You have accessJournal of UrologyHistory of Urology Forum1 Apr 20131117 WHITE'S OPERATION: THE HISTORY OF 19TH CENTURY ATTEMPTS TO TREAT PROSTATE DISEASE WITH ORCHIECTOMY Tristan Nicholson, Sara Best, and William Ricke Tristan NicholsonTristan Nicholson Madison, WI More articles by this author , Sara BestSara Best Madison, WI More articles by this author , and William RickeWilliam Ricke Madison, WI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.709AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Contemporary medical therapies for benign prostatic hyperplasia (BPH) rely on the basic knowledge that the prostate depends on testicular androgens. While the complications of BPH have been known since ancient times, the first elucidation of its hormonal etiology occurred in the late 19th century. Some fifty years before the hormonal regulation of prostate cancer was understood, American surgeons performed surgical castration and relieved the suffering of some BPH patients. METHODS We reviewed primary literature available in PUBMED and papers from the University of Pennsylvania archives. RESULTS Dr. J. William White, MD, PhD (1850-1916) was a prominent American surgeon at the University of Pennsylvania. Among White's contemporaries, theories of BPH development were numerous and included arterial sclerosis, prostate growth compensatory to bladder changes, prolonged ungratified sexual excitement, and second marriages late in life. Dr. White believed a systemic, chemical influence of the testicles drove prostatic hypertrophy. He further extended this idea to suggest that castration would be followed by prostatic atrophy, which he demonstrated in a canine model. In 1893, he presented his experience with patients suffering from end-stage BPH who improved following bilateral orchiectomy. Dr. White followed this with a detailed case series of 111 patients, showing an improvement in urination in 87%. Regarding one patient he reported, “the patient is practically cured.” He was meticulous in reporting clinical courses, as well as ensuing complications. Among his initial cohort, there was an 18% mortality rate following surgery, although some patients were moribund prior to surgery and succumbed to sepsis; excluding these, his mortality rate was 7%. White's operation was adopted by many of his colleagues, although his approach spurred spirited discussion between advocates for castration and early proponents of prostatectomy. The approach pioneered by Dr. White and his colleagues, targeting androgenic maintenance of the prostate, remains today as a mainstay of medical therapy for BPH. CONCLUSIONS The late 19th century was an important time for surgical advances in the treatment of prostate disease. The bold experiments of Dr. White and his contemporaries paved the way for our contemporary understanding of the critical role of sex steroid hormones in BPH. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e457 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tristan Nicholson Madison, WI More articles by this author Sara Best Madison, WI More articles by this author William Ricke Madison, WI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...