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Year : 2022  |  Volume : 38  |  Issue : 4  |  Page : 247-248

The paradox of why and how in urology!

Associate Editor, Indian Journal of Urology, Fortis Memorial and Research Institute, Gurugram, Haryana, India

Date of Web Publication1-Oct-2022

Correspondence Address:
Anil Mandhani
Associate Editor, Indian Journal of Urology, Fortis Memorial and Research Institute, Gurugram, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/iju.iju_315_22

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How to cite this article:
Mandhani A. The paradox of why and how in urology!. Indian J Urol 2022;38:247-8

How to cite this URL:
Mandhani A. The paradox of why and how in urology!. Indian J Urol [serial online] 2022 [cited 2022 Dec 7];38:247-8. Available from:

I happened to be chairing a session on an oft-repeated topic of bladder cancer. An accomplished medical oncologist and urologist were debating the need for neoadjuvant chemotherapy, where the discussion was to treat occult micrometastasis before even considering cystectomy. The second half of the session had one more debate on the template of lymph node dissection in bladder cancer. It was interesting to see speakers contesting convincingly to prove their points with supporting literature. In both the debates, I could observe an interesting contradiction in the philosophy of treatment.

The point was that when we support one philosophy, such that neoadjuvant chemotherapy takes care of occult metastasis of which we do not have evidence at the time of treating one patient, then how would we know that occult metastasis followed a designed lymphatic path and limited itself to one station of the template? It was an intriguing thought indeed.

It is frequently seen that we as surgeon scientists in India, deliberate on issues based on published literature parroting the minds of authors who have published that knowledge. It happens quite often with most of us who are not generating evidence despite having such a beautiful platform as the Indian Journal of Urology. With a 1.4 billion population and strength of knowledge in our urology fraternity, inputs on original scientific research are very dismal. Is it not a paradox in itself?

A paradox is defined as a logically self-contradictory statement or a statement that runs contrary to one's expectations.[1] That statement could be a deterrent to the philosophy of delivering health care in the field of diagnostics and therapeutics.

It is time we need to challenge paradoxes existing in urology and start analyzing them by promoting sessions on critical thinking in various scientific meetings. Rational thinking would be the first step in addressing paradoxes to a considerable extent. Many such paradoxes exist in urology and a few of them I must cite here for better understanding. Blind radiation to the prostatic fossa after radical prostatectomy when there is a microscopic involvement of the seminal vesicle is not rational. Emerging trends address this contradiction with salvage radiation with the help of better imaging. For years, we are replacing nonabsorbable bladder mucosa with the absorptive surface of intestinal mucosa for urinary diversion for the want of a better alternative! Other examples are the removal of a bladder cuff in upper tract TCC, reinforcement of the diseased urethra as a part of the circumference rather than replacement, and the eternal paradox on localized prostate cancer, which is to treat or not to treat it.[2]

Similarly, paradoxes exist in technology. Rapid development in technology in various subspecialties of urology has changed our surgical practice and helped us improve the outcomes. Urology as a surgical specialty is mostly technology dependent and evolves very rapidly too. However, paradoxically, the pace of change in technology is not parallel to the pace of change in the rate of complications. Often the purpose of technology is contextualized, i.e. aimed at one particular purpose or context. For example, the da Vinci robot was designed to do radical prostatectomy, but this technology is being decontextualized for various other indications, some of which are useful, but some could be paradoxical to the actual need for technology. It is time to realize this paradox and deliberate on it. Peter Ducker a management consultant once said, “there is nothing so useless as doing efficiently something that should not have been done at all.”

It is my privilege to dedicate this editorial to present and past editors Dr. Rajeev Kumar and Dr. Nitin Kekre, who have provided dignity to the Indian Journal of Urology. We urologists should contribute to science by addressing such contradictions in urology and adapting to the philosophical view of surgical practice. I would invoke a famous quote from philosopher Friedrich Nietzsche, who said that “If you know the why, you can do it anyhow.” Much of the prime time in scientific meetings is taken away from discussing “HOW” and no time or interest is left for deliberating on “WHY.” There are paradoxes looking at us for finding “WHYs” and I am sure that the future belongs to us, and we need to shape Indian urology as a formidable and respectable force to reckon with by beginning to focus more on WHY instead of HOW.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

   References Top

“Paradox”. Oxford Dictionary. Oxford University Press. Available from: [Last retrieved on 2016 Jun 21].  Back to cited text no. 1
Available from: -05292000.pdf. [Last retrieved on 2022 Sep 01].  Back to cited text no. 2


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