Be patient and listen to patients

Dr. Ervin Kocjancic, urology professor and Director for the Division of Pelvic Health and Reconstructive Urology at the University of Illinois in Chicago, is a world-renowned expert in pelvic health, urinary incontinence, and reconstructive urology. He visited Brno at the invitation of The International Clinical Research Center of St. Anne’s University Hospital. During his visit, he shared his experience at a public lecture with doctors and medical students from several hospitals and healthcare facilities in Brno. On that occasion, we asked him for a short interview.

What made you decide to become a doctor?
Simple question – simple answer… I think I was born with this idea. But seriously, to tell you the truth, I don’t remember wanting to be anything else in childhood. The funny thing is that the reason for being a doctor was that my parents forced me to go to bed very soon. So I dreamed of a profession where I could go to sleep late, which I had somehow connected with medicine and doctors.

You studied in Trieste and are now in Chicago. Why the change – from Europe to the US?
I have worked at many university hospitals, both in Europe and America, and I must say that the style of work is vastly different. And the American one suits me. In Europe, especially in Italy, it is based on a hierarchy, so when you are not like seventy years old, no one is listening to you. While in the US it is just the opposite, if you have good ideas, then they will listen to you and give you a chance. You get what you need for research, not just material resources, but also freedom and independence. This is very important and that trust moves you forward. So it’s not just about finances… An example – in Italy, we came up with the idea of how medicine could contribute to the development of new tools. But it was purely tied to our industry. If you are a urologist, treat prostate or kidney cancer, just examine this. While in the US with a good idea all doors are open to you, you don’t just talk to your research team, but you work directly with developers, the commercial sector, programmers, designers, and other people, which is simply a priceless opportunity.

Do you generally see any developments in the health of society?
As the generation that emerged from baby boomers in the 1970s is getting older, for example the number of prostate cancer and associated complications, is growing significantly. This is actually a pretty good example and I will go back to the previous question to explain the further difference between seeing problems in the US and Europe. It is not in the quality of medical care, both in Europe and in the US are top doctors who can take care of a prostate cancer patient properly. The difference is something else. In Europe, you will get rid of the tumor, but secondary things are no longer in their care, so your complications are already your concern. Of course, if you know who to contact or have money for a private clinic, that’s not the problem, but if you don’t have one, then you’re alone. While in the US it is very well organized. There is a Cancer Survivorship program, which includes, for example, special centers where everything is available to patients, so as to make it as easy as possible for them to return to life – whether as a wig for patients after chemotherapy or how to cope with incontinence after bladder cancer. In this program, experts from different areas work together – as a penis reconstruction specialist, I am in close contact with cancer experts to be available if necessary. We do not just focus on eliminating cancer, but on improving the quality of life in general. We try to listen to the patients, care for them does not end with a successful operation.

As you mentioned – you are an expert in penis reconstruction. What was your most complex case?
I remember one young man who could be about twenty years old. He was a victim of serious gunshot wounds, he had to be amputated with lower limbs, including genitals. However, he was young and wanted to lead a normal sex life as possible. Usually it is done by modeling it from skin tissues that are taken with the nerves and veins. However, this patient had the body so covered with scars that it was impossible and the only option for him was a penis transplant, which is only done in several centers in the US and South Africa. And it is precisely in this area that I would like to implement at the present time.

Is there still a milestone in this area that no one has ever achieved, and you would you like to?
Perhaps to grow or develop a penis in the lab and transplant it successfully… As far as I know, there are already some experiments in this area, but no one has finis hit yet. Then I also have ideas for developing new medical devices that would simplify our work, which are not such milestones, but if they improve patient care then it is also an important thing.

What is the composition of the patients who will come to you?
At present, there is a very high demand for operations of this type, which is related to the fact that we have already moved to a level where the outputs are really good. Recently, I have seen an increase in transgender patients, which is, of course, associated with a shift in their perception in society. Another group is patients suffering from disorders such as micropenis or overactive bladder. Last but not least, they are war veterans who have suffered severe injuries associated with genital mutilation. If you agree or not – penis is an important part of male identity, it’s not just a cosmetic thing.

How do you relax in the operating room?
Basically, I’m a happy man because my work really enjoys me and I don’t see it as a stressful thing. My other passion is classical music. Now I’m going back to my first answer, as I wished to be a doctor, so the musician was my next choice. They also don’t have to go to sleep soon (laughs). I love classical music in any form, whether at concerts or just listening to it at home in my chair – one song from different artists and looking for subtle differences. I also played, but the problem is that if you don’t practice for a while, it will signify a lot of quality. So I’m not playing anymore because I would be dissatisfied with myself… Frustrating when I can’t play at the level I wish.

So a perfectionist?
Yes.