, you're sort of, ifyou're removing tissue, you're
sort of eliminating both.
(09:02):
One of the things that's beenunfortunate with the advent of
some of the medications is that,well, there have come to light
some fairly serious long-termconsequences, side effects of
the medications.
We have discovered a linkbetween Tamsulosin or Flomax,
(09:25):
which is commonly used to treatthe dynamic components of alpha
blocker, with increased risk ofdementia.
There seems to be a link.
And then with finasteride,there seems to be an increased
risk of depression in theelderly.
Okay, so in addition, there's alitany of other potential side
effects, but they also don'treally prevent deterioration of
(09:47):
bladder function over time, andwhat really does do that is
procedures, and so the pendulumis swung a little bit towards
earlier intervention versuswaiting until they fail, medical
therapy and this sort of thingwhich has been yeah.
Speaker 1 (10:02):
And then you have organ dysfunction Right yeah,
how about that?
And so you know what other?
And then you do prostatectomies, where you remove prostates in
patients who have prostatecancer.
Speaker 2 (10:16):
Well, I don't personally do that much anymore
because I've done hundreds ofprostatectomies, but they're all
open Okay.
But actually I've been able tosuccessfully recruit a partner
and we're hoping to get anotherone as well.
And the partner that I haverecruited, who's going to be
starting first week of September, he's robotically trained, so
(10:36):
he'll do robotic.
Speaker 1 (10:37):
Okay, yes, and I've met this physician and he seems
like a great guy, yeah, comingstraight out of Wash U.
Yeah, and he's Venezuelan.
I believe he is.
Speaker 2 (10:48):
He's Venezuelan, yeah , so it's interesting because I
speak Spanish fluently and he'sfrom Venezuela, I train at Grav
Maga and he's Israeli Hisparents live in Israel, so we
sort of have these weirdcommonalities.
Speaker 1 (11:04):
So this is a weird thing.
So he was telling me that hewas Israeli, from Venezuela.
Yes, and I know one personexactly who's Jewish and from
Venezuela.
I don't know her personally,but her name is Steffi Cohen and
she's a world champion powerlifter.
And so I just said, hey, do youknow Steffi Cohen?
(11:26):
Yeah, I know her.
He said she was at my weddingand so I thought how crazy is
that?
But he seems like a great guyand I also have another mutual
friend with him, um, who'surologist?
But I've only heard good things, and so I think he was.
Speaker 2 (11:39):
he was on the um Venezuelan national water polo
team, really so he traveledaround the world competing.
How about?
Speaker 1 (11:45):
that Crazy, I think.
The urology department's in therunning for the most
interesting department I try tobe and then you have Dr Naughton
and Dr Scully as partners aswell.
Yes, correct, yeah.
Was there anything thatinspired you initially to go
into urology?
Speaker 2 (12:03):
Actually, when I was in college I had a good buddy
and we're still close friendsand his uncle is a now retired
urologist, okay, and we used togo to his house because he had
this sweet pad in san diego,where I'm from, and he always
had this really great musiccollection and he always had top
shelf liquor that he wouldserve us and he was growing up
(12:24):
steaks and everything and um, hewould hang out with us and
listen to music and everythingand he's this really interesting
, great guy.
But I but I always was askingmy buddy like what's wrong?
Why did he go into urology?
Like what's wrong with him?
And he anyway, but I alwaysreally liked the guy.
But when I went to med school Isaid the last thing I would ever
(12:44):
do is urology.
Okay, but I was on generalsurgery as a third-year med
student and we had a mandatoryspecialty rotation and I was
scheduled to do plastics, whichappealed to me because of the
artistic sort of aspect, and soI was scheduled to do plastics
and the week before thescheduled rotation I got a page
(13:07):
because we had pagers back thenfrom the secretary of the
department who told me that theprofessor who was going to be
overseeing.
My rotation was actually goingto be on vocation for two of the
four weeks so they had tocancel the rotation.
So I was scrambling for aspecialty.
So I talked to the chiefresident I was on trauma surgery
at the time and he said youshould do urology.
(13:28):
I said urology, why would Iwant to do that?
He said, first of all, you needa rotation and they'll take you
.
Second of all, coming off ofgeneral surgery and rotating on
urology, you will find it's likenight and day.
Those guys are so much happier,they enjoy their job so much
more.
They do these big cancer casesand then they do all these
minimally invasive cases andthey can tailor the practice to
(13:50):
however they want to practice.
They just don't seem to be allcases and they can tailor the
practice to however they want topractice.
They, um, they just they don'tseem to be all stressed out all
the time.
They have very busy daytimeschedule.
In the evenings they don't goin as much as a general
surgeon's orthopods or othersurgeons do.
So it's a really great work,work, life balance.
And so, worst case scenario,you learn about an organ system
(14:11):
that most other physicians don'tknow much about.
Speaker 1 (14:13):
Yeah.
And so I rotated on it, therest is history right, that's
where it came from.
Speaker 2 (14:18):
It really was night and day.
I mean, you went in there andyou're joking around and telling
dirty jokes.
Speaker 1 (14:22):
Yeah, I actually had to do a year of general surgery
and I did a month of urology andI actually found it enjoyable.
I mean it's a nice niche wherethere's not a lot.
Speaker 2 (14:33):
I mean, I'm sure in some areas people are
encroaching on it, but it waslike you know, like we got
called from the Gynocs and theywould have us, you know put in
(14:56):
urethral stents and things likethat, because you have a
cervical cancer, that's, youknow, pinching off the kidneys,
and it's kind of surprising kindof how many areas of the
hospital that the urologistswere involved with.
Oh right, we're always gettingcalled in by other surgeons to
help them, help them all.
Speaker 1 (15:02):
Yeah, yes, yeah yeah.
Somebody accidentally nicks theureter and then, all of a
sudden, you're involved.
Speaker 2 (15:09):
Or sometimes they just have a patient on the table
.
They can't get a catheter in.
Yeah, I mean, or it's involved.
Or sometimes they just have apatient on the table.
They can't get a Catherine.
Yeah, I mean, or it's right orthe inadvertent bladder injuries
, the funny thing.
Speaker 1 (15:18):
So that was like my job when I was like the, the
radonc intern who was doing amonth in urology, and they would
be like we can't get aCatherine, and you know, buck,
who was my chief, would say,jason, get a Kude and put some
gel down there and just shove itin.
And I was like I'm going to theICU and there's like this is
(15:40):
not at this hospital, but Iwould go to the ICU.
There's like a nurse who's putin like 1,000 catheters and I've
put in three and I'm taskedwith getting the job done.
But in surgery you do have thiskind of gung ho mindset of like
you know, come hell or highwater, I'm going to get the job
done.
And so I think I got them allin, but um, but it.
But it was an enjoyable monthand you know they were all
(16:02):
really funny guys and I I don'tknow what it is, but most
urologists are are fun guys totalk to and they have a good
sense of humor and there's kindof a good atmosphere there.
Speaker 2 (16:12):
You sort of have to do the job.
It's a requirement.
It comes with the territory,but it's funny.
What they say about surgeons isthat they're usually right but
never in doubt.
That's how you have to be,randall.
No one wants a wishy-washysurgeon, right?
Speaker 1 (16:28):
Yeah, that's right.
That's right.
Yeah, you need to be decisiveright in the operating room.
There's not much room for kindof futzing around.
Yeah Well, randall, Iappreciate you joining us here
on the podcast.
I'm glad to work with you hereand I'm happy that you and your
team are here at St Luke'staking care of our mutual
(16:50):
patients.
Speaker 2 (16:53):
We're glad to be here and we just keep expanding, so
can they get a full complementof us?
Yeah, very good, Because Tomwill retire one of these days
and we need to keep it going.
Speaker 1 (17:02):
Yeah, all right.
Well, thanks so much.
Speaker 2 (17:05):
Well, thanks for having me.
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