Q and A: Dr. Alan Wein
A luminary figure in urology, Dr. Wein reflects on some of his major accomplishments and how his profession has changed in his 60 years as a physician and researcher.
With a career in urological academic medicine spanning more than 60 years, Alan Wein, M.D., Ph.D. (honorary), FACS, has established himself as a luminary figure in the specialty. His expertise is seen in his numerous research projects and the lives of patients he has helped with urinary disorders. In addition, he has cemented his legacy in terminology and classification systems still used in the field.
Though Dr. Wein has taken a step back from his days at the University of Pennsylvania, he remains active as part of the Desai Sethi Urology Institute at the University of Miami Miller School of Medicine. Here, he serves as a professor of clinical urology and director of business development and mentoring.
We had a chance to talk with Dr. Wein and learn more about his career highlights and impact.
Where did your passion for medicine stem from and why did you specialize in urology?
I grew up in a small town in West Virginia, where doctors and lawyers were the most respected people around. During summer jobs, I shadowed various medical professionals and was fortunate to find that I genuinely liked the field, which led me to pursue medicine.
When choosing a specialty, I saw doctors as having two different personalities, basically — medical and surgical. The surgical side tends to involve quicker, decisive actions that fit my personality well.
Within surgery, I was drawn to urology because it was a more contained field at the time. You could master a broad scope and handle almost any challenge. Urology wasn’t purely surgical, as a lot of problems had a medical component or solution, the patients were of all ages and the urologists I observed had fulfilling careers, with solid patient relationships and a good work-life balance.
How has the field changed since you started in the specialty?
It’s amazing to see how the field has evolved since I began more than 60 years ago. Earlier on, the field had very few subspecialties, but now it has changed markedly, and for the better. We have experts in pediatric urology, oncology, andrology, reconstruction, incontinence and pelvic floor disorders, endourology and stone disease, sexual dysfunction and, of course, minimally invasive surgery, not to mention the technology that has changed with the times for even more precise medicine. Precision medicine is now a buzzword that means something, and artificial intelligence is beginning to make its mark in all medical fields.
With these new and current tools, our diagnoses are much more accurate, and our array of treatments is much better. Everything has been heightened threefold. It’s still a great field, even if it’s not as circumscribed as it used to be, and there are still even more advances to go.
You created the term overactive bladder. How did this come about?
I coined the term “overactive bladder” with my colleague and longtime friend, Paul Abrams, from the Bristol Urological Institute. Before this term, we used “urgency/frequency syndrome” and “unstable bladder” to describe a range of urological symptoms that weren’t well understood. Paul and I didn’t like those terms, as they seemed to suggest a mental condition.
It’s amazing to see how the field has evolved since I began more than 60 years ago. Precision medicine is now a buzzword that means something, and artificial intelligence is beginning to make its mark in all medical fields.
—Dr. Alan Wein
Things changed when a company asked us to lead a symposium on “unstable bladder.” We agreed, but only if we could rename it something else. They agreed and out came the term “overactive bladder.” It was a concise term that both specialists and primary care providers physicians and patients could understand, and the International Continence Society eventually adopted it as the official term for the condition.
You also created a classification, “system failure to store, failure to empty.” What does this mean and what was the impact of this classification on the field?
I’ve always been inclined to try and simplify complex medical concepts so they’re descriptive and easy to understand. When I looked into the terms describing disorders of urination, I noticed that existing terminology addressed mainly neurological disorders but wasn’t generalizable.
After thinking about the physiology involved, I realized that lower urinary tract function comes down to two basic actions: filling (storing) and emptying (voiding). For the bladder to store urine, it must maintain low pressure, have a closed bladder neck and urethra and avoid involuntary contractions. To empty properly, it needs a strong, sustained contraction, an unobstructed bladder neck and an open urethra.
This framework lets us categorize dysfunctions simply as “failure to store” or “failure to empty,” no matter the underlying cause. It also helps in selecting diagnostic studies and treatments by focusing on which of these two functions is impaired, allowing for a straightforward and organized approach to both diagnosis and treatment.
What led you to the Desai Sethi Urology Institute and what is your role?
There comes a time in one’s career when it feels right to start slowing down and stepping back. When I decided to leave Penn, I knew I wanted to live in southeast Florida, as I already had a place here and often visited on weekends.
Around this time, I began discussing my post-Penn career with Dr. Parekh, someone I’ve long admired as a leader in the field. We talked about me joining the institute part-time, where I’d see patients with lower urinary tract issues and urologic cancer in a non-surgical capacity.
My role also includes administrative work, mainly in a mentoring capacity, which I’ve always enjoyed. Additionally, I continue to author and advise on studies and edit texts, and I serve as editor-in-chief for Neurourology and Urodynamics, the leading journal in lower urinary tract and pelvic floor disorders, and the journal Urology Case Reports.
What advice would you give to aspiring and young urologists?
It depends on what you want to achieve in the field and whether you’re drawn to it for the right reasons. You first need a genuine interest in the science of urology. It’s okay to start medical school with a specific focus—say, urologic oncology—but once you’re a resident, immerse yourself and learn everything you can. One must also respect those who teach you. They’re not only sharing their knowledge but also managing actual patients who are essential to your learning.
It’s important to consider early whether you want to specialize further or go into academic practice. Residency is the perfect time to observe and learn from the staff. Look at how satisfied they are with their careers and lifestyles. This can help you decide whether you’re drawn to academic medicine, a large, “private” group practice or perhaps a smaller one. Personally, I found academic practice with a high patient volume suited me best, and it’s been a deeply fulfilling path.
Tags: Department of Urology, Desai Sethi Urology Institute, Dr. Alan Wein, overactive bladder