A brief history of urology at Baylor University Medical Center.

Although recognition of urology as a separate specialty or subspecialty of general surgery is relatively recent, evidence of many diseases and even some surgical procedures dating to ancient times have been discovered, diseases that later came under the purview of urology. Bladder stones have been found in Egyptian mummies dating to several millennia BCE, and the rite of circumcision is thought to have been practiced in Egypt as early as 4000 BCE (Figure ​(Figure11). Ritual circumcision on the eighth day of life was practiced by the ancient Hebrews as evidence of God's covenant with Abraham, a story related in Genesis 17: 10–14. A more elegant artistic portrayal of this ancient rite may be seen in Rembrandt's etching of the circumcision of Christ, a copy of which is included in the Karen G. and Dr. Elgin W. Ware, Jr., collection of prints and drawings at the University of Texas in Austin. Figure 1 Circumcision as practiced in early Egypt. Photo © Christine Osborne/CORBIS The Oath of Hippocrates dating to the fifth century BCE includes the following provision: “I will not cut, even for the stone, but will leave such procedures to the practitioners of that craft.” The practitioners referred to by Hippocrates tended to be concerned primarily with bladder stones, which are known to have been common in the Middle Ages and the Renaissance. These stones, which were probably due to dietary deficiencies and bladder outlet obstruction, were usually found in men. At the end of the pre-Christian era, ancient Hindu surgeons attempted to remove bladder stones through a suprapubic incision, but the operation lapsed until 1556 when Pierre Franco successfully performed this procedure on a child. Two centuries later, the preferred approach was through the perineum, and several surgeons attained prominence as itinerant lithotomists by virtue of having attained a certain proficiency in this procedure. One French lithotomist known as Frere Jacques (Figure ​(Figure2a2a) was said to have performed this procedures in 45 seconds, a record for all time, but it remained for the eminent English surgeon William Cheselden to perfect this approach in the 19th century. The great English diarist Samuel Pepys underwent this operation with outstanding success, relating that he not only was relieved of symptoms but subsequently attained a reputation for sexual prowess, which he attributed to the procedure. The term “lithotomy position” is derived from the perineal approach to the bladder. Figure 2 Surgeons renowned for removing bladder stones: (a) Jacques Beaulieu, also known as Frere Jacques (1651–1714) and (b) Jean Civiale (1792–1867). Photos reprinted from Bush RB, Bush IM, Javadpour N, Landes RR, Wilkey JL. One Hundred Famous ... The procedure for crushing a bladder stone is known as lithotrity, contrasted to the open lithotomy, the proverbial “cutting for the stone.” The first lithotrity was performed in 1824 by Jean Civiale in France (Figure ​(Figure2b2b). Another harbinger of the later development of urology as a specialty was the practice of “water casting,” which involved diagnosing a variety of diseases by the simple expedient of observing the patient's urine in a flask; these practitioners were known as uroscopists or water casters (Figure ​(Figure33). Figure 3 A servant brings a patient's urine to the physician for visual analysis, called “water casting.” Photo © William A. Bake/CORBIS. These and other steps in the evolution of urology as a specialty were forerunners of a number of developments in the 19th century, developments that marked the beginning of a separation from the discipline of general surgery, although the two remained closely associated. In addition, urology was closely associated with dermatology, and for several decades in the early 20th century The Urologic and Cutaneous Review was recognized as a reputable medical journal. One of the first dedicated urologists in this country, Dr. Edward L. Keyes, Sr., began his career as a professor of dermatology. Dr. Keyes was organizer and first president of the American Association of Genito-Urinary Surgeons in 1888. He is remembered for having said of Dr. Hugh Hampton Young, a later urology great and authority on prostate diseases, that “the prostate makes most men old, but it made Hugh Hampton Young.” Perhaps one thing that contributed to the splitting off of urology from general surgery was the development of the cystoscope in the 19th century. Beginning in 1807, a number of instruments were devised to peer into body cavities, but it was not until 1877 that Max Nitze (Figure ​(Figure44), in collaboration with an instrument maker in Dresden, fabricated the first cystoscope. The cystoscope, particularly the Nitze system, was improved during the ensuing years; it was only after the invention of the incandescent lamp by Thomas Edison in 1880 and subsequent miniaturization that an instrument similar to that used today was developed. Figure 4 Max Nitze (1848–1906). Photo reprinted from Bush RB, Bush IM, Javadpour N, Landes RR, Wilkey JL. One Hundred Famous Names in Urology. Northridge, Calif: Riker Laboratories, 1973. Recognition of urology as a separate specialty took a giant step forward with the organization of the American Urological Association (AUA) in 1902, with Dr. Ramon Guiteras as the first president. Since its organization, the AUA has become the standard-bearer of American urology; its publication, The Journal of Urology, was begun in 1917. Today, the AUA is a preeminent organization in American medicine, involved in undergraduate education and research as well as socioeconomic and political affairs. The first 2 decades of the 20th century were closely identified with a colorful figure in the person of Dr. Hugh Hampton Young (Figure ​(Figure55). Dr. Young was referred to by some as the “father of American urology.” Originally from San Antonio, Texas, Dr. Young obtained his bachelor's, master's, and medical degrees from the University of Virginia. He then began a residency in urology under William Stewart Halsted in 1896. In 1897, Dr. Halsted asked him to head the Department of Genito-Urinary Surgery at Johns Hopkins, and Dr. Young spent the remainder of his long and productive life there until his death in 1945. Others who contributed to the specialty lived during this period, including Drs. Bransford Lewis, F. E. B. Foley, Thomas Kirwin, Charles Huggins, Edwin Beer, William Braasch, Henry Bugbee, Frank Hinman, Herman Kretschmer, George Cahill, and many others. Figure 5 Hugh Hampton Young, father of modern American urology. Photo reprinted from Bush RB, Bush IM, Javadpour N, Landes RR, Wilkey JL. One Hundred Famous Names in Urology. Northridge, Calif: Riker Laboratories, 1973.