The birth of pediatric urology in the United States: From pioneers to subcertification.

INTRODUCTION: Pediatric urology is a subspecialty of urology that emerged from a culture in which children with urological disorders were cared for by general urologists and general pediatric surgeons. The development of pediatric urology as a subspecialty was years in the making, highlighted by individuals who recognized that children with urological conditions were not just "small adults," but required special experience and training. Subspecialization was initiated by persistent visionaries who recognized the need for a trained cadre of experts to provide better care for children. It took the coordinated effort of all subgroups and leaderships in pediatric urology to push these efforts over the goal line. The focus of this review is to highlight certain individuals who played major roles in this vision and to document the efforts of many to coordinate the pathways to sub-specialization. METHODS: The careers of Meredith F. Campbell and Frank B. Bicknell were researched to identify their rationale and roles in developing pediatric urology as a distinct medical specialty in the United States. In addition, the minutes of the meetings of the Pediatric Urology Advisory Council (PUAC) with the American Board of Urology (ABU) were reviewed. The origins of the Society for Pediatric Urology (SPU) and the American Academy of Pediatrics Section of Urology (AAP-SOU) were researched. The contributions of each to the certification of pediatric urology as a distinct subspecialty was delineated. RESULTS: Campbell was Chair of Urology at the New York University (NYU) School of Medicine and wrote prolifically about pediatric urology. He published one of the first practical textbooks in pediatric urology, almost completely self-written, in 1937. Bicknell, a general urologist in Michigan on the faculty at Wayne State University School of Medicine, led the initiative to create the Society for Pediatric Urology (SPU) that first met at the 1951 annual American Urological Association (AUA) meeting in Chicago and included nine attendees. Subsequently, John Lattimer (College of Physicians and Surgeons at Columbia University) organized a well-attended meeting of urologists interested in pediatrics at the 1964 annual AAP meeting in New York City. This led to the formation of the AAP Section on Urology. Integral to the justification for the development of a subspecialty was evidence of a published corpus of content. In addition to published textbooks devoted exclusively to pediatric urology, this was further fulfilled by the AAP Section on Urology Pediatric Supplement to the Journal of Urology, first published in 1986, and later with the Journal of Pediatric Urology in 2005. The SPU and the AAP Section on Urology came together to form the Pediatric Urology Advisory Council (PUAC) in 2000, which worked with the ABU to create subspecialty certification in pediatric urology with an independent exam, first administered in 2008 to 176 applicants. CONCLUSION: The metaphor "We have stood on the shoulders of giants" is apt for pediatric urology: Meredith Campbell, Frank Bicknell, David Innes Williams (Hospital for Sick Children, London), and J. Herbert Johnston (Alder Hay Hospital, Liverpool) come to mind among the first generation of pediatric urology pioneers, and others among their colleagues also had significant impact. Clearly this is a story of persistence and attention to detail on the part of those giants and those who followed. Pediatric urology became a distinct discipline after the SPU and AAP-SOU came together to create a robust cohort of pediatric urologists who through education and negotiation were able to help the ABU and the American Board of Medical Specialties (ABMS) recognize that subspecialization would lead to better care for children with urologic disorders. This benchmark set a high bar for future subspecialization in urology and other fields.

[The urological case reports of the Hippocratic Corpus : Medical practice in classical Greece]. / Die urologischen Fallberichte des Corpus Hippocraticum : Medizinische Praxis im klassischen Griechenland.

OBJECTIVE: Which theoretical and practical competences do the urologic case histories of the Hippocratic Corpus convey? MATERIALS AND METHODS: The 431 Hippocratic case histories have been studied for reports and communication on diagnostic methods, treatment, and prognosis related to urologic diseases. RESULTS: Within the seven books of the Hippocratic Epidemics, a total of 69 patients with urologic symptoms are described; in 21 cases the urologic disease is dominant. The leading clinical signs were urine discoloration and urinary sediment, polyuria, testicular swelling and pain, hematuria, stranguria, anuria, and renal pain, the most frequent diseases were nephritis and urolithiasis. Most patients were men in juvenile and adult age; 33 sick persons are named. The statements of patients regarding the course of their illness were often sparse. Diagnostic tests were restricted to inspection and palpation. Otherwise, treatment was confined to conservative measures. The dietary decisions for treatment of nephritis were differentiated but nonuniform. CONCLUSION: The Hippocratic physician diagnosed and treated diseases of the urinary tract. Inflammatory conditions and traumatic lesions are described in detail. Highest priority was awarded to uroscopy. Nephritis was a widespread disorder und usually associated with other symptoms, above all fever. The urinary tract was often regarded as an indicator of physical and mental health. Conservative treatment measures dominate in the case reports.

[Urology in Upper Palatinate-what archeology, historical research, and historiography reveal : Part 1: from Roman Antiquity to the late Middle Ages]. / Urologie in der Oberpfalz ­ Was uns Archäologie, historische Forschung und Geschichtsschreibung verraten : Teil 1: von römischer Antike bis Spätmittelalter.

Since 1924, it has been possible to qualify as a specialist in urology in Germany. The first hospital departments for the treatment of urological conditions were established as early as the end of the German Empire and the Weimar Republic. However, the beginning of specialist medical care in the Bavarian administrative district of Upper Palatinate, often known as the "poorhouse" of Germany until the second half of the last century, was much later. Nevertheless, the lineage of "urological" activity here can be traced back to much earlier eras. Of course, it must be accepted that the evidence from times long past is weak. This is especially applicable when it comes to a topic such as the treatment of the sick and the preservation of health, which is not only considered a science but also often a central focus of life for us today, because in history it was often only mentioned in the fight against epidemics and in anecdotal descriptions. This is a circumstance which, when looking at the history of urology, gives rise to the hope of finding one or two interesting sources. This article not only aims to trace the history of the development of urology in a rural area from contemporary history to the present day, but also to explore the treatment of urological diseases in this region since late antiquity. Furthermore, we invite readers to look at other places of urological remembrance in a similar way.

[Development of medicine in Lwów (Lemberg, Lviv). Part 1: beginnings and establishment of urology until 1944]. / Entwicklung der Medizin in Lwów (Lemberg, Lwiw). Teil 1: Anfänge und Etablierung der Urologie bis 1944.

Innovations in diagnostic techniques due to the introduction of endoscopy and the development of X­ray technology were fundamental in reducing the dependence on surgery and to recognize urology as a new discipline. Thereafter, endoscopic surgery came to the fore. The aim of this article is to present the development of urology in Lviv as an independent discipline and its distinction from surgery. Well-known Lviv surgeons who were interested in surgery of the urogenital system are discussed. The beginnings of urology and its development within the framework of surgical departments and ultimately as an independent institution in the interwar period are described. The fate of the Polish department of urology in the interwar period and during the Second World War is also described. J. Molendzinski, G. Ziembicki, Z. Lenko and S. Laskownicki can be described as the founders of urology in Lviv (Lemberg). Extensive research in archives and libraries in Poland and Ukraine has been undertaken in the preparation of this article.

Frank B. Bicknell: Pioneer in Pediatric Urology and Founder of the American Urological Association History Forum.

OBJECTIVE: To explore and document the life and urologic contributions of Dr. Frank B. Bicknell. METHODS: We researched the life of Dr. Bicknell via his publications, archived documents from the Didusch Museum and through the description of his life and accomplishments by his colleagues including John K. Lattimer and Frank Hinman Jr. RESULTS: Frank B. Bicknell (1907-1999) attended the University of Michigan (1925-1928) and Universityof Michigan Medical School (1928-1932) prior to his internship and urology residency at the Receiving Hospital, Detroit, Michigan (1932-1936). He served in the Merchant Marine in the 1930s, sailing around the world. He was a major in World War II and served as Professor of Urology at Wayne State University. In 1951 Dr. Bicknell got together a small group of eight urologists interested in pediatric urology during the AUA Annual Meeting. Drs. Campbell, Barber, Johnson, Mertz, Hinman Jr., Spence and Lattimer all met in Dr. Bicknell's Chicago hotel room and would form The Society for Pediatric Urology. At the time, Dr. Bicknell's brother-in-law had just become president of the American Academy of Pediatrics (AAP). Dr. John Lattimer with the help of Dr. Bicknell's brother-in-law was able to get a room at the AAP meeting which he filled with 2500 people, thought to be the largest collection of urologists in one room at the time. The success of the session led the AAP to develop a Section of Urology and impressed upon the AUA the magnitude of interest in pediatric urology. This allowed pediatric urologists to secure an exclusive session on the day before the main AUA meeting which has persisted since that time.Dr. Bicknell founded the History Forum in 1966 and chaired this very popular event during its first decade. The forum now occupies an entire afternoon during the AUA annual meeting, with papers presented on historic urologic topics. The highlight of this assembly is the annual lecture on the history of medicine. In 2000, this oration was renamed the Frank Bicknell History of Urology Oration to honor the founder of the History Forum. CONCLUSION: Dr. Frank Bicknell was an early leader in pediatric urology and urologic history who helped found The Society of Pediatric Urology and the AUA History Forum.

[Development of medicine in Lwów (Lemberg, Lviv) : Part 2. Establishment of Ukrainian university urology after 1944]. / Entwicklung der Medizin in Lwów (Lemberg, Lviv) : Teil 2. Etablierung der ukrainischen universitären Urologie nach 1944.

The beginnings of medicine and Polish urology in Lemberg (Lviv) were described in part 1 of the previous publication. The aim of this article is to show the further development of Ukrainian urology after World War II. The authors also present the leading Ukrainian urologists of the postwar period. In 1976 Professor Cesar K. Borzhyievsky became the head of the department of urology, which had been officially established as an independent unit. During the last 31 years of the free Ukraine (from December 1991) there have been profound sociopolitical changes in Eastern Europe, which formed the basis for a rapid and revolutionary modernization of medicine and increased cooperation with western urologists. This is the path that Ukrainian urologists have followed. In the course of time it has driven developments in scientific research, education and public service to the point where the clinic can compete with the best international urology clinics. For the preparation of this study extensive research was carried out to collect literature and documents in Polish, German and Ukrainian archives and libraries. Personal contacts and reports from numerous Ukrainian urologists were helpful. Unfortunately, the current state of urology in Lemberg of today is limited by the war and the lack of personal contacts.

[Granting of venia legendi as an indicator of specialization : Victor von Ivánchich de Margita (1812-1892) "Lecturer for surgery of the urogenital organs" in Vienna in 1851]. / Die Erteilung der Venia legendi als Gradmesser einer einsetzenden Fachdifferenzierung : Victor von Ivánchich de Margita (1812­1892) "Docent für die Chirurgie der Harnorgane" in Wien, 1851.

Alongside Paris, Vienna was one of the early centers of specialization and professionalization in medicine and urology in the 19th century. Especially the 2nd Vienna Medical School (Erna Lesky) with its main representatives Carl Freiherr von Rokitansky (in Czech: Karel Rokytanský; 1804-1878) and Joseph Ritter von Skoda (1895-1881) was able to create the perfect scientific environment for young students to become acquainted with new fields of research often in an interdisciplinary setting, e.g., chemistry, microscopy or pathology in combination with clinical departments like surgery. We analyze the process of habilitation using the example of a urologist to outline this process within the history of science.

25-year perspective on prostate cancer: Conquering frontiers and understanding tumor biology.

Major changes in the field of prostate cancer over the last 25 years include the implementation of prostate specific antigen screening and the recognition that BRCA confers hereditary risk of prostate cancer. Quality of life and survivorship have driven risk stratification for localized prostate cancer, facilitated by molecular signatures and leading to increased acceptance of active surveillance as a mainstream treatment option. Advances in technology have improved efficacy and reduced toxicity in both radical prostatectomy and radiation therapy for localized prostate cancer. Improved understanding of the androgen receptor has yielded substantially more effective therapies. Future growth areas include personalized treatment based on genomic and genetic information, theranostics radiopharmaceuticals, and more aggressive treatment of metastatic disease to include focal therapy. Multidisciplinary management between specialized urologists, radiation oncologists, and medical oncologists remains central to maximizing patient outcomes.

The Lifelong Mysterious Relapsing "Kidney" Disease of the Founder of Turkey; Atatürk (1881-1938) in Connection with European Medical and Political History.

INTRODUCTION: Although Mustafa Kemal Atatürk (1881-1938) was a national hero with his intrepid and enlightened attempts to establish modern Turkey from the remnants of Ottoman heritage, he had been suffering from lifelong "kidney disease" that appeared with intermittent flank pain and fever without an identified source. However, we think that this physical pain that he endured only increased his motivation to focus on his military and political aims. Methods & Results: In this historical review article, we have focused on his personal medical life and specifically his "kidneys" from the beginning of the complaint till his death through European medical and political history with geographic locations and speculated upon it via past, near past, and recent medical literature. CONCLUSION: Mustafa Kemal Atatürk, the great military and political leader for his country, had always suffered from uro/nephrological problems throughout his life. We think that this was one of the reasons that urology has been privileged and thus to be the oldest separated medical surgical branch in Turkey and to some significant extent with European urological history.