Urology

UROLOGY, literally the science of urine. But if in the Middle Ages there could exist 'urologists' who determined disease based on the external appearance, smell, or taste of urine, then modern advances in both theoretical and practical medicine force us to expand the scope and meaning of the term U. The modern concept of U. includes the diagnosis and treatment of all surgical diseases of the urinary system, starting from the external opening of the urethra and ending with the tissue surrounding the kidney. The simultaneous involvement in the pathological process of the male genital organs in many cases also forces this branch of medicine to be combined with purely urological diseases. In recent times, following the lead of the French school, the study and treatment of inflammatory diseases of the genitourinary tract caused by the gonococcus (gonorrhea) has been separated from venereology. Among other specialties, U. is one of the youngest and only at the beginning of this century did it fully develop and differentiate. The lack of anatomical and physiological data, and the impossibility of accurate diagnosis due to the imperfection of instruments, naturally hindered its development. At the end of the 19th century, U. flourished in France in the school of Mercier and Guyon. Both of them were mainly concerned with diseases of the lower urinary tract - the urethra and bladder. Guyon did especially much for U. Possessing great observational ability and erudition, he thoroughly developed the semiotics and diagnostics of urological diseases and despite the fact that he worked in the period 'before bacteria' and 'before cystoscopy', his lectures to this day are a handbook for every urologist. The department he headed, the first urological department in the hospital of Necker in Paris, became the cradle of modern U. Simultaneously in England (Thompson, Fenwick), the doctrine of kidney stone disease was being developed, and Freyer somewhat later proposed his operation for prostate removal in its hypertrophy through high bladder incision. The development of instrumental techniques - the improvement of optical instruments - served as a stimulus for the discovery of the cystoscope by the German urologist Nitze. The improvement of it almost simultaneously by Casper in Berlin and Albarran in Paris made it possible not only to directly inspect the inner surface of the bladder with the eye, but also to obtain urine separately from each kidney. From this time on, the development of U. moved forward in giant steps, facilitated by advances in radiographic techniques and the chemical industry. In France, Albarran and Ambard studied methods for determining the functional capacity of the kidneys, Janet proposed a method for the aseptic treatment of gonorrhea, and Marion and Le-gueu developed the technique of surgical intervention on the kidneys. In Germany, Casper developed the technique of endovesical interventions, Joseph and Richter improved the diagnosis of kidney diseases, introducing into practice tests with indigo carmine and florizin, Israel developed the clinic and technique of surgical intervention for kidney diseases, and Lichtenberg and Voelcker introduced the method of contrast radiographic examination of the kidneys - pyelography, which quickly changed and was first improved by Roseno, then by Lichtenberg himself - intravenous pyelography (see Pyelography). In America, Beer developed the method of endovesical electrocoagulation of bladder tumors, and Caulk - endovesical resection of the hypertrophied prostate. The stimulus for the scientific development of urological problems were special urological societies, congresses, and periodic literature. The first Urological Society was formed on the initiative of Guyon in Paris in 1900 and began to hold annual congresses there. Then a similar society arose in Berlin. Congresses of German urologists are periodically held in Berlin and Vienna and attract a significant number of participants from other countries. The last congress was held in Munich in 1929. The Italian Urological Society, founded in 1923, meets annually once and publishes its works, which are very popular. The specialized periodic literature on U. consists of two German journals, two French, two American, one English, Italian, and Spanish. The most widespread is Zeitschrift f. Urologie, founded by Casper in 1907. Important aids for scientific work are Jahresberichte i. Urologie, published annually from 1905 to 1931 under the editorship first of Colman, then of Lichtenberg, and the exhaustive abstract section in Zeitschrift f. urolog. Chirurgie. Thanks to the improvement of research methods, thanks to advances in technique, diagnosis in U. in individual (and far from rare) cases has reached very great accuracy. In terms of the number of patients, in terms of the importance for the body of those functions whose disorders are the object of U., the latter is rapidly taking one of the honorable places in medicine. However, to establish the boundaries of U. is extremely difficult. All modern U. must be permeated with a surgical spirit, surgical thinking, and it should be definitely said that only one who has gone through a good surgical school can be a urologist. Indeed, if we take outstanding urologists, all of them came from surgical clinics and only later specialized in U. The development of U. in Russia proceeded much more slowly than in the West. From archival data we know that in 1716 'to Moscow arrived an operator for stone diseases, the Macedonian Fotii Nikolaev and brought with him a student Dmitrii Mikheev, who subsequently became the teacher of his son-in-law, the townsman Benediktov'. Benediktov in 1767 passed an examination in St. Petersburg and received the right to perform lithotomy operations in hospitals. 'His numerous operations, despite the careless treatment afterward, were successful. Mortality reached only 4%' (Ower). Benediktov, his students Gorbatovsky and Sadowsky traveled to various cities in Russia and performed operations there. The first physician who performed lithotomy should be considered Professor Gildenbrand of Moscow University. He performed lateral sectioning and carried out about 3,000 operations. High bladder incision was first performed in 1823 in Mogilev by Grum-Grzhimailo, but unsuccessfully. The stone was so large that it could not be removed - a fistula was created. The operation of high bladder incision received civil rights only after 1897, when the zemstvo doctor of Nizhny Novgorod Assendelft reported on 630 cases he had operated on with 2.5% mortality. The results he obtained made an epoch in the history of lithotomy in Russia. High incision gradually completely replaced perineal incision. Here we should note the school of Professor V. I. Razumovsky, who did much to develop the technique of bladder suturing. The wide prevalence of stone disease in Russia and dissatisfaction with the method of bloody intervention forced physicians from ancient times to seek other methods of therapy. Lithotriptors were ordered in 1829 for all medical educational institutions and hospitals. Professor of surgery at Moscow University Pohl performed 162 lithotrities over 24 years with 19.2% mortality. Narrowings of the urethra attracted the attention of Russian physicians to an extraordinary degree, and one of the first dissertations (Razvetsov) of the Moscow medical faculty concerns strictures. He considers inflammation and trauma as the etiological factor and explains the formation of narrowing by the appearance of a contracting scar. He prefers treatment by dilation to urethrotomy. Here we should mention the constantly cited works of Vasiliev on traumatic strictures, Froenstein on gunshot wounds, and on the method of radical operation - resection of the urethra with preliminary urine diversion, developed in Russia by Khol'tsov. Renal surgery received wide distribution in Russia thanks to the work of Fedorov and his clinic. We should point to the works of Oppel on tuberculosis of the kidneys, Karaff-Korbut on atony of the ureters, Pereshchikin on pyelography, Kuznetsky on kidney stones, Chaika on nephrotomy. If the father of renal surgery in Europe should be considered Simon, then the founder of renal surgery in Russia is Fedorov, who outlined his rich experience in the monograph 'Surgery of the Kidneys and Ureters'. The most developed problem among us in the Union is that of kidney ptosis. The works of Botkin, who deserves the credit for introducing into daily practice the technique of examining patients in various body positions, Delitsin and Volkov, who published an extensive monograph of experimental-anatomical character on the pathogenesis of the mobile kidney, Radzievsky, Gotlib, Epstein, Butkevich, who developed the clinic and therapy of the disease, gave us an exhaustive description of the disease. The first urological department in Russia was opened at the Odessa City Hospital and was headed by Vdovikovsky. In 1867, an andrological clinic was founded at Moscow University, which was first entrusted to Medvedev, and in 1884 to Sinitsin. The latter was mainly interested in diseases of the lower urinary tract (bladder and urethra). After his death (1907), the clinic was successively headed by Martinov, Dzirne, Bogdanov, and from 1922 Froenstein.

The nature of the clinic's activity has changed sharply recently; it has taken up large-scale U. and now has the largest kidney material in the Union. At the beginning of this century, a urological department was opened at the Obukhov Hospital in St. Petersburg, under the direction of Prof. Khol'tsov. If we add to this the urological department at the Jewish Hospital in Kiev (headed by Prof. Ratner), this exhausts the entire list of urological departments in the Union before the revolution. Soviet medicine has put forward the slogan of providing the working population with specialized medical assistance, including urological. In connection with this, scientific and practical work on various problems of theoretical and practical U. has taken on broad dimensions. At present, in all major centers of the Union, we have specialized urological hospital departments, and in a number of medical institutions, urological departments and associate professorships have been opened. The scale of scientific research work in U. can be judged by the enormous number of works published by Soviet urologists in contemporary Russian and foreign periodicals. Since 1923, there has been a specialized journal 'Urology,' founded by Prof. Fronshtein. Four All-Russian congresses and one All-Ukrainian congress have been held. There are two urological societies—in Moscow and Leningrad—and two urological sections at the medical societies of Kharkov and Tiflis.