What drew Steve Hudak ’00 to reconstructive urology is the complexity of the surgeries. “I found them to be technically challenging, interesting, and life-changing for the people who receive them,” he says. “They restore people’s quality of life in hidden areas that aren’t commonly talked about.”
Hudak decided on his sub-specialty during his first humanitarian trip to Honduras as a urology resident in 2007. He’s returned to the country as a volunteer eight more times over the past decade. He describes the ratio of urologists to the general population there as staggering. In the U.S., a busy urologist numbers about one per 30,000 people. In Honduras, approximately 30 urologists serve a country of nine million.
As a result, Hudak says, urologists in Honduras are inundated with prostate problems, kidney stones, and recurrent bladder infections. But, like anywhere in the world, Hondurans also experience traumatic urogenital injuries, which require a lot of time and technical expertise to correct. Local doctors are so busy performing more common surgeries that they often don’t have the time, training, or resources to treat these people. “That’s the need that we, as volunteers, help try to address,” Hudak says.
Hudak describes arriving at a clinic on the first day of his trips to find 200 people waiting in line before the doors open at 7:00 a.m., with looks of gratitude on their faces. “We learn a lot about personal resilience before the first surgery is even performed,” he says. He describes one patient in his early 80s who had to walk two hours to take a five-hour bus ride to receive monthly medical care. “To be able to help remedy that problem so that he didn’t have to do that anymore was really life-changing and career-impacting,” Hudak says.
In his everyday life, Hudak practices surgery as a lieutenant colonel in the U.S. Army at Brooke Army Medical Center in San Antonio, Texas. After completing his genitourinary trauma and reconstructive surgery fellowship in 2012, he began seeing a dramatic increase in the number of U.S. soldiers returning home from war in Afghanistan with urogenital injury. Compared to previous wars and conflicts, he says, “In Afghanistan, combat casualty care improved to such a degree that despite the injuries being more catastrophic, more people were surviving them. We began to see patterns of complex urogenital injury that in previous conflicts were unsurvivable and thus were rarely seen or treated.”
Hudak admits that while he can provide material support in the form of surgical assistance, complex urogenital injuries have severe emotional and interpersonal impacts, and there’s no standardized care pathway in either military or civilian environments to comprehensively manage patients beyond surgical procedures.
So Hudak and his colleagues have set out to lay the groundwork for one through the Trauma Outcomes and Urogenital Health (TOUGH) project, a long-term study that seeks to acquire data on soldiers who’ve sustained urogenital injuries overseas. The database that tracks these individuals stops receiving entries once a soldier returns home, but Hudak and company are following up to assess the scope of problems—sexual, urinary, reproductive, and interpersonal—five and ten years down the road.
“The effects of urogenital injuries are always going to be sensitive and intimate, and public discussions about them are typically quite vague,” Hudak says. “But that’s where my excitement and my passion come from: giving a voice to an area of need that doesn’t have one.”