I was part of the AUA–Japanese Urological Association (JUA) Exchange Scholar Program and had the great fortune to observe Dr Akio Horiguchi at the National Defense Military Hospital in Kawagoe, Japan, in April 2023. In preparation for my first ever trip to Japan I reached out to 2 prior AUA-JUA scholars, which was tremendously helpful. The support I received from the AUA staff who organized my trip was excellent and I cannot thank them enough.

Once I landed in Japan, my adventure began. The hospital was located about a 1.5-hour train ride from Tokyo and I had to make several connections, which was surprisingly easy with the signs in English and Japanese and the help of the internet. I had pre-ordered a small portable router which was my hot spot for the entire trip, and I highly recommend it. It was super reliable, easy, and efficient, just like everything in Japan.

When I arrived at my hotel, it was early evening and I decided to get dinner. Just 2 minutes from the hotel in a small alley was a ramen restaurant, and I ordered by pointing to the picture on the menu. This was the first time I experienced the incredibly delicious Japanese cuisine, which was superb every day of my trip. No matter where you eat, it will be amazing, with my favorite food options, believe it or not, in the railway stations. Bento boxes, baked goods, sushi made to order, everything is meticulously prepared with attention to detail, fresh and delicious. It is truly gourmet food accessible to everyone.

The next morning, I was picked up from my hotel by a urology resident, Dr Jumpei Katsuta, who I later learned was given the task to be my interpreter and tour guide for the duration of my stay. I have never experienced hospitality like I did during my time in Japan. Everyone is friendly, offering to help with directions, going out of their way to accommodate the guest. And then I met Dr Horiguchi, Japan’s most prominent reconstructive urologist, who focuses his work on urethral stricture disease and is one of very few in the field who runs a basic science lab to push our subspecialty forward. I can envision that the treatment of stricture disease will drastically change with basic science discoveries. With these extreme scientific efforts, collaboration, and especially global collaboration, is of utmost importance, and Dr Horiguchi’s team is leading by example. The challenges I foresee that may hinder advancement are a lack of funding, research infrastructure, and time, which are all critical for rigorous investigation.

In the operating room I had the opportunity to observe several urethroplasties. I learned about a very different operating room setup with the scrub table positioned next to the patient so that the instruments can be handed to the operating surgeon from the patient side, which has the advantage that the surgeon does not have to turn around while operating in the perineum. For his pubectomy Dr Horiguchi uses a burr-hole drill with a diamond tip, which I have since incorporated into my posterior urethroplasty set. My favorite part was the opportunity to talk with Dr Horiguchi and pick his brain about complex cases.

During my observation, I made sure to be part of the team and rounded with residents in the morning. Some management variability between the US and Japan came to my attention; patients who had undergone a urethroplasty were admitted until the day their catheter was removed, compared to the same or next-day discharge that I was used to in the US. Many of these differences are driven by the health care system overall and both have their pros and cons.

Once my observation at the National Defense Military Hospital had come to an end, I took the Shinkansen (maybe one of my favorite things to do in Japan) to make my way down to Kobe to attend the JUA Annual Meeting. The meeting was extremely well organized, and it was an honor to be invited to the President’s Dinner the evening before the meeting and to have a breakfast meeting with the leadership of the JUA.

Through this trip I had the opportunity to get immersed in a different culture and build professional connections that promise future collaboration. Dr Horiguchi and I are colleagues and now friends, and he visited my institution (University of Washington) just a few months after my return to the US. He gave an excellent grand rounds talk, and it was exciting to have him share his expertise with our department. We met up again at the most recent AUA Annual Meeting and both sat on the board of directors for our society (Genitourinary Reconstructive Surgeons). During our board of directors meeting we had a research brainstorming session led by the president of Genitourinary Reconstructive Surgeons (Dr Hunter Wessells), and Dr Horiguchi presented his basic science work, which sparked interest and was recognized as an invaluable effort to expand our knowledge of stricture disease. To the future scholars, congratulations! You will embark on a trip of a lifetime that will change your own practice, expand your mind through cultural immersion, and challenge you to think about your subspecialty in a global way.