From novelty to the every-day: the evolution of ureteroscopy.

Ureteroscopy revolutionized the surgical approach to the upper urinary tract, and is well recognized as a cornerstone of modern urology. Although now commonplace, ureteroscopic equipment and techniques were truly revolutionary. A review of the innovations and innovators that developed ureteroscopic surgery sets the stage for a more thorough understanding of what can be done ureteroscopically, and may additionally better inform what limitations remain. Given that future advancements in urologic therapy will be dependent upon a similar pursuit of paradigm shifting improvements in disease management, an overview of the development of modern ureteroscopy may inspire such change.

Death of the Safety Guidewire.

The safety guidewire has been an integral tool in endourologic percutaneous and ureteroscopic procedures for the last three decades, providing access to the collecting system or ureter in the event of loss of renal contact or ureteral perforation, respectively. However, recent advances in endourologic techniques and instrumentation have obviated the need of routine safety guidewire placement. Today the establishment of a "through-and-through" flank to urethral meatus guidewire eliminates the need of an additional guidewire during percutaneous procedures. Likewise, the availability of smaller flexible ureteroscopes, as well as modern ureteral access sheaths, has reduced the necessity of safety guidewire placement in ureteroscopic procedures. Herein, we trace the historical development of the safety guidewire concept, review recent advances in technologies that have obsoleted the safety guidewire, and evaluate recent data suggesting that continued use of a safety guidewire during ureteroscopic procedures may indeed be counterproductive.

Where next for the endoscope?

The concept of examining the body's interior and its organs dates back to ancient times. The roots of modern endoscopy lie in early nineteenth century Europe, and the intervening centuries have seen a steady evolution of devices and techniques. Nowadays, a wide variety of urinary tract disorders are successfully managed in a minimally invasive manner thanks to the endoscope and related technologies. Distal-sensor, 'digital', endoscopes have the potential to revolutionize the field, and change the way in which we use and think about endoscopy. Virtual endoscopy, capsule endoscopy, and a range of other techniques derived from physics and molecular biology all promise great improvements in visualization of the urinary tract and other urologic structures. Ultimately, the continued improvement of these minimally invasive technologies will enhance the quality of care that we can offer our patients.

[Introduction of cold light to endoscopy]. / Die Einführung des Kaltlichts in die Endoskopie.

It is the aim of the paper to describe how, 40 years ago, optic glass fibers were developed, and what has been K. Storz's contribution to the new technology. In 1951 the term "Cold Light" was used the first time for illumination of a French type film- and photoendoscope. In 1957 the gastroenterologist B. Hirschowitz at Ann Arbor, U.S.A. succeeded making glass fibers of high light-guiding properties. In 1961 the Cystoscope Makers Inc (ACMI) at New York using these fibers brought the first flexible gastroscope on the market, still equipped with a conventional electric lamp. But in 1960, the year before, the physicist's of ACMI, J. H. Hett and L. Curtiss built the first cold light endoscope using glass fibers for both light and images conduction. In the following years ACMI equipped all of his endoscopes with this new type of illumination. Not before 1963 did K. Storz and the other German manufacturers produce their first cold light cystoscopes. Not possessing the know-how of glass fiber manufacturing, they had to get their fibers from abroad. K. Storz transmitted the term "cold light", which before had been the label of his French-type endoscopes, to the new glass fiber illumination. He constructed an excellent light source for fiber illumination without having light cables of his own fabrication. That is why his name is intimately connected with cold light illumination. But, nevertheless, the invention of the new glass fiber illumination must be credited to B. Hirschowitz and the physicists of ACMI in the U.S.A.

[Birth and development of ureterorenoscopy]. / Inicio y desarrollo de la ureterorrenoscopia.

In this paper we describe the history of the development of rigid ureterorenoscopy. It started in 1979 and today is a reality in most urological departments of the world. From the first ureterorenoscope with a extraordinarily large caliber and no dilation or operative systems, the current technique have developed, so that from hydraulic water pump to laser fragmentation have enabled to make ureterorenoscopy a common procedure for the resolution of urinary stones, extraction of foreign bodies in the ureter or kidney, treatment of stenosis, diagnosis of unilateral hematuria and endourological treatment of selected urothelial tumors.

Carlos Younger de la Peña (1920-1996). "La urología madrileña en la segunda mitad del siglo XX" / Carlos Younger de la Peña (1920-1996). "Urology in Madrid during the second half of the 20th Century"

Carlos Younger de la Peña (1920-1996) fue uno de los urólogos representativos en su época, tanto de la Urología en general como de la escuela madrileña en particular, durante los cuarenta años comprendidos entre 1945 a 1985. Su formación profesional estuvo vinculada al Servicio de Urología del Hospital de la Princesa dirigido por el doctor Pedro Cifuentes Díaz y posteriormente por el doctor Luis Cifuentes Delatte. La importante influencia de la Urología francesa llevaría a Carlos Younger a completar sus estudios en los Servicios de Urología de los profesores J. Cibert (Lyon), Truc (Montpellier) y Couvelaire (París). A su regreso de Francia realizaría su Tesis Doctoral con el título de “Estudio experimental de la Ureterosigmoidostomía según la técnica de CoffeyI” dirigida por el profesor J. García Orcoyen en 1957. Sus primeras publicaciones comienzan en 1946 finalizando con cerca de las cien, incluyendo las comunicaciones a los distintos Congresos y Reuniones de la Especialidad. Establecido en su Clínica particular de la madrileña callede Ferraz alterna su práctica profesional entre los enfermos de la Seguridad Social y el Hospital Central de la Cruz Roja. Al final de su vida había recogido cerca de las 10.000 historias clínicas. Perteneció a distintas Sociedades científicas (entre ellas la Internacional de Nefrología) y recibió diversos Premios como el de la Asociación de Cirujanos de la Infancia por su trabajo “Extrofia Vesical” y el de la Academia de Medicina de Valladolid por su estudio “Hipertensión Vasculorrenal”. En 1961 efectuaría el segundo homotrasplante renal en España. Su interés profesional se centró preferentemente en la uro-oncología, la urología infantil, la urología ginecológica y la cirugía endoscópica. Dejaría numerosos discípulos con los mismos intereses. La vida profesional de Carlos Younger de la Peña, en el periodo analizado, es muy significativa de la evolución de la Urología y de los urólogos durante medio siglo

Carlos Younger de la Peña (1920-1996) was one of the representative urologists of his time, both in urology as a whole and particularly in urology in Madrid, during the 40 years between 1945 to 1985. His professional training was linked to the department of urology in the “La Princesa” Hospital chaired by Dr. Pedro Cifuentes Díaz first and Luis Cifuentes Delatte posteriorly. The important influence of French urology led Carlos Younger to complete his studies in the departments of urology chaired by professors J. Cibert (Lyon), Truc (Montpellier) and Couvelaire (Paris). When he returned from France he completed his doctoral thesis with the title “Experimental study on the ureterosigmoidostomy type Coffey I” directed by Prof. J. Garcia Orcoyen in 1957. His first publications started in 1946 and he ended with almost 100, including communications to various speciality congresses and meetings. Established in his private clinic in the Ferraz Street in Madrid he alternated his professional practice between Social Security patients and the Red Cross Central Hospital. At the end of his life he had collected near to 10.000 patients’ clinical records. He was member of various scientific societies (among them the International Society Of Nephrology) and received various awards such as the one from the Pediatric Surgeons Association for his work on “bladder exstrophy “and the one from the Medical Academy of Valladolid for his study “Vascular renal hypertension”. In 1961 he performed the second renal transplant in Spain. His professional interest was preferentially focused on uro-oncology, pediatric urology, gynecologic urology, and endoscopic surgery. He left many disciples with the same interests. The professional life of Carlos Younger de la Peña, in the period of time under analysis, is much significant as a reflex of the evolution of urology and urologists over half a century

Ureteroscopy. Development and instrumentation.

Advances in ureteroscope and working instrument designs now allow the treatment of a variety of upper urinary tract disorders in a minimally invasive fashion. This field has benefited from the close cooperation between endourologists, engineers, and manufactures. Continued cooperation should result in even further improvements in ureteroscopic instrumentation. This article also presents the development of flexible and rigid ureteroscopes and working instruments. Knowledge of these features can assist the urologist in choosing the most appropriate tool for different ureteroscopic tasks.