Urologist Jozef Marenčák: I feel sorry for the patients, I feel for them

Like other doctors, you consider your profession a mission. Did you decide to become a doctor as a child?
Even as a small child I wanted to be a doctor because my mother was very sick and I imagined that I would help her. That was quite the first decision. Later, when I had more sense, it came to me completely natural. I have always been drawn to medicine.

You originally wanted to be a gynecologist. What happened that you “ended up” in urology?
I spent part of my childhood in an orphanage, so I didn’t have big eyes after I finished medicine. I definitely wanted to do the surgical discipline. I gained my first urological experience, also practical, during a study stay in Hlboka, where I worked for three years, later I was also in Germany and the United States. When I started surgery in Skalica, I found out that they don’t have a urologist there. That’s when the idea of ​​establishing a urology department came into my head. And I succeeded, it was my life’s work. A little sand will remain behind me. Perhaps.

Why are you so modest?
I’m not (laughs). But life is like that. Even a small furrow is big when you look at it through the eyes of an individual who is struggling.

Jokes about urologists are "out of bounds...

urologist, urology, Jozef Marenčák Jokes about urologists are “outside of normal conversation”.

You are not the first doctor who wanted to operate after graduating from medicine… What is actually so attractive about operations?
Maybe it’s the adrenaline. A certain way of proving to yourself that you have what it takes.

I suppose it is the best that can be achieved in medicine.
Today I see it with different eyes. There are a lot of things that I wouldn’t be able to do even as an operator if my colleagues didn’t help me. I cannot operate without an anesthesiologist, an internist, and when complications arise, I need other colleagues. Plus, I need a team. I used to play football – one man never makes a team. It is always a collective work. When two out of eleven don’t play well, nine pulls it off. But one can play just fine – if the other ten don’t play at all, it doesn’t work.

Do lay people know which expert to go to when they have a problem?
They don’t know that. The fault is on the side of the general practitioners – if they were as they are in England, with sufficient knowledge, they would be able to do many things. But that’s an ideal idea. The fault may also be on the part of the urologists. There are many patients and few urologists. Anyway, I never required a referral from a GP. Simply, if a patient came to me with a urological problem, I tried to help him.

At the prostate cancer press conference, you said you felt sorry for them…
Yes it is. I empathize with them and see my profession as a mission. I want to help them. I’m not conceited, I don’t think I always succeed 100 percent, but I try to do my best and do my best for each patient. Everyone makes mistakes. Me too, but not intentionally, in the sense that sometimes I “didn’t want to” or some patient was unsympathetic to me. Mistakes related to the progress of science – today, for example, I would choose different procedures than twenty years ago. That’s why I keep moving forward to take advantage of everything that is possible today.

The causes of erectile dysfunction are psychological...

erectile dysfunction, urology The causes of erectile dysfunction are psychological or anatomical, but most often a combination. Because life is hard today.

Today, impotence is called erectile dysfunction. Is there a lot of it these days?
Is a. In most cases, the causes are psychological or anatomical, but most often a combination. Today life is difficult – providing for a family, time stress at work – all this affects people. It used to not be. It is a huge boulder that pulls people.

When we read various articles on women’s websites, it seems as if sex is the meaning of life for men. For many, for most. Let’s compare it – what does the urologist’s practice say?
I’d say it’s a part of life, although, as everywhere, there are exceptions. I come into contact with men who do not want to give up sex. They tell me that if they have some time left before the end of their lives, they want to live it to the fullest. They tell me this after difficult conversations, and it usually happens that I start to respect many people, because in the end I find out that even if they don’t look like it, they have a deep view of life and think about many things. So it would be bad enough if I didn’t try to help these people. I openly ask them what they want and expect and I try to find a way for them. Unfortunately, in medicine, you also have to think about the economic side, stick to the budget, look for a way so that the patient is not harmed. Today in Slovakia it is already difficult to manage a department based on words only, because commerce has spread everywhere and, in the end, life is not easy.

Men are said to have a similar relationship to testicles as women have to breasts. If they are to lose them or him, they suffer equally. Even those who no longer live sexually. Can it be compared? Let’s imagine the breast, it is a beautiful, perfect organ, an ornament…
Maybe it evokes memories for them, they feel incomplete. I don’t know, I’m not a psychologist. Why take an organ from them that, let’s say, they don’t need relatively, but maybe they would miss from a psychological point of view and it would be difficult for them to fall asleep without it? Why should they wake up from the dream?

While a woman can protect herself from an unwanted pregnancy in several ways, the only option for a man is to tie the vas deferens. Is there interest in this procedure?
We do this only exceptionally, in cases where the woman cannot or for some reason refuses contraception, maybe once or twice a year, and we need the written consent of the person concerned. We cut the vas deferens so that the sperm cannot pass through and the man is unable to fertilize.

Reassurance that I am with the patient and will do for him...

urologist, Jozef Marenčák, interview with the patient The assurance that I am with the patient and will do my best for him is probably what will help him breathe in the initial shock, says the urologist.

Is it irreversible?
We had a case where the person changed his mind after 3-4 years. He found a new partner and wanted to have another child with her. We found the vas deferens, but it may not work anymore.

There are perhaps the most jokes about urologists. Bladder, oven, incontinence, sex… Did you hear one that made you laugh out loud?
He heard it, but I won’t repeat it, because these are mostly jokes, let’s say, quite outside the scope of normal conversations.

Urology is specific, and since it is connected with sex, you are probably confronted with embarrassments every day. The urologist must be funny enough to be able to get through the visit with the patient, right?
When someone comes to urology, they are very scared. It’s hard to turn it into a smile. Of course, sometimes I make light of the situation, but it is always necessary to approach the problem responsibly. I realize that it is a huge trauma, especially for a man. Just come and talk about it. I confess that I never had a problem with the conversation. Maybe also thanks to the fact that patients feel that I want to help them. And above all, I really listen to them – and I’m immediately looking for a solution, what can be done. I think I’m up to it and I can estimate it. I don’t need a psychologist for a patient, certainly not. And I have patients who have two, even three cancers.

How does a person, despite knowing how to report it, walk home with such a difficult diagnosis?
It’s certainly not easy. The conversations are different, depending on the patient, but the assurance that I am there for him and will do my best for him is probably what will help him breathe, at least in the initial shock.

A little sand will remain behind me.  Perhaps.

Jozef Marenčák A little sand will remain behind me. Perhaps.

You are 63 years old. Do you have an idea how long you will work?
Until I rule and be content with what I do. Today I don’t feel old yet, I have something to say, but when that time comes, I will step back from the operating table.

What have you been doing with yourself all your life to make you look so good?
I am happily married.

Doc. MUDr. Jozef Marenčák, PhD. (63)

he is a urologist. In 1985, he founded the urology department at the Skalica Hospital, where he is still the head.

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