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162 ERECTILE DYSFUNCTION THROUGH AGES
O2 HISTORY OF UROLOGY 2 Wednesday, 18 March, 14.30-16.00, Room K2
161
Jaques-Louis Reverdin (1842-1929): The surgeon and the needle Fariña-Pérez L.A.
162
Erectile dysfunction through ages Hanchanale V., Matanhelia S. Royal Preston Hospital, Dept. of Urology, Preston, United Kingdom
Hospital Povisa, Dept. of Urology, Vigo, Spain Introduction & Objectives: With the development and rise of abdominal laparoscopic techniques, the old Reverdin needle has had a revival, because it proved to be useful for the endoscopic closure of laparoscopic access ports, in order to lower the incidence of incisional port site hernias. Several new modifications of the Reverdin needle, with different names, are in the market now. This new use of such an old instrument suggested a review of the life and work of Jaques-Louis Reverdin, the Swiss surgeon formed in Paris and founder of the modern Swiss surgery . Material & Methods: Biographical and bibliographical review of Jaques-Louis Reverdin and his contributions to surgery. Results: Jaques-Louis Reverdin (1842-1929), born in Geneva, made his medical studies in Paris, and he practised in several well-known hospitals such as Pitié (with Goselin), Saint Louis (with Guérin), Lariboisière, and Necker (with Felix Guyon). In 1869 he published and presented in several meetings, a pioneering experience of successful free skin graft procedure, that is still performed in several cases and constitutes the first human organ transplantation ever. In 1870 he presented his doctoral thesis “Étude sur l’uréthrotomie interne” with the experience of his master Guyon (63 operations, 1 decease), gaining the Civiale prize and the bronze medal of the Paris Faculty of Medicine. He returned back to Geneva in 1872 to begin a long surgical practice and Faculty teaching, and he made seminal contributions to the knowledge of thyroid diseases, in particular on the clinic of function deficiency following exeresis of the thyroid gland (postoperative myxoedema). His findings paralleled those made in Bern by Theodor Kocher, the surgeon that received in solitary the Nobel prized for these studies in 1909. With Jean-Louis Prevost and Constant Picot, they were founders of the “Revue Médicale de la Suisse Romande ”, the most important Swiss medical journal. He is remembered in the field of Urology for a special needle driver intended to trough a suture in a time were catgut and silk were the most employed sutures to control organ pedicles. Conclusions: Reverdin, -that pertains to the glorious epoch where surgery, performed under anaesthesia and with the antisepsis postulates of Lister and Pasteur, reached most of his goals-, is remembered for the first human transplant (skin grafting) and, fortunately, one of the several surgical instrument he designed, the Reverdin needle, has had a revival in up-to- day laparoscopic surgery.
163
Uroscopy, the diagnosis of love sickness and the emergence of Pisse-Prophets Rao A.R. Wexham Park Hospital, Dept. of Urology, Wexham, United Kingdom Introduction & Objectives: The art of Uroscopy has been practiced for centuries as the only available method of assessing the patient’s internal milieu. Practiced by the ancient Hindus, advocated by the great Hippocrates, the technique percolated into the middle-ages. This study focuses on the use of Uroscopy in the diagnosis of LoveSickness and the emergence of the pisse-prophets. Material & Methods: Literature concerning the art of uroscopy was extensively reviewed. Particular emphasis was given to the Flemish painting and Illuminated Medieval Manuscripts, which expound with one of the most beautiful depiction of this art of uroscopy. Research was also carried out in the emergence of the pisse-prophets and the satire images depicting animals as physicians. The presentation primarily focuses on the depiction of this illness on paintings and emblems. Results: The middle-ages saw the emergence of research into the illness suffered particularly by young women. The “wandering womb” as suggested by Hippocrates, soon became a diagnosis of choice by the physicians of the middle-ages for obscure illness of women. The diagnosis was achieved primarily by taking of the pulse and examining the urine of the woman in a special receptacle known as the “matula”. It was possible to diagnose that the young lady suffered from love-sickness and in many cases, a diagnosis of pregnancy would be made. This illness has been well captured by beautiful paintings by the Flemish masters such as Gerard Thomas, Gerrit Dou, David Teniers, the Elder and Youngers and others. Lovesickness was also portrayed in beautiful emblems. This practice of uroscopy was soon taken advantage of by quacks and this saw the emergence of the pisse-prophets. This quackery has been beautifully portrayed in medieval manuscripts, stained glass painting and misericords by animal physicians. Particularly apes were shown performing uroscopy suggesting that common man was being fooled. Uroscopy continued well into the latter parts of 19th Century and only declined with the advent of chemical analysis of urine. Conclusions: Although Uroscopy was used in a scientific manner by the physicians in the past, its use in the diagnosis of lovesickness prompted the emergence of the pisseprophets. The physician attending a young maiden with one hand on the pulse and the other holding matula has been captured in a series of beautiful Flemish paintings.
Introduction & Objectives: Erectile dysfunction (ED), traditionally referred to as impotence, ‘an inability of a male to obtain and maintain an erection adequate for sexual intercourse’. Historically, impotence was believed to be of psychological origin and many believed it to be a curse. We present journey of ED through ages from potions and aphrodisiacs to modern medicines and physical devices. Material & Methods: Web-based search was performed for the terms ED, impotence and its historical aspects. Historical articles, ancient writings were reviewed and cross referenced. Results: Ancient Chinese books from 16th century B.C. were first to discuss about philosophy of impotence in. Later, Sushruta gave detailed description of impotence and its remedies in 800 B.C. in ‘Samhita of Sushruta’. He stated ‘by using Utkarika a man would be able to visit a hundred women’. Hippocrates (400 B.C.) believed that an erection was caused by an increased flow of air. In middle Ages, brutality methods were practiced to restore impotence. In 13th century Thomas Hoccleve was first to introduce the “mpotencia” latin word for “impotence”. In 14th Century, Leonardo da Vinci was the first to explain erections as an increased flow of blood to the penis. In 1889, the French neurologist Charles Brown-Séquard injected himself with an extract from the testicles of dogs and guinea pigs, and reported a rejuvenation of his physical and mental abilities which lead to the idea of androgen therapy. In 1908, Frank Lydston ligated the dorsal vein and claimed 53% success rate in ED. The credit of first penile implant with use of rib cartilage goes to Nicholai Bogoras. Neurovascular basis of erections was proven by Eckhard (1983). Use of ‘papeverine’ for management of ED was first demonstrated by Brindley. Discovery of ‘sildenafil’ for managing ED was accidental while assessing its efficacy in angina patients and this formed the basis modern pharmacotherapy for ED {Phosphodiaestrase (PDE5) inhibitors}. Oral pharmacotherapy with sildenafil is now well established for the treatment of impotence and is currently recommended as a first-line therapy. In recent years the use of vacuum device, intracavernosal and intraurethral therapy with alprostadil has increased. Conclusions: The history of erectile dysfunction and aphrodisiacs is fascinating where science meets mythology. Mankind’s quest for eternal erections has ended with the discovery of sildenafil.
164
Stones, moans and groans of Michelangelo Thomas J.S., Karim O.M.A., Motiwala H., Laniado M., Rao A.R. Wexham Park Hospital, Dept. of Urology, Slough, United Kingdom Introduction & Objectives: Michelangelo was an Italian Renaissance painter, sculptor, architect, poet and engineer. He is most famous for the sculptures of David and Pietà. He is also well recognised for the fresco scenes from “Genesis” and “The Last Judgement” that adorn the wall of the Sistine Chapel. However, as Urologists, we seldom know that Michelangelo suffered from Renal Colic, which is well documented in his personal letters and also that he may have depicted his disease as clues in his famous artistic works. Our research focused on Michelangelo’s Urological disease of recurrent renal colics. Material & Methods: Comprehensive MEDLINE review and personal works of Michelangelo were reviewed. Experts on his works were also consulted. Relevant images of the works depicting his Urological disease will be reproduced in the presentation Results: Michelangelo di Lodovico Buonarroti Simoni (March 6, 1475 – February 18, 1564) was born in 1475 in Caprese, Tuscany. Michelangelo became interested in anatomical dissections at an early age and by the age of 18 began performing his own dissections. This exposure helped Michelangelo in creating fascinating works such as David with anatomical precision. Much less is known about the illnesses suffered by this great artist. Correspondences by Michelangelo strongly suggest that he had episodes of renal colic starting at a very young age. This is supported by the fact that he was diagnosed as having “gouty” arthritis in 1555. In the fresco by Raphael (1483–1520) at the Vatican, Michelangelo’s right knee was shown to be swollen and deformed presumably by gout. Michelangelo sought the help of the famous Rome Physician, Realdo Colombo, for the treatment of his recurrent renal colics. Colombo is supposed to have treated him with some sort of injections, which may have benefited these colics. There are also references that he may have consumed large amounts of the spa water from Fiuggi as a panacea for his colics. So consumed by the chronicity of the disease, it is postulated that the mantle of the creator in his famous painting of the “Separation of Land and Water” in the Sistine chapel is in the form of a bisected kidney. It is also been suggested that he may have died because of renal failure due to obstructive nephropathy. Conclusions: Although famous world-wide for his artistic works, Michelangelo’s painful Urological condition was an enigma that disturbed him through out his long life. Our research has shown that he may well have suffered from Gout, which in turn strongly supports the possibility of Uric Acid stones. Michelangelo had tried to understand his condition with the anatomical knowledge he possessed. He may have represented his physical condition in “hidden codes” in his famous works.
Eur Urol Suppl 2009;8(4):161
161
Jaques-Louis Reverdin (1842-1929): The surgeon and the needle Fariña-Pérez L.A.
162
Erectile dysfunction through ages Hanchanale V., Matanhelia S. Royal Preston Hospital, Dept. of Urology, Preston, United Kingdom
Hospital Povisa, Dept. of Urology, Vigo, Spain Introduction & Objectives: With the development and rise of abdominal laparoscopic techniques, the old Reverdin needle has had a revival, because it proved to be useful for the endoscopic closure of laparoscopic access ports, in order to lower the incidence of incisional port site hernias. Several new modifications of the Reverdin needle, with different names, are in the market now. This new use of such an old instrument suggested a review of the life and work of Jaques-Louis Reverdin, the Swiss surgeon formed in Paris and founder of the modern Swiss surgery . Material & Methods: Biographical and bibliographical review of Jaques-Louis Reverdin and his contributions to surgery. Results: Jaques-Louis Reverdin (1842-1929), born in Geneva, made his medical studies in Paris, and he practised in several well-known hospitals such as Pitié (with Goselin), Saint Louis (with Guérin), Lariboisière, and Necker (with Felix Guyon). In 1869 he published and presented in several meetings, a pioneering experience of successful free skin graft procedure, that is still performed in several cases and constitutes the first human organ transplantation ever. In 1870 he presented his doctoral thesis “Étude sur l’uréthrotomie interne” with the experience of his master Guyon (63 operations, 1 decease), gaining the Civiale prize and the bronze medal of the Paris Faculty of Medicine. He returned back to Geneva in 1872 to begin a long surgical practice and Faculty teaching, and he made seminal contributions to the knowledge of thyroid diseases, in particular on the clinic of function deficiency following exeresis of the thyroid gland (postoperative myxoedema). His findings paralleled those made in Bern by Theodor Kocher, the surgeon that received in solitary the Nobel prized for these studies in 1909. With Jean-Louis Prevost and Constant Picot, they were founders of the “Revue Médicale de la Suisse Romande ”, the most important Swiss medical journal. He is remembered in the field of Urology for a special needle driver intended to trough a suture in a time were catgut and silk were the most employed sutures to control organ pedicles. Conclusions: Reverdin, -that pertains to the glorious epoch where surgery, performed under anaesthesia and with the antisepsis postulates of Lister and Pasteur, reached most of his goals-, is remembered for the first human transplant (skin grafting) and, fortunately, one of the several surgical instrument he designed, the Reverdin needle, has had a revival in up-to- day laparoscopic surgery.
163
Uroscopy, the diagnosis of love sickness and the emergence of Pisse-Prophets Rao A.R. Wexham Park Hospital, Dept. of Urology, Wexham, United Kingdom Introduction & Objectives: The art of Uroscopy has been practiced for centuries as the only available method of assessing the patient’s internal milieu. Practiced by the ancient Hindus, advocated by the great Hippocrates, the technique percolated into the middle-ages. This study focuses on the use of Uroscopy in the diagnosis of LoveSickness and the emergence of the pisse-prophets. Material & Methods: Literature concerning the art of uroscopy was extensively reviewed. Particular emphasis was given to the Flemish painting and Illuminated Medieval Manuscripts, which expound with one of the most beautiful depiction of this art of uroscopy. Research was also carried out in the emergence of the pisse-prophets and the satire images depicting animals as physicians. The presentation primarily focuses on the depiction of this illness on paintings and emblems. Results: The middle-ages saw the emergence of research into the illness suffered particularly by young women. The “wandering womb” as suggested by Hippocrates, soon became a diagnosis of choice by the physicians of the middle-ages for obscure illness of women. The diagnosis was achieved primarily by taking of the pulse and examining the urine of the woman in a special receptacle known as the “matula”. It was possible to diagnose that the young lady suffered from love-sickness and in many cases, a diagnosis of pregnancy would be made. This illness has been well captured by beautiful paintings by the Flemish masters such as Gerard Thomas, Gerrit Dou, David Teniers, the Elder and Youngers and others. Lovesickness was also portrayed in beautiful emblems. This practice of uroscopy was soon taken advantage of by quacks and this saw the emergence of the pisse-prophets. This quackery has been beautifully portrayed in medieval manuscripts, stained glass painting and misericords by animal physicians. Particularly apes were shown performing uroscopy suggesting that common man was being fooled. Uroscopy continued well into the latter parts of 19th Century and only declined with the advent of chemical analysis of urine. Conclusions: Although Uroscopy was used in a scientific manner by the physicians in the past, its use in the diagnosis of lovesickness prompted the emergence of the pisseprophets. The physician attending a young maiden with one hand on the pulse and the other holding matula has been captured in a series of beautiful Flemish paintings.
Introduction & Objectives: Erectile dysfunction (ED), traditionally referred to as impotence, ‘an inability of a male to obtain and maintain an erection adequate for sexual intercourse’. Historically, impotence was believed to be of psychological origin and many believed it to be a curse. We present journey of ED through ages from potions and aphrodisiacs to modern medicines and physical devices. Material & Methods: Web-based search was performed for the terms ED, impotence and its historical aspects. Historical articles, ancient writings were reviewed and cross referenced. Results: Ancient Chinese books from 16th century B.C. were first to discuss about philosophy of impotence in. Later, Sushruta gave detailed description of impotence and its remedies in 800 B.C. in ‘Samhita of Sushruta’. He stated ‘by using Utkarika a man would be able to visit a hundred women’. Hippocrates (400 B.C.) believed that an erection was caused by an increased flow of air. In middle Ages, brutality methods were practiced to restore impotence. In 13th century Thomas Hoccleve was first to introduce the “mpotencia” latin word for “impotence”. In 14th Century, Leonardo da Vinci was the first to explain erections as an increased flow of blood to the penis. In 1889, the French neurologist Charles Brown-Séquard injected himself with an extract from the testicles of dogs and guinea pigs, and reported a rejuvenation of his physical and mental abilities which lead to the idea of androgen therapy. In 1908, Frank Lydston ligated the dorsal vein and claimed 53% success rate in ED. The credit of first penile implant with use of rib cartilage goes to Nicholai Bogoras. Neurovascular basis of erections was proven by Eckhard (1983). Use of ‘papeverine’ for management of ED was first demonstrated by Brindley. Discovery of ‘sildenafil’ for managing ED was accidental while assessing its efficacy in angina patients and this formed the basis modern pharmacotherapy for ED {Phosphodiaestrase (PDE5) inhibitors}. Oral pharmacotherapy with sildenafil is now well established for the treatment of impotence and is currently recommended as a first-line therapy. In recent years the use of vacuum device, intracavernosal and intraurethral therapy with alprostadil has increased. Conclusions: The history of erectile dysfunction and aphrodisiacs is fascinating where science meets mythology. Mankind’s quest for eternal erections has ended with the discovery of sildenafil.
164
Stones, moans and groans of Michelangelo Thomas J.S., Karim O.M.A., Motiwala H., Laniado M., Rao A.R. Wexham Park Hospital, Dept. of Urology, Slough, United Kingdom Introduction & Objectives: Michelangelo was an Italian Renaissance painter, sculptor, architect, poet and engineer. He is most famous for the sculptures of David and Pietà. He is also well recognised for the fresco scenes from “Genesis” and “The Last Judgement” that adorn the wall of the Sistine Chapel. However, as Urologists, we seldom know that Michelangelo suffered from Renal Colic, which is well documented in his personal letters and also that he may have depicted his disease as clues in his famous artistic works. Our research focused on Michelangelo’s Urological disease of recurrent renal colics. Material & Methods: Comprehensive MEDLINE review and personal works of Michelangelo were reviewed. Experts on his works were also consulted. Relevant images of the works depicting his Urological disease will be reproduced in the presentation Results: Michelangelo di Lodovico Buonarroti Simoni (March 6, 1475 – February 18, 1564) was born in 1475 in Caprese, Tuscany. Michelangelo became interested in anatomical dissections at an early age and by the age of 18 began performing his own dissections. This exposure helped Michelangelo in creating fascinating works such as David with anatomical precision. Much less is known about the illnesses suffered by this great artist. Correspondences by Michelangelo strongly suggest that he had episodes of renal colic starting at a very young age. This is supported by the fact that he was diagnosed as having “gouty” arthritis in 1555. In the fresco by Raphael (1483–1520) at the Vatican, Michelangelo’s right knee was shown to be swollen and deformed presumably by gout. Michelangelo sought the help of the famous Rome Physician, Realdo Colombo, for the treatment of his recurrent renal colics. Colombo is supposed to have treated him with some sort of injections, which may have benefited these colics. There are also references that he may have consumed large amounts of the spa water from Fiuggi as a panacea for his colics. So consumed by the chronicity of the disease, it is postulated that the mantle of the creator in his famous painting of the “Separation of Land and Water” in the Sistine chapel is in the form of a bisected kidney. It is also been suggested that he may have died because of renal failure due to obstructive nephropathy. Conclusions: Although famous world-wide for his artistic works, Michelangelo’s painful Urological condition was an enigma that disturbed him through out his long life. Our research has shown that he may well have suffered from Gout, which in turn strongly supports the possibility of Uric Acid stones. Michelangelo had tried to understand his condition with the anatomical knowledge he possessed. He may have represented his physical condition in “hidden codes” in his famous works.
Eur Urol Suppl 2009;8(4):161