The development of urology as a scientific and clinical discipline.

I T IS A STAGGERING task to attempt to describe the development of urology in this space. So many things have happened since the end of the 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 the History of Urology by Leonard J.T. Murphy.' ·' Urology is one of the oldest and also one of the newest surgical specialties. The Hippocratic Oath interdicts "cutting 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 the treatment of urinary calculi immensely. This is probably the 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 the invention of the cystoscope. 4 Many years of work led to the present superb visualization of the urinary tract. One of the greatest discoveries was intravenous pyelography by Swick, an American, in the early 1930s. , .• Dilatation of the 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 the United States, it became a recognized specialty much earlier and was taught as such. The oldest uTological association in the world, the American Association of Genito-Urinary Surgeons, was initiated in 1886. Ramon Guiteras founded the American Urological Association in 1902, and in 1912 the 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 the first President. Properly, to understand the 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 the introduction of sulpha drugs and antibiotics was the single greatest advancement. The concept and development of exiracorporeal lithotripsy is, in my opinion, the second greatest contribution. [t is surely the greatest technical advancement in urological surgery. 3 Another great surgical advancement eagerly accepted by urology is the 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 the modern use of intestine as part of the urinary tract.1.10 Formerly, Coffey's operation, ureterosigmoidostomy for continent urinary diversion , was the only general use of intestine." In the past 40 years, intestine has been used in almost every conceivable way. 10 It is used to divert urine to the 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 the urinary bladder. ''''' One of the greatest achievements in reconstructive urological surgery is reconstruction of the 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