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Robotic Surgery and Sexual Medicine: too distant worlds? An interview with Daniar Osmonov

Daniar Osmonov
MD, PhD, FECSM
Dept. of Urology and Pediatric Urology
University hospital Schleswig-Holstein
Campus Kiel, Germany

Mrs. Kalz
Coordination of the Kurt-Semm-Center for minimal invasive and robotic surgery
Scientific projects manager
University Medical Center Schleswig-Holstein, Campus Kiel, Germany

Mrs. Kalz: Hello, Dr Osmonov, nice to meet you. You have an excellent reputation as an expert in robot-assisted surgery. You belong to the team that originally introduced robotic surgery in Kiel. You have invested loads of dedication and energy in this robotic surgery program, which finally resulted in the foundation of the internationally renowned Kurt-Semm Center for interdisciplinary digital medicine in Kiel.The question lies close at hand: how did you develop so pronounced an interest in sexual medicine on top of robotic oncology? Aren’t these two topics worlds apart?

Osm: First of all, thank you for your time and interest in doing this interview with me for ESSM today! Well, your question is simple and hard to answer at the same time.

To be honest with you, I have no straight forward answer. I think it is actually as simple as this: I love medicine in general and all fields – at least those in urology – have the potential to intrigue me. However, I´ll try to explain in more detail …

One of the reasons why I chose a German career in urology is because there is a systematic training curriculum, which includes all aspects of urology, such as infections, oncology, gynecology, pediatrics, stone treatment, andrology, endoscopic surgery, laparoscopy, robotics and many others. I have always wanted to learn urology from scratch and as hands-on as possible. I also wanted to gain basic medical knowledge, such as human anatomy and physiological processes in the body to be able to fully understand all aspects of modern urology. It’s been a long way to obtain a comprehensive view on all topics associated with urology. Few other disciplines in medicine cover such a wide range. So, I have always been someone who likes variety in what they do.

Mrs. Kalz: But why did you choose sexual medicine and penile prosthetics as one of your favorites? That seems to be a rather unobvious and rare choice.

Osm: Let me explain. There is something that connects robotics and sexual medicine, at least from my point of view. The issue at stake here is the patients’ quality of life, which is what medicine is ultimately about. I have been performing radical prostatectomies since 2001 and I see huge numbers of these patients. Most of them express gratitude for successful treatment, especially with respect to getting rid of the cancer. Being able to have helped a patient to be cancer-free, has always made me glad, and by reverse I feel upset in a case of unsuccessful treatment. I felt sure that successful cancer treatment provided real satisfaction and that it would be of consequence when looking back at one’s own life. It was clear for me until I had one interesting clinical case.

I performed robot-assisted prostatectomy on a 41-year-old patient with high-risk prostate cancer. Unfortunately, I could not preserve the neurovascular bundle which resulted in a severe erectile dysfunction. He came to my office 3 months later and said something like: “Thank you for saving my like, doctor, but yet I have to confess to you I am deeply unhappy, because I am not a man anymore in the way I used to be! We used to have a fulfilled love-life, my wife and I, and now there’s nothing going.”

Mrs. Kalz: That must have been disappointing for you.

Osm: Yes definitely. I had seen some more patients like the one I mentioned, but until then I had been very practical about it, just telling the patients the facts why this happened and that he could seek help in such and such a way. This patient was different, somehow, maybe because he was in my own age-group. Suddenly it was not only a clinical case for me, but I say a truly unhappy young man sitting in front of me. It helps me to put myself in his place and I realized that the situation of complete erectile dysfunction was a very grave one, especially at such a young age.

Mrs. Kalz: Ok, now I can see the connection. But how did this case evolve further. Were you able to help the young patient?

Osm: After some unsuccessful attempts with PDE5 inhibitors and auto-injection therapy, I decided to treat his erectile dysfunction surgically by inserting a penile implant. Eight weeks the patient showed up again. I’ll never forget how happy he was.  He apologized for his negative state of mind after the prostate surgery and said he just came to let me know how glad he was now with his penile implant.

In that moment I understood: “It is a good thing to save somebody’s life, but to make your patient happy is yet the ultimate reward.”

Mrs. Kalz: Has it changed your professional life?

Osm: After that case I started a penile prothesis program in Kiel and I have since been able to expand from a “one-man show” to one of the best-known high-volume centers in Germany. And one more thing: While my wife rarely tells me that I made her happy, it is a great feeling to hear it from so many patients after penile prosthesis implantation. To my experience, nothing makes patients that have lost their erectile function as happy as a rehabilitation of erectile function and thus their ability to have a meaningful relationship that includes all aspects love and partnership. There is beauty in the art of sexual medicine!

Mrs. Kalz: Thank you Daniar! It has been a great experience to talk to you and to find out what is behind sexual medicine for you.

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