Five historical innovations that have shaped modern urological surgery.

Throughout history, many innovations have contributed to the development of modern urological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern urological surgery: External shockwave lithotripsy, transurethral resection of prostate, cystoscope, perioperative prostate-specific antigen and robotic surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of urological surgery and their ongoing relevance in contemporary and perioperative practice.

The state of TURP through a historical lens.

In 1926 Maximilian Stern introduced a new instrument to treat obstructions at the vesical orifice and baptized it resectoscope. With reference to astonishing historical statements about the new instrument and surgical technique made by the pioneers and their critics we will value why transurethral resection of the prostate (TURP) remains the gold standard for most men suffering from lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. TURP is currently challenged by recently introduced new instruments and techniques claiming advantages over TURP. However, TURP offers an excellent balance between high efficacy in symptom relieve and low morbidity along with low costs and favorable long term outcome compared to other treatment options. We will outline these arguments demonstrating that even after a century has elapsed, since its introduction into the urologists armamentarium, TURP continues to stand the passage of time.

Centenario de la RTU de próstata. (Valoración crítica de su evolución) / Centenary of TURP. Critical appraisal of its evolution

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Historical evolution of transurethral resection at the University of Iowa: Alcock and Flocks.

PURPOSE: In 1935 Nathaniel G. Alcock proclaimed that transurethral resection of the prostate "...cannot be taught and can be learned only by hard, tedious experience." However, his resident assistant, Rubin H. Flocks, added basic science and anatomical knowledge to Alcock's surgical experience to create a body of work that even today provides insight into the complexities of transurethral prostatic resection. MATERIALS AND METHODS: Even as Alcock studied preoperative and postoperative urethrography images to provide demonstration of the enlarged prostate, he firmly believed in the learning curve of surgical proficiency. However, when Alcock and Flocks began studying autopsy material they were able to pinpoint distribution of the prostatic blood supply, and demonstrate techniques to control bleeding and perform transurethral resection in an organized fashion. Autopsy specimens also demonstrated the previously unrecognized correlation between incomplete resection and complicated wound healing. Flocks' further work with surgical illustrations demonstrated an optimal technique. RESULTS: In his 1932 report to the American Urological Association Alcock detailed not only his surgical success, but also his mortality rate related to resection and prostatic obstruction and its complications. In autopsy specimens with barium sulfate injections into prostatic blood vessels Flocks demonstrated that complete resection of prostate adenoma was possible and produced the desired outcome with good wound healing. CONCLUSIONS: The strong collaboration between Alcock and Flocks, particularly during the 1940s, culminated in a movie presentation of the prostatic resection technique as viewed from inside the bladder antegrade toward the prostate that remains a model for surgical practice today.

Mis comienzos en laparoscopia / My first steps in laparoscopic surgery

OBJETIVO: El autor describe algo de sus comienzos en laparoscopia, de dónde le vinieron algunas de sus ideas, el porqué y los medios con que contó al empezar. Cuenta brevemente su aportación a la Urología, que puede servir de modelo para los que están empezando. MÉTODOS: Desde que el autor era un adolescente, su padre, que era urólogo, supo transmitirle el entusiasmo por su trabajo; se sentía atraído por el instrumental desde el litotritor de Freyer hasta el resector de Iglesias. También se interesó especialmente por los libros de urología antiguos. Le causaba especial admiración ver operar en directo a don José María Gil Vernet y cuenta que fue el primer urólogo al que le vio usar un laparoscopio para el diagnóstico del testículo abdominal. En 1985, mientras estaba en la universidad de Oxford, se le ocurrió diseñar un sistema de balón para disecar el espacio retropúbico, que al cabo de los años daría lugar a la cirugía extraperitoneal. Al año siguiente tras leer el manual de laparoscopia de Semm, describió la varicocelectomía laparoscópica. Entre sus trabajos destaca el haber descrito en 1993 por primera vez la técnica de la cistectomía radical con conducto ileal laparoscópico. En 1997 ideó un sistema robótico, mediante brazo maestro esclavo, concebido inicialmente para la resección transuretral. RESULTADOS/ CONCLUSIONES: Considera que una buena idea es algo valiosísimo, que no tiene precio, porque a todo aquel que tenga ambiciones y la consiga, le permitirá salir de la mediocridad

OBJECTIVES: The author describes his first steps in laparoscopic surgery and the sources of some of his ideas. He thanks his father’s influence and the technical stimuli that catalysed his scientific curiosity. For the benefit of young urologists at the beginning of their careers he shows how the frustrations of working with the early instruments became the vital challenges that inspired creative solutions. METHODS: His urological surgeon father inspired in his young son a passion for his calling. He developed an immediate and compelling interest in the shape and function of urological instruments like, for example, Freyer’s lithotripter and the Iglesias resectoscope. Books of urological history and the works of pioneer urologists fascinated him. Watching José María Gil Vernet operate particularly impressed him and he says that Gil Vernet was the first urologist he saw using a laparoscope to diagnose an abdominal testicle. While working in an Oxford University hospital in 1985, he designed a balloon device to dissect the retropubic space. This procedure was the precursor of what several years later became extraperitoneal surgery. The following year, he read the manual of Semm’s laparoscopy and later described a laparoscopic varicocelectomy. In 1993, he published the first description of a laparoscopic radical cystectomy and ileal conduit. In 1997, he adapted a surgical robotic system with a master-slave arm to carry out firstly a transurethral resection. RESULTS/CONCLUSIONS: He says that a good idea is beyond price because it helps the inspired individual to make true a long-held ambition and achieve the signal success that lifts him out of the mud of mediocrity