372 The contribution of Sir Thomas Spencer Wells to urology

Abstract

INTRODUCTION AND OBJECTIVES: Jozef Dietl was one of the greatest European physicians of the 19th century. During a time when primitive and frequently harmful therapeutic methods existed, he was progressive and rational. We explore the life and contributions of Jozef Dietl, with a focus on his description of 00Dietl0s Crisis00 and his impact on Urology. METHODS: A review of the literature was completed, both in English and German, reviewing the life of Jozef Dietl, as well as a literature search for the terms 00Dietl0s Crisis00, 00nephroptosis00, and 00ureteropelvic junction obstruction00 (UPJO). RESULTS: In 1864 Dietl described the symptoms attributable to a kink in the ureter or renal vessels when a mobile kidney descended, resulting in sudden attacks of abdominal pain, nausea, and vomiting, known as 00Dietl0s Crisis00. Initially used to describe a 00wandering kidney00 that caused symptoms when it turned upon its pedicle, creating a partial incarceration, nowadays the term 00Dietl0s Crisis00 is used to ascribe the symptoms of any UPJO. Dietl promoted conservative approaches of abdominal support using corsets, abdominal belts, and finally, placing gentle pressure on the lower pole of the kidney to slide it posteriorly towards the lumbar region for relief of prolonged pain. CONCLUSIONS: Jozef Dietl was one of the most influential European physicians of the 19th century as well as a renaissance man, playing significant roles in improving hospital hygiene, using evidence based medicine to stop bloodletting in treating pneumonia, promoting the concept of therapeutic nihilism to allow the body to heal itself, and classifying and advocating therapeutic hot springs. He also had political interests, serving as mayor of Krakow for 8 years, during which time he reformed the educational system. Despite all these varied accomplishments, he remains best known for his contribution to Urology in describing 00Dietl0s Crisis00.