Standing the test of time: long-term results of standard procedures in urology

Abstract

The Old Operating Theatre Museum is one of London’s most intriguing historic interiors. It is found in the garret of St Thomas’s Church, Southwark, which was originally a part of St Thomas’s Hospital. It is the oldest of its kind in Great Britain (dating from 1822, a similar age to the Etherdome in Boston) and perfectly illustrates why operating rooms in the United Kingdom are traditionally called ‘theatres’: they tended to be semi-circular amphitheatres with the operating table in the centre to allow students to observe the surgical procedures (Fig. 1). It is only a logical extension of this amusing analogy to the performing arts to note that there are premieres, debuts, re-runs and flops, triumphs and tragedies also in surgery. In this issue of the World Journal of Urology we focus on what in theatrical realms is called the repertoire, i.e. ‘a list of pieces, which a company has rehearsed and is prepared to perform’. Like an opera, a surgical procedure has to stand the test of time, surviving fashions, seasons and cycles before it becomes part of the repertoire. In some cases, it even has to overcome the embittered resistance (and envy) of the opinion-leading establishment: When the young physician Werner Forssmann of Berlin, pioneer of cardiac catheterization (and a urologist), later winner of the Nobel prize, performed his spectacular self-experiments in 1929 [1], his famous fellow-countryman and chief Ernst-Ferdinand Sauerbruch commented scornfully that ‘One does not shove spokes up the vessels. That’s for the circus. A German surgeon does not do such a thing!’ and dismissed him from the Charite. Similar reactions were observed, when extracorporeal shockwave lithotripsy [2], ureterorenoscopy and, most recently, laparoscopy were introduced in urology. What are the features of a surgical procedure to make it part of the repertoire? It should be curative in the first place, cost effective, simple, reproducible, feasible under all circumstances, easy to teach, with a short learning curve and a low complication rate. In addition, its benefits should be durable. For this issue of the World Journal of Urology we have invited international authorities in their respective fields to deal particularly with the latter aspect. They were asked to report their own experiences with a certain technique (presenting some of the largest existing contemporary series) and review the literature providing a reference database for teaching students and residents and informing patients and peers. Taran and Elder critically assess the results of orchidopexy for the undescended testis, one of the most commonly encountered congenital abnormalities of the genitourinary tract. As outcome measures they defined the presence of a viable, palpable testis in the scrotum, fertility and risk of testicular cancer. Their analysis provides a perfect basis for counselling parents of affected children. Wilcox and Snodgrass took on the extremely difficult task of addressing a field which is notorious for the lack of a standard procedure. Stratified according to the type of operation performed they specifically look at voiding abnormalities, cosmetic aspects and sexual function outcome, concluding that more detailed studies into the long-term effect in adult life are required before we can fully understand the impact of our hypospadias repairs. Exactly 100 years after Trendelenburg had described his technique for the surgical reconstruction of the exstrophy bladder [3], Woodhouse, North and Gearhart teamed up to combine a pediatric with an adolescent urologist’s view on this complex subject in a unique transatlantic approach. In their thoughtful dissection of the available data on continence, voiding and secondary complications, they also provide an insight into the E. W. Gerharz (&) Department of Urology, Bavarian Julius-Maximilians-University Medical School, Oberdurrbacher Strasse 6, 97080 Wurzburg, Germany E-mail: Gerharz_E@klinik.uni-wuerzburg.de Tel.: +49-931-20132012 Fax: +49-931-20132013