Mental Health in Non-Oncologic Urology Patients

Anderson, D., Kumar, D., Divya, D., Zepeda, J. L., Razzak, A. N., Hasoon, J., Viswanath, O., Kaye, A. D., & Urits, I. (2022). Mental Health in Non-Oncologic Urology Patients. Health psychology research, 10(3), 38352. https://doi.org/10.52965/001c.38352

One of my closest friends, who shares both my city and medical school journey, has recently achieved a significant milestone by securing a position in the urology training pathway in Australia. To celebrate her accomplishments, I felt it was timely to explore the important intersection between urology and psychiatry.

Urology is a surgical subspecialty of medicine that focuses on the function and illnesses of the urological system, also known as the urinary system. This system extends from above the kidneys, including them, and down to the genitalia. It plays a crucial role in fluid management, salt and mineral regulation, reproduction, and other vital functions. Although the urological system is a common site for cancer, such as prostate cancer, bladder cancer, and kidney transplants, non-cancerous urological conditions often receive less attention. This may be due to the perception that they are less glamorous or lucrative compared to “curing cancer.”

Regarding my friend's achievements, it is worth noting that Australia’s specialist colleges are private entities that often limit the number of available training positions. This limitation is sometimes justified by a shortage of educators, but in reality, it can also be a strategy to maintain scarcity and financial flow. In contrast, psychiatry has seen a push for more practitioners due to public demand, though the psychiatric college sometimes keeps trainees in positions longer due to their lower cost compared to fully qualified specialists. In the competitive world of surgery, factors such as nepotism and connections often overshadow passion and expertise. Hence, my friend's success in entering the urology training program is particularly impressive, and I am confident she will excel as a surgeon.

This article aims to highlight the mental health challenges faced by patients with non-cancerous urological conditions, with the hope of raising awareness and improving education among those working with these patient groups. One such condition is Peyronie’s disease, which involves a painful curvature of the penis due to a lesion. The physical effects of Peyronie’s disease are significant, and research indicates that 81% of men with this condition experience emotional difficulties, with more than half facing relationship issues. Despite being previously considered rare and stable with minimal health impact, Peyronie’s disease has a notable emotional toll. Interestingly, surgical intervention may not always improve mental health outcomes, potentially leading to negative perceptions of body image and sexuality. Contributing factors include the vascular, neurological, and hormonal systems, as well as medications and psychiatric health, alongside conditions like diabetes, high blood pressure, tobacco use, and other substances.

Erectile dysfunction, often associated with Peyronie’s disease, also has considerable health implications. Men with erectile dysfunction frequently use antidepressants, which can be a double-edged sword as some medications may exacerbate the condition. Addressing this issue is crucial, as there are effective psychotherapies and more appropriate medications available. It's important to acknowledge these issues in both males and females, as the associated embarrassment and shame can significantly impact mental health. The combined effect of these conditions can lead to severe anxiety, depression, loneliness, and sleep disturbances. The disease burden from such conditions is high and often underreported due to stigma. As the condition worsens, it affects self-esteem, relationships, and daily tasks, creating a challenging situation.

Fortunately, various therapies are available, though few address both psychiatric health and social life in conjunction with treating the underlying condition. A combined approach involving psychological therapy, physical therapy, and lifestyle changes can be beneficial.

In conclusion, the urological system encompasses a diverse range of illnesses, each with distinct psychiatric needs. There is a notable lack of research on the psychiatric aspects of these conditions and their impact on mental health. Conditions like prostatic hyperplasia, kidney stones, and urinary retention highlight the diversity within urology and the varied psychiatric needs of patients. Addressing these needs is crucial for improving overall patient care and well-being.