A surgeon with ideas

Needless to say, he is as devoted to his research as ever. His expertise in bladder and prostate cancer and reconstructive urology is renowned worldwide. His many achievements include being the holder of an international patent for an implantable device that treats urinary incontinence. However, when it is put to him that he always wants to make everything around him better, he dismisses the idea. “They’re often thoughts that many people have, but I’m not a businessman with the flair to turn these thoughts into reality. I sometimes have ideas and try to take them further.” Prof. Stenzl therefore maintains very close contact with developers and engineers in the medical technology sector. “Urology is a discipline in which techniques such as endoscopy, laparoscopy and laser treatment play a major role.” This surgeon is therefore also Director of the Inter-University Center for Medical Technologies Stuttgart-Tübingen (IZST). In this role, he is involved in the successful “Incisions and insights” workshop series that is conducted on a regular basis in collaboration with BioRegio STERN Management GmbH at the University of Tübingen’s Institute of Clinical Anatomy and Cell Analysis. Prof. Stenzl and other doctors discuss surgical procedures that are demonstrated live on anatomical specimens using both endoscopic and open surgery. “These events aren’t about us trying to show how good we are. Instead, our aim is to demonstrate the difficulties and shortcomings we face, so that medical technology engineers can then develop ideas to make things easier for patients in the future,” Prof. Stenzl emphasises.

In terms of research, Prof. Stenzl is currently working on a project that is using organoid models of urothelial carcinoma to examine the clinical effects of epigenetic changes. In this DFG project, tumour tissue is taken from patients and developed into organoids – 3D structures – that can then be used to test which chemotherapy works most effectively. What’s more, since speed is important to Prof. Stenzl – and not just when he’s on his bike – he is also thinking about how screening test processes for men can be made faster. “At the moment, men come to the practice for a urine test and an ultrasound examination. If biomarker abnormalities are detected, such as PSA in their blood, another appointment is then made for an imaging test such as an MRI. Next, there’s an appointment for a consultation and then a biopsy. The whole process stretches out over weeks,” Prof. Stenzl complains. “What I want to see is a set-up where the patient comes in the morning, the PSA result is in by lunchtime, and the MRI – if needed – is performed in the afternoon. If a biopsy is required, this would then be performed no later than the following day, with pathological findings being reported that same day. If these ‘logistics’ mean the result is available within a maximum of 36 hours, this saves the patient psychological stress and also reduces the associated costs and resources for the healthcare system.” Prostate-specific antigen (PSA) is a biomarker that is made only by the prostate gland. A raised level of PSA in the blood can be a sign of prostate cancer.

Whether you’re a king or a road sweeper, bodily functions are always the same

Prof. Stenzl was in no doubt about the area he wanted to specialise in. “From very early on, I wanted to go into urology. It’s a very small discipline, but my interest lies in reconstructive urology, which I enjoy. People always think of urology as a ‘man’s thing’, but 30 percent of my patients are women.” Prostate and bladder cancer are two of the most common types of cancer, and urinary incontinence is a problem that affects large numbers of people. Prof. Stenzl is a renowned specialist when it comes to maintaining bladder function for these patients, too, thereby avoiding the need for a catheter and urine bag – which even younger men can otherwise find themselves having to contend with. Unfortunately, only very few men undergo regular cancer screening tests. “The assumption is that it’s only old men who need to see a urologist. However, check-ups for young men, too, are extremely useful for both the early diagnosis of testicular tumours and the timely correction of congenital abnormalities,” the urologist insists. “Since compulsory military service was abolished, many men don’t have any contact with a doctor until very late on. It’s different for women, because they consult a gynaecologist at a relatively early age for various reasons, including to discuss contraception. What’s more, women are often more disciplined when it comes to looking after their health and are less shy about consulting a doctor about genital problems.” He is well aware that, for people outside the medical world, urology can sometimes be an embarrassing subject. “But we’re all people – whether we’re a king, a politician or a road sweeper, we all have the same bodily functions. The failure of these bodily functions in the pelvic or genital region – incontinence, impotence or infertility, for example – is what we deal with day in, day out in urology, but these issues are often considered taboo. Whether or not these things work properly comes down to internal factors such as hormones, cardiovascular function and physical and psychological fitness, and external influences such as diet, social stress and the job a person does. If patients tell us about these issues, they can be treated.” So how does Prof. Stenzl encourage patients to talk about the “unmentionable”? “It’s simply a case of openly broaching these subjects and remaining factual. I need to know what doesn’t work and when.” He frequently also has to plug major gaps in knowledge. “On the Internet, you find ignorance combined with a lack of taboos. During our work in the operating theatre, we often see the horrific results of penis enlargement procedures, for example, because men have a completely false idea of what ‘normal’ is.”