The history of surgery in disorders of sexual development.

Disorders of sexual development (DSD) have been documented throughout human history with fascination. Healers of all cultures have struggled to explain, and later correct with surgery, the physical manifestations of DSD. DSD was portrayed in the mythology, legends, and art of the ancient Greeks, Romans, Sumerians, Babylonians, and Egyptians. Techniques of feminizing genitoplasties date to the time of Celsus in the time of Christ. Acceptable operative therapy for feminine phenotypes of DSD came in the 19th and 20th centuries. Masculinizing procedures, inherently more complex than feminizing genitoplasties, initially were variations of procedures for severe forms of hypospadias. Today most total penile reconstruction procedures use reconstructive and microvascular techniques invented in 20th century.

The history of the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction.

AIMS: To review the history of the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). METHODS: We reviewed Society meeting minutes, contacted all living former Society presidents, searched the William P. Didusch Center for Urology History records, and asked Society members to share their important Society experiences in order to gather important historical information about the Society. RESULTS: The Society initially formed as the Urodynamics Society in 1969 in the backdrop of a growing passion for scientific research in the country after World War II ended. Since then, Society meetings have provided a pivotal forum for the advancement of science in lower urinary tract dysfunction. Meetings occurred annually until 2004, when the meeting schedule increased to biannual. The journal, Neurourology and Urodynamics, became the official journal of the Society in 2005. SUFU has authored important guidelines on urodynamics (2012), non-neurogenic overactive bladder (2012), and stress urinary incontinence (2017) and has shared important collaborations with other societies, including the American Urological Association (AUA), the International Continence Society (ICS), and the International Society of Pelvic Neuromodulation (ISPiN). SUFU has also been instrumental in trainee education and helped to establish formal fellowship training in the field in addition to holding a yearly educational meeting for urology residents. The Society has been led by 21 presidents throughout its history. CONCLUSION: Throughout the Society's near half-century long existence, the Society has fostered research, published guidelines, and educated trainees in order to improve the care of individuals suffering from lower urinary tract dysfunction.

A Historical Review of Gender-Affirming Medicine: Focus on Genital Reconstruction Surgery.

Gender dysphoria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) is characterized by a marked discrepancy between one's birth-assigned sex and one's gender identity and is sometimes addressed by gender-affirming surgery. As public visibility and institutional support for the transgender and gender non-conforming population continue to increase, the demand for competent multidisciplinary teams of medical professionals equipped to care for this population is expected to rise-including plastic surgeons, urologists, gynecologists, endocrinologists, and breast surgeons, among others. Genital reconstruction procedures for the male-to-female and female-to-male transgender patient present unique surgical challenges that continue to evolve from their respective origins in the 19th and 20th centuries. A historical review of surgical techniques and standards of care attendant to gender-affirming medicine is presented, with foremost emphasis placed on how techniques for genital reconstruction in particular continue to evolve and advance. In addition, the current status of transition-related health care in the United States, including research gaps and contemporary clinical challenges, is reviewed. Frey JD, Poudrier G, Thomson JE, Hazen A. A Historical Review of Gender-Affirming Medicine: Focus on Genital Reconstruction Surgery. J Sex Med 2017;14:991-1002.

Early hypospadias repair: the contributions of Harvey Cushing.

PURPOSE: The early evolution of surgical reconstructive techniques has been well documented in the literature. However, a review of the Johns Hopkins hospital surgical files revealed an interesting participant in early hypospadias repair: Harvey Cushing (1869-1939). METHODS: Following IRB approval, we reviewed the surgical records from 1896 to 1912 and selected from among his non-neurosurgical patients, one case of first-stage hypospadias repair. RESULTS: Cushing operated upon the 21-year-old patient, performing a first-stage repair of hypospadias, in conjunction with a repair of a right inguinal hernia. The patient was discharged following a second stage operation. At that time, the patient was in good condition and was voiding appropriately. There was no further follow-up. CONCLUSION: The repair of hypospadias evolved through the work of European surgeons, from the mid-eighth century through the early nineteenth century. The case we report here illustrates Cushing's early work in the fields of urologic and plastic surgery.

Conocimiento de las enfermedades urogenitales en la obra de Gaspar Casal, «Historia natural y médica del Principado de Asturias» (1762) / Knowledge of the urogenital diseases in the work of Gaspar Casal, «natural and medical history of the Principality of Asturias» (1782)

OBJETIVO: Gaspar Casal (Gerona 1680, Madrid 1759) realiza la mayor parte de su obra médica en Oviedo, donde vive treinta y cuatro años, antes de volver a Madrid como médico de la Real Cámara. Fruto de su trabajo en Asturias es el libro póstumo «Historia natural y médica del Principado de Asturias» (Madrid, 1762), considerado el mejor exponente de la medicina española del siglo XVIII, y donde se describe por primera vez el «mal de la rosa», más tarde llamada pelagra o avitaminosis B. MÉTODOS: Estudio de la vida de Gaspar Casal y análisis de su única obra «Historia natural y médica del Principado de Asturias», especulando sobre el conocimiento de las enfermedades nefro-urológicas y genitales que se deduce de este texto. RESULTADOS: Casal conoce y trata la litiasis renal, que relaciona en unas ocasiones con las dolencias articulares y la gota, y en otras con la abundancia de comida y la vida sedentaria. Otras enfermedades acompañadas de poliuria y edemas que describe, son compatibles con el diagnóstico actual de nefritis infecciosa o degenerativa. Utiliza en pocas ocasiones el sondaje vesical en los casos de estranguria y anuria, incluye posiblemente en el término de «iscuria renal o supresión alta» a algunos enfermos con anuria y a otros con retención de orina, aunque también usa el término «iscuria vesical» para estos últimos. Los síntomas disuria-estranguria y hematuria, los trata sólo con terapia empírica, y se intuye en su texto que para los cirujanos locales no era habitual el alivio de estos síntomas mediante el sondaje uretral. Atiende una epidemia de paperas, con orquitis en los varones, que trata mediante sangrías, aunque se mostró contrario al abuso de las mismas. Sólo ocasionalmente hace tratar quirúrgicamente ciertas enfermedades testiculares. CONCLUSIONES: «Historia natural y médica del Principado de Asturias» refleja el espectro de las enfermedades que en la primera mitad del siglo XVIII ocupaban el trabajo de un médico, a saber, las derivadas de las carencias alimentarias, infecciosas, parasitarias y las degenerativas y vásculo-cerebrales en personas añosas. Desde el punto de vista nefro-urológico, es muy interesante comprobar el conocimiento en esa época de la enfermedad litiásica y de los síntomas del tramo urinario inferior, tratados al modo recomendado por los clásicos, con tratamiento físico y preparados empíricos, pocas veces con sondaje; y, en menor medida, los resultados del tratamiento médico de las orquitis y el tratamiento quirúrgico de algunas lesiones testiculares (AU)

OBJECTIVES: Gaspar Casal (Gerona, 1680, Madrid, 1759) made most of his medical work in Oviedo (Asturias, Spain), where he lived for thirty-four years, before his return to Madrid as a doctor for the Royal House. Fruits of this work is the book «Natural and medical history of the Principality of Asturias» (Madrid, 1762), considered the best exponent of the Spanish medicine of the 18th century, and where the «disease of the rose», known later as pellagra or hypovitaminosis B, was first described in. METHODS: Study of the life of Gaspar Casal and analysis of «Natural and medical history of the Principality of Asturias», speculating on the knowledge about nephro-urologic and external genitalia diseases that can be deduced from the text. RESULTS: Casal knows and treats kidney lithiasis, relating it either to joint diseases and gout, or to dietetic excess and sedentary life in some of his patients. Other diseases coursing with poliuria and oedemas, are compatible with the nowadays diagnosis of infectious or degenerative nephritis. He rarely uses a bladder catheter for cases of stranguria and anuria, probably including some patients with anuria and others with urinary retention in the term «renal ischuria or high suppression», although he also uses the term «vesical ischuria» for the last ones. He treats the symptoms disuria-stranguria and haematuria, with empiric therapy, and, as it may be deduced from the text, some local surgeons didn't use or know to alleviate those symptoms with urethral catheterisation. He attends an epidemics of mumps, with orchitis in male patients, that were treated with bloodletting, although he stood against the misuse of phlebotomy in several diseases. Only occasionally he orders surgical treatment for several testis diseases. CONCLUSIONS: «Natural and medical history of the Principality of Asturias» reflects the spectrum of diseases that conforms the day-to-day working schedule of a Spanish family doctor in the beginning of the 18th century, that is to say: diseases resulting from dietary shortage, infective, parasite, degenerative and vascular-cerebral diseases in older patients. From the nephro-urologic point of view, it is very interesting to read about the knowledge on stone diseases and lower urinary tract symptoms, that were treated as recommendedby the classic authors, with physical therapy and empiric formulas, rarely with bladder catheterization. To a lesser degree, the results of the medical treatment of orchitis and the surgical treatment of some testis diseases are also depicted (AU)

Inicio de la docencia urológica en la universidad española. Dr. Alberto Suárez de Mendoza / The start of urological teaching in the Spanish University. Dr. Alberto Suárez de Mendoza

OBJETIVO: Presentamos la semblanza del Dr. Suárez de Mendoza, uno de los primeros urólogos formado en Urología en el Hospital Necker, de París, junto al Dr. Guyon, que abrió el campo a la creación de la especialidad en España y el primer profesor oficial de la asignatura en la Facultad de Medicina de Madrid. MÉTODO: Hemos revisado su expediente académico en el Archivo Histórico Nacional y buscado datos en la Facultad de Medicina y en el Colegio de Médicos madrileño sobre su presencia en España. Extraído de los Reales Decretos información sobre la escuela libre de Medicina y la creación de las especialidades médicas en los planes de estudios universitarios y, por último, analizamos su obra escrita. RESULTADO/CONCLUSIÓN: Consideramos al Dr. Suárez de Mendoza una de las personalidades que dieron entidad a la Urología en nuestro país, por su formación, por su amplitud de saberes y por su vasta experiencia, como profesor de la asignatura en la Universidad española, como autor de un gran número de trabajos publicados y como inventor por sus aportaciones al desarrollo de la anestesia y de la Urología. Su tratado, el primero en español que recoge con detalle las primeras innovaciones en los medios de exploración urológicos, nos permite conocer y valorar el progresivo avance y evolución del conocimiento que presenta la Urología

OBJECTIVES: We present a biographical sketch of Dr. Suarez de Mendoza, one of the first urologists trained as so in the Necker Hospital in Paris with Dr. Guyon, who opened the field to the creation of this speciality in Spain, and first official professor of the subject of in the Faculty of Medicine of Madrid. METHODS: We reviewed his academic expedient in the National Historical Archive and search for data about his presence in Spain in the Faculty of Medicine and Medical College of Madrid. From the Royal Decrees we obtained information about the Free School of Medicine, and the creation of medical specialities in the University study plans; finally, we analyzed his written works. RESULTS /CONCLUSIONS: We consider Dr. Suarez de Mendoza one of the personalities giving entity to Urology in our country, for his education, for the amplitudeof his knowledge, and for his wide experience, as professor of the subject in the Spanish University, as author of a great number of published works, and as inventor of his contributions to the development of anesthesia and urology. His treaty, the first in Spanish coveringin detail the innovations in urological examination methods, enables us to know and value the progressive advance and evolution of knowledge in urology

El magisterio del profesor D. Francisco Romero Aguirre / The teaching of Dr. Romero Aguirre

Objetivo: Con ocasión del fallecimiento del profesor D. Francisco Romero Aguirre (Zaragoza, 7.IV.1918-28.VI.2006) queremos poner de manifiesto su gran vocación docente, para lo que recorremos su vinculación a la Universidad desde el comienzo de sus estudios hasta su magisterio como primer catedrático de Urología de la Licenciatura en la Universidad española (1961), y su labor al frente de la Escuela Profesional de postgrado en Urología de la Universidad de Zaragoza. Métodos: Revisamos su biografía, su obra editada y las publicaciones de la Cátedra de Urología de la Universidad de Zaragoza y extraemos cuantas referencias encontramos de su actividad docente. Resultado: Desde el inicio de su formación académica mantuvo una constante unión con la Universidad y colaboró en todas las disciplinas con las que tuvo relación hasta lograr ser responsable de la enseñanza de la Urología. Su talante universitario y su gran preparación hicieron ver al catedrático de Patología Quirúrgica la conveniencia de separar la Urología del tronco común de la Cirugía, propuesta que, aceptada por el claustro de la Facultad de Medicina de Zaragoza y elevada al ministerio, dio lugar a la designación de la Urología como asignatura independiente en la Licenciatura de Medicina. Su labor como responsable estuvo marcada por el trabajo y constantes logros en las clases, por numerosas publicaciones, por realización de cursos de doctorado y monográficos de Urología y por la dirección de tesis y memorias, todo lo cual permitieron la creación de la Escuela profesional de especialización urológica con la que culminaron sus más de cuarenta años de dedicación al magisterio universitario. Conclusión: Encontramos en el profesor Romero una vida dedicada íntegramente entregada a la Universidad y a su magisterio. Su gran formación urológica y propedéutica hicieron que fuese la persona que reunía las condiciones y las aptitudes necesarias para hacerse cargo y desempeñar satisfactoriamente el puesto, en la Facultad de Medicina de Zaragoza, de responsable de la enseñanza de la Urología, que, gracias a su virtud y buen hacer, fue elevada por vez primera en la Licenciatura española al rango de asignatura (AU)

Objectives: After the death of Professor Francisco Romero Aguirre (Zaragoza 6/7/1918-6/28/2006) we want to make known his great teaching vocation, so that we covered his link with University from the start of his studies to his professorship as first professor in urology in the Spanish University (1961), and his work at the chairmanship of the Professional Postgraduate School of Urology in the University of Zaragoza. Methods: We reviewed his biography, his edited works and publications of the Urology Chair at the University of Zaragoza, and obtained as many references as we found about his teaching activity. Results: From the start of his academic training he kept a constant union with University and cooperated in all disciplines he had relation with before he got the responsibility of teaching urology. His university spirit and great formation had the chairman of surgical pathology see the convenience of separating urology from the common trunk of surgery, a proposal that, being accepted by the staff meeting of the Faculty of Medicine of Zaragoza and submitted to the Ministry resulted in the designation of urology as an independent subject in the degree of medicine. His labour as responsible was marked by work and continuous achievements in his classes, many publications, doctorate and urological monographic courses carried out, thesis and memories directed, all of which enabled him to create to the Professional Urological Specialization School, the culmination of more than 40 years dedicated to teaching in the university. Conclusions: We find Prof. Romero’s life completely dedicated to University and teaching. His wide urological and propedeutical formation made him a person who joined the necessary conditions and abilities to take the responsibility and carry out a satisfactory performance as responsible of teaching urology in the school of medicine of Zaragoza, a subject which thanks to his virtue and good performance was for the first time elevated to the level of independent subject (AU)

Hojas urológicas del Dr. Narciso Serrallach Mauri, escritas hace casi 100 años / No disponible

Se expone un resumen de los trabajos y comentarios más interesantes del Dr. Narciso Serrallach Mauri, presentados en Hojas Urológicas, revista que bajo su propia dirección editó de forma continuada desde 1913 hasta 1935, anual o semestralmente. En ella pueden encontrarse los temas urológicos que en aquel entonces eran de mayor actualidad y despertaban el mayor interés así como las publicaciones y actividades de las sociedades médicas donde desarrolló su actividad profesional urológica. Se hace hincapié también en la valoración de su actividad en relación al estado de la ciencia y de la sociedad en el periodo estudiado (AU)

We present a summary of the most interesting works and commentaries by Dr. Narciso Serrallach Mauri, presented in Urological Records, a journal edited under his direction continuously from 1913 to 1935, annually or every six months. The state-of-the-art urological topics of the time rising the highest interest can be found in the journal, as well as in the publications and activities of the medical societies where he carried out his professional urological activity. We also emphasize the evaluation of his activity in relation to the estate of science and society at his time (AU)

[Burch procedure: experience of 45 years of history]. / Operación de Burch: experiencia a 45 años de historia.

It has been 45 years since John C. Burch first described his "colposuspension of the Cooper's ligament" technique for the surgical management of stress urinary incontinence. Half a century later, his legacy remains alive. His technique, and its further modifications, still occupies a privileged place among the surgical options for the management of the stress urinary incontinence. Even now, Burch procedure is considered the gold standard with which all the other new techniques must be compared in order to measure their effectiveness. In the past few years, there have been important advances in the knowledge and standardization of the female urodynamics. This has increased the accuracy of the medical assessments to have a better selection for this surgical procedure. Then, with the technique focused on such cases, the results of the procedure have been optimized, considering that its complications are not serious and they are relatively infrequent. The success rates of this technique are up to approximately 90% in 5 to 10 years follow-ups and 69% in 10 to 20 years follow-ups. Therefore, it is believed that Burch's urethropexia continues contributing greatly to the management of the stress urinary incontinence. This revision includes 33 articles, all of them related with this matter from Ovid database.

Urogenital surgery of the 15th century in Anatolia.

PURPOSE: We examined the urological procedures of the 15th century covered in the surgery textbook, Cerrahiyyetu'l Haniyye. MATERIALS AND METHODS: Three copies of the surgery textbook, Cerrahiyyetu'l Haniyye (Sultan's Surgery), by Serefeddin Sabuncuoglu, who lived in Turkey between 1385 and 1470, were evaluated. The colorfully miniaturized and illustrated textbook, written 536 years ago, covers a number of surgical disciplines, including urology. We evaluated urological sections with regard to the type of procedures, definitions and approaches for certain diseases and surgical tools used for urological operations. RESULTS: The textbook reviews the surgical treatment of urological conditions such as varicocele, hydrocele, hermaphroditism, imperforated urinary meatus, meatal stenosis, hypospadias, penile and scrotal lesions, and circumcision techniques. It includes definitions of diseases, etiologies and surgical therapies, and describes surgical instruments. The author also illustrated surgical approaches and instruments. CONCLUSIONS: A treasure trove of surgical knowledge, Cerrahiyyetu'l Haniyye has enlightened urologists from the 15th century to the present day.

Reconstruction of seminal ducts in obstructive azoospermia.

Depending on the localization of the obstruction of the seminal ducts, either a microsurgical reconstruction (tubulovasostomy, vasovasostomy) or a transurethral resection of the ejaculatory ducts is carried out. We have compared the effectiveness and economic advantages of reconstructive microsurgery of the epididymis and vas deferens with standard procedures in animal experiments. Microsurgical invagination techniques in tubulovasostomy are equal to the standard procedure from the point of view of the patency and fertility rates. They are also easier to learn and carry out. Less time is required for the invagination technique, and also less microsurgical suture material. The double-layer technique in vasovasostomy is equal to the one-layer microsurgical technique from the point of view of patency and fertility rates. The one-layer technique requires less time and suture material. It seems that the discrepancy between the patency and the fertility rate is related to immunological processes after reconstruction of the seminal ducts. In cases of obstructive azoospermia it is necessary to investigate the individual conditions and possibilities of the infertile couple. As a result of the high success rate obtainable today by surgical reconstruction of the seminal ducts, this must constitute the first type of treatment to be considered, before any of the procedures of reproductive medicine are undertaken.

From the history of penis reconstruction.

The authors present an account of the history of penis reconstruction following a diagnosis of transsexualism as well as after loss due to injury or for oncological reasons. A basic review is presented of the classical as well as microsurgical reconstruction methods.