Taking vital reconstructive urology skills to Ukraine

In reconstructive urology, the smallest details matter, and no patients are exactly the same. Reconstructive surgery is one of the most complex types of surgery. Its purpose is not only to restore a lost or deformed part of the body, but also to restore its function. And it is unlikely that a successful outcome can be achieved solely through a technically well-performed operation. Within a year, both cosmetic and functional results can be seen, along with improvements in the patient’s quality of life.

Without an EU Passport?

There are often complaints about being born in the "wrong" country, receiving the "wrong" education, or being taught the "wrong" things. However, my experience confirms that if you are determined to excel at your job, you must be willing to study and make a significant personal effort. It’s true that having a European passport and a degree from a prestigious university might make starting a career easier. Yet, no matter your background, the journey can be challenging and often filled with obstacles. These are simply excuses not to try. The European School of Urology did not select me based on my nationality or gender but solely on my professional achievements. Once you receive such a scholarship, you become an independent doctor and, indirectly, a representative of your country. You shape perceptions of the level of qualification in your homeland. I am immensely proud that Ukraine secured this grant, allowing me to work alongside top specialists in urology.

For non-EU citizens, there are some challenges to overcome when receiving scholarships. However, my experience proves these challenges can be managed. Renting an apartment, for example, is more difficult without a guarantor, and bureaucracy with the Migration Service can be overwhelming. There is also a lack of clear legal norms for temporary medical work in the EU. Nevertheless, with the support of the EAU and my colleagues in Lisbon, we overcame these obstacles. I obtained a temporary medical license for one year, meeting the European Union's requirements for foreigners practising medicine in Europe.

EAU Guidelines in daily practice

During my scholarship, I observed how an individualised approach to patient care works in practice, particularly how the EAU Guidelines are used daily. I learned the importance of selecting treatment, conducting procedures, and managing patients based on statistically significant results and evidence. In addition, I was surprised by the multidisciplinary collaboration within the hospital, with weekly multidisciplinary uro-oncological meetings held, with clinical oncologists, radiologists, pathologists, chemotherapists, all urologists and residents participating. These specialists were actively applying the EAU recommendations for each case. I hope that on my return to the Ukraine, I will also be able to implement these same approaches, as it benefits both patients and practising doctors to make good treatment decisions on solid scientific foundations. 

My non-surgical time was spent on self-education and analysing clinical data according to new standards. This once again confirmed that in the Ukraine we should strive to achieve exactly this level of interpretation of our clinical data, which will allow our work to be published in peer-reviewed journals in the future. This experience helps me prepare my project study results for publication, and pass on my knowledge to my Ukrainian colleagues and scientists. 

Excellent team leadership is key

My supervisors were Dr. José Palma dos Reis (head of dept.) and Dr. Francisco Martins. They helped me integrate into the team as a full partner and supported me in every way. Dr. José Palma dos Reis was my mentor, but also a real support for all the surgeons. With him you are always in "surgical safety". During these few months, I had the opportunity to work with Dr. Martins, a world renowned and experienced surgeon in the field of reconstructive urology. In particular, working with the materials of international experts on the complex issue of empty bladder and complications of artificial urethral sphincter in men has not only given me theoretical knowledge, but also changed the approaches to all my previous non-European experience in preparing scientific projects and analysing the data obtained. 

I am collaborating in several studies, such as a study on bladder devastation (risk factors that define patients requiring cystectomy, exposure to radiation, previous urethral surgery) and the need for urinary diversion, a second multi-institutional study on artificial urethral sphincters, and a third study on the analysis of the treatment of anterior urethral strictures by a method using perineal access has already been completed. This direction of research was chosen precisely because, with the demands of modern times, younger and younger patients are undergoing such operations, and for them not only the anatomical result is important, but also the functional one. Therefore, under the guidance of my supervisors, I have not only acquired new practical surgical skills, but also hope to publish the research results of two international projects, a multi-institutional study and the results of urethral plastic surgery, artificial urethral sphincters and penile prostheses in peer-reviewed journals. 

Medical support for Ukrainian victims

Another incredibly positive aspect of my scholarship was the teamwork and support of the urology dept. at Santa Maria Hospital. Lisbon quickly became my second home. Together, we were able to save Ukrainian patients who were recently injured and needed medical assistance. Open, friendly, and sincere colleagues from the dept. supported me every day and gave me the opportunity to receive both their highly qualified advice and free treatment for Ukrainian victims in Portugal. In particular, thanks to Dr. Ricardo Silva, one of the largest military hospitals in the Western Region of Ukraine, which receives the majority of the wounded for rehabilitation and is one of the largest centres for combat spinal injuries, received significant support in the preparation of neuro-urological examination protocols, training in urodynamic examination (never before in the Western region) and support in the correction of treatment using neuromodulation methods. His daily support and ability to consult on difficult cases gives hope to hundreds of people with disabilities and many medical professionals who are currently unable to leave the country to study abroad. It is incredible how everyone helps you in everything, be it a nurse or a fellow doctor, and tries to make you a full member of the team without any reproach or interpretation as a person with a slightly different initial level of education. Even seemingly small things like daily communication - most of them even tried to communicate in English in my presence so that I could understand. I also want to mention the warmest nurses and secretaries who sincerely helped me with everything in a motherly way.

The ‘whole’ patient – preoperative to postoperative long-term follow up

I had the opportunity to assist not only in reconstructive surgeries, but also the incredibly technical nephrectomy with extensive caval thrombi, all types of oncological and general pathology (both open and laparoscopic), in addition to urogynaecology and neurourology. Under the guidance of Dr. Tiago Oliveira, an excellent technical surgeon who performs complex laparoscopic operations that seem to be mastered with incredible ease, he emphasised not only the surgical aspects, but also mentorship and support. Although it is not only about years of theoretical and practical work training, each of them also has incredible human qualities. Performing laparoscopic surgery at a high level has inspired me to study oncology more deeply. Working with them, my time “stood still” in a positive way: professionalism and atmosphere all together. This is an incredible, highly professional place that cares not only about the technical performance of the operation, but also about the long-term outcomes of each patient. 

To summarise the first results of my scholarship, I now truly believe in the fleeting nature of time when you are happy and doing what you love. Kudos to the EAU and especially the EAU Scholarship Programme for not only providing an incredible year in a highly specialised environment, but also the opportunity to learn and work with the best of the best. Their support and help is invaluable. And for those who do not believe - try it and maybe you too will receive an EUSP scholarship that will change your life for the better.

Back in Ukraine

Thanks to my scholarship and all the support, we did a lot of surgery on many victims abroad last year. The plan was to come back to Ukraine and focus on reconstructive and plastic surgery and work more as a surgeon. However, there was an urgent need to help patients with spinal injuries. Now I work as a full-time doctor at the Rivne Regional Clinical Hospital, Rivne Oncology Center (Western Ukraine). And as much as possible, I try to find time to volunteer at the War Veterans Hospital. This is one of the largest centres for rehabilitation of spine patients and war victims. The main problem for patients with spinal lesions is urinary and bowel problems, we are no longer talking about the loss of their sexual function or quality of life. My colleagues, the rehabilitation physicians and surgeons, and I, are trying to do neuro-urology here in order to somehow improve the lives of these patients and to prevent them from dying of kidney failure, which is quickly caused by untreated urinary problems. 

Over the past year, we have set up a laboratory where we can perform urodynamic studies, which are extremely important for diagnosing urinary tract conditions and selecting treatment. Although such an examination is routine in modern clinics around the world, for our western region with a population of several million and several thousand wounded, it was an almost heroic act. There’s a lot of people, and they're young people, with multiple injuries. Not only do they have technical injuries to the spinal cord, but they also have multiple injuries to internal organs from bomb fragments, which are also difficult to treat. There is very little information on the treatment of patients with combined spinal cord injury, such as lumbar spine injury from a fall and a bullet injury to the cervical spine, or bullet wounds to the spine with simultaneous large pelvic injuries. Research indicates that in most cases Ukrainian spine patients will not live more than 5 years after the injury. They die of urosepsis or kidney failure. In recent months, we held a neurourology conference at the Veterans Hospital, attended by 1,050 participants from different parts of the country and international colleagues. 

I continue my relationships with those I worked alongside in Portugal. I am very proud of this. This is now my second spiritual homeland. I also helped them with statistical analysis of data and gave presentations to help their residents understand this complex issue a little better while I was there as an intern. 

I also have an invitation to visit the urology dept. in Lisbon again this October-November to work with the urologists with the analysis of the database that we started last year. It’s very hard for residents to understand some points of medical statistics and how to prepare data for publication, but in my opinion, if explained in a simple way, it is not as hard as it looks.