My Two Urologists' Very Different Approaches

First of all, I have had the problem of frequent urination at least since age 9. And secondly, I am definitely under a doctor’s care.

Anyway, my first urologist recently retired. There’s no need to identify him. So let’s just call him Dr. A. He was my father’s urologist too. And we always judged him to be intelligent, dedicated and capable. He said my frequent urination was caused by an incomplete emptying of my bladder. He said owing to its dangers and my relative youth, there was no need for surgery yet.

And when I went there to take the ‘uroflow’ test, Dr. A would basically say, ‘Well, you’re still not completely emptying. Okay, see you next time!’ I’m not saying he was indifferent. But that is a not too inaccurate portrayal of what happened.

Now, I am seeing a much younger doctor. Call him Dr. B. And he has a much much different approach. He almost gets upset that I am not completely emptying my bladder. One time, he literally told me, if I don’t urinate by the end of the day, go to the emergency room. Dr. A never said that. (And remember that I’ve had this problem since 9.) Oh, and Dr. B says he wants to do surgery. Just a couple stitches on either side is all it would take, he told me. In fact, he was almost ready to schedule me for surgery, until I said, wait a minute! Let me think about it. And then he looked mildly insulted.

Why such differences in approaches to basically the same medical field? And which one was the correct approach? Because I could always see another doctor. In fact there are plenty more in that same office that are colleagues of Dr. A and that I am sure would have his same approach. And I’ve also have to ask, am I doing something wrong here? That last one may just be my irrational worry talking. But I had to include it.

Oh, has anyone else had similar experiences? :slight_smile:

The knowledge of medicine isn’t static. Yes, physicians are required to do continuing education, but it’s also human nature to do what you’ve known best to work. So in some respects there’s a likely probability the Dr. B is more aware of new developments and advancements in urology than Dr. A.

It’s obvious that you’ve had this condition for quite some time, and it hasn’t improved under the care of Dr. A. Dr. B has a much different approach and could possibly cure you, which hasn’t occurred under Dr. A’s care.

I might suggest a third opinion. Some doctors have a better bedside manner than others and there is nothing wrong with seeking someone that suits you better.

Maybe a third opinion will give you a majority that you will feel more secure about.

Other than having to pee frequently, is the incomplete emptying causing problems? Infections, e.g.? (I ask because my mom had that surgery for that reason.)

If it isn’t causing problems besides frequency, how much does the frequency bother you?

As far as why the different approaches, could be age/recency of training, but also could just be a difference of orientation – conservative medical management vs. more aggressive, interventionist, surgical orientation.

@eschrodinger No infections thus far. But drs. say that’s a possibility. So are ‘bladder stones’, ironically according to Dr. A. Not kidney stones he told me. Bladder stones.

Practical problems only arise when I leave the house. But I can often hold it, till I get home. (Also I am a lover of coffee. I probably shouldn’t. But what can I say? I just don’t want to give it up.) :slight_smile:

he literally told me, if I don’t urinate by the end of the day, go to the emergency room

Given that you told him you have frequent urination, why would he worry about this? Wasn’t he listening?

Something is missing here. If he’s going to ‘fix’ the problem with surgery and a couple of stitches, you don’t have a problem that could suddenly turn into an emergency. If you have frequent urination because of a UTI, it can’t be fixed by surgery and a couple of stitches.

If you have a problem that can be fixed with surgery and a couple of stitches, and can be safely left alone for many years, then some doctors will see that as an obvious fix that will increase your quality of life and will please everybody. And other doctors will see that as an unnecessary intervention, that is tempting fate and contrary to nature.

Not every circumstance has solid evidence based guidelines. And as the saying goes: where science fails Black Magic prevails. Another saying is that some surgeons think only cold steel can heal.

Some physicians do things certain ways just because that was how they were told to do it and another was told another way. Doing more is an easy bias to fall into. Doing less is often harder to do.

I have no idea which one is right but I’d personally want to clearly understand what the procedure is expected to change and how, and get at least one more opinion before considering it.

IANA medical anything …

I’d chalk that up to an abundance of caution. Through listening, the doc knows that a) the patient is at increased risk of UTIs, and b) the patient has a decades-long history of tolerating (=ignoring) long-term urinary tract oddities.

IMO warning the patient about the one oddity that cannot be safely ignored is just being thorough. The doc might also have usefully mentioned that if one sees blood or other unexplained discoloration in the urine, visit the ED.

IME dealing with taking older relatives to the doc, one of the challenges is that old folks are so used to putting up with their pieces and parts being more and more troublesome over the years that they’re often fully ready to ignore serious sudden-onset symptoms too.

Interesting. I used to have some issues that one urologist thought was related to either the prostate or bladder. Every time I went, he would first perform the old “fat finger up the butt” check, if you know what I mean, and I dreaded it. I even asked him if it was necessary, and he assured me that it was. He suggested a type of minimally invasive surgery, but I wanted to get a 2nd opinion, so went to a different urologist.

I guess it’s a small world, because the 2nd urologist told me that he was good friends with the 1st, as they had worked together at some point. Anyway, I was mentally preparing for the fat finger test during the appointment, and it never came. When I was leaving, and just in case he forgot, I asked him why he didn’t do it. He told me that it’s completely unnecessary and doesn’t tell you anything except that you might have an enlarged prostate, which I obviously did not have. So no point. I never went back to the first guy.

I once asked my doctor about taking pills to resolve a minor nail fungus issue. He told me that these pills can harm your liver and he did not make a habit of prescribing potentially life threatening treatments for non-life threatening issues. Given that these pills exist and are presumably prescribed by doctors to cure toenail fungus, his position on the matter is not universal.

So, to your urologists, Dr A may feel like my Dr, and Dr B may feel like doctors who prescribe antifungal pills. Your issue isn’t life threatening, or severely debilitating, could surgery be that dangerous? It may have been that dangerous for most of Dr A’s career, and far less dangerous now.

Due to time and moves, I’ve had a number of urologists. They ranged from modern to medieval.

The urologist should be able to conduct painless internal exams and discuss the diagnosis and prognosis in detail. He/she should specifically answer the issues you have presented here.

I was at my urologist earlier this week. There was a large poster, in the waiting room, describing the URoLift for non invasive prostrate treatment.

Looks like it could help a lot of men more completely empty their bladder. I may be a candidate in a few years. Flomax helps but I’m getting older and may need a better solution.

I’m thankful they’re developing procedures that don’t require slicing away at the prostrate.

Just like people draw the different conclusions from the same facts, so do doctors. I had an interesting experience when I broke a leg bone in the ankle area 15 years ago. This happened on a Tuesday. They told me that they would have to operate but would have to wait for the swelling to recede some. Thursday evening a 40 something surgeon came into my room and said he would operate the next day and that he would be inserting a metal plate to stabilize the bone and that he would put on a cast and I would have to use crutches for six weeks. I didn’t like the idea, but what could I do. I decided I would probably get up the steps somehow to the bedroom and stay there for six weeks; my wife would keep me fed. As it happened there was no free ER that day (too many icy collisions) and they postponed it till Saturday. At 9 AM they wheeled me to the operating floor and a 60-something surgeon came in to the corridor and explained that he was going to put a metal plate in and that he wanted me to walk on that leg as much as it felt comfortable to. And added that if I walked on it enough, I would not need physical therapy. So I asked him why his advice was so different from the other guy’s. He replied, slightly heatedly, that he had been telling people for years that once the bone is stabilized with the metal plate, it was stable. And so it turned out. No case, no crutches and no PT and I have been fine ever since. So it is not always the younger ones with the better treatments. I might mention that my even younger physician DIL still insists that I should have had PT.

::Telephone rings::

“Urology department, can you hold?”

Only briefly. :wink: