FR01-09 THE HUTCH DIVERTICULUM

Abstract

INTRODUCTION AND OBJECTIVE: In the history of the specialty of urology, multiple surgical techniques for the treatment of bladder diverticula and correction of vesicoureteral reflux have been described. The purpose of this study is to tell the unique story of the discovery of the “Hutch diverticulum” and the first surgery for its repair. METHODS: Literature review of published articles as well as primary source texts including surgical logs from the McGuire Veterans Administration (VA) Medical Center in 1950-1952 containing operative details and technique. RESULTS: John Hutch was a pioneering expert in neurogenic bladder and ureterovesical reflux, best known for discovering the “Hutch diverticulum" and his initial surgical technique for the treatment of this condition. John Hutch completed his urology training under Carl Bunts between 1948 and 1951 at the McGuire Veterans Affairs Hospital in Richmond, VA, where there was a strong focus on spinal cord injury (SCI) patients after World War II. Carl Bunts implemented a two-film cystogram protocol for all SCI patients and created a database of the films. He worked with his resident, John Hutch, to identify surgically treatable causes of upper tract deterioration in the SCI population. Together, they demonstrated that 13% of SCI patients developed reflux 3-years post-injury. Of these, 34.5% required nephrostomy tubes. In addition, most urologic mortality (64.3%) was due to reflux complications. In their second study of 300 cystograms, 94 showed reflux, and of those individuals, 60/94 (63.8%) showed outpouchings at the uretero-vesical junction, postulated to cause reflux. Acting on this information, they performed the first ureterovesicoplasty on May 17th, 1950. This led to a series of operations in which the Bunts-Hutch team demonstrated successful resolution of reflux in 7/9 cases, restored kidney function in 3/3 cases, and successful maintenance of postoperative kidney function in 6/6 cases. This culminated in Hutch winning first prize in the 1951 AUA essay competition. However, because the competition rules only permitted one author, Dr. Bunts allowed his resident to be the sole author on the paper; hence, the “Hutch diverticulum" was coined. CONCLUSIONS: John Hutch and Carl Bunts used an innovative imaging database to make early observations on vesicoureteral reflux and perform the first ureterovesicoplasties. The “Hutch diverticulum" (perhaps better called the Bunts-Hutch diverticulum) and the description of its surgical repair laid the groundwork for improved understanding and treatment of neurogenic and pediatric vesicoureteral reflux. Source of Funding: None