The Development of Urology as a Scientific and Clinical Discipline

Abstract

I T IS A STAGGERING task to attempt to describe development of urology in this space. So many things have happened since end of second World War that this could simply be a list with references to try to help anyone interested in a special topic to find an appropriate source. The best reference to urological history is History of Urology by Leonard J.T. Murphy.' ·' Urology is one of oldest and also one of newest surgical specialties. The Hippocratic Oath interdicts for stone, and suggests it should be left for experts. Fortunately, in these days, cutting for stone is not as common as it used to be. The astonishing development of extracorporeal sound wave lithotripsy changed treatment of urinary calculi immensely. This is probably greatest technical advance in our field . 3 Another classical surgical procedure is still a topic for discussion. Circumcision, which at onc time was widely condemned, is now given respectability as a way to decrease urinary tract infection in boys. The greatest stimulus to urology, as a specialty, occurred with invention of cystoscope. 4 Many years of work led to present superb visualization of urinary tract. One of greatest discoveries was intravenous pyelography by Swick, an American, in early 1930s. , .• Dilatation of prostatic urethra with balloons for benign prostatic hypertrophy (BPH) is under study and currently used.' It is thought to be successful in appropriate cases, but probably not long lasting. In Europe, until after World War II, general surgeons performed most urological surgery. In United States, it became a recognized specialty much earlier and was taught as such. The oldest uTological association in world, American Association of Genito-Urinary Surgeons, was initiated in 1886. Ramon Guiteras founded American Urological Association in 1902, and in 1912 Association declared urology to be a specialty. The International Society of Urology originated in Paris in 1907. The Journal of Urology was introduced in 1917 by Hugh Hampton Young, affectionately known as the father of American urology. 8 The European Association of Urology celebrated its IXth Congress in June 1990. The American Society of University Urologists was organized in 1967. William H. Boyce was first President. Properly, to understand writer's perspective, one should know that when he was in medical school, sulpha drugs, penicillin, and other early antibiotics were first introduced. All other advances mentioned in this report did not exist at that time. Probably introduction of sulpha drugs and antibiotics was single greatest advancement. The concept and development of exiracorporeal lithotripsy is, in my opinion, second greatest contribution. [t is surely greatest technical advancement in urological surgery. 3 Another great surgical advancement eagerly accepted by urology is development of kidney transplantation. This has led to a proliferation of many other types of transplantation, and surely Starzl covers this completely in his report, which is included in this issue. 9 Another tremendous rediscovery in surgical urology has been modern use of intestine as part of urinary tract.1.10 Formerly, Coffey's operation, ureterosigmoidostomy for continent urinary diversion , was only general use of intestine. In past 40 years, intestine has been used in almost every conceivable way. 10 It is used to divert urine to skin, as in Eugene Bricker's operation (uretero-ilio-cutaneous anastomosis). Small intestine is used as a substitute for damaged ureters , and in a number of complicated operations for surgical procedures, to replace and enlarge urinary bladder. ''''' One of greatest achievements in reconstructive urological surgery is reconstruction of urinary space. From 1969 to 1990 these imaginative procedures, after previous diversions, have been reported by W. Hardy Hendren of Boston Children's Hospital. He is a leader in this field. He