- Email: [email protected]
Memorial for Chris Heyns, M.D., Ph.D., F.C.S.S.A.
Biography Memorial for Chris Heyns, M.D., Ph.D., F.C.S.S.A. Richard A. Santucci On August 2, 2014 at the age of 65 years, Christiaan (Chris) Heyns died suddenly in Johannesburg, South Africa, after chairing a meeting of the South African Urological Association. My initial response, after sadness and shock, was a genuine regret for the world. I knew that humankind was a bit less smart, a bit less witty, and a little less caring now that he was gone. It is difficult to sum up a person, but the best way to describe Chris Heyns as a man, was “wise.” Wisdom, to me, is such a rare commodity that it deserves our special notice. Chris was the sort of person who was generally taciturn but who could deliver, on request, the definitive answer on a wide range of subjects. I often saw him in action in the boardroom of the Societe Internationale d’Urologie; speaking last, he was so often able to give a summary and plan for the complex subjects being discussed. Regularly, his word was so logical, so right, and so reasonable that it just “had” to become the plan. As a urologist, Chris was prolific. He authored >156 journal articles, 15 chapters and books, and presented >145 of his papers at meetings. His research opus is remarkable for both its depth and breadth. The range is actually astounding: trauma, embryology, nephrolithiasis, imaging, prostate cancer, bladder cancer, benign prostatic hyperplasia, penile cancer, urethral stricture, Fournier gangrene, fistula, infectious disease, training, incontinence, pediatric urology, vasectomy, and so forth. Among these many contributions, three were particularly important to my own understanding of urology and deserve special treatment here.
NONOPERATIVE MANAGEMENT OF RENAL STAB WOUNDS IS POSSIBLE AND PREFERABLE Although Chris was not the first researcher to suggest that nonoperative management of selected stab wounds may be possible, his “prospective” trial in 54 patients was the definitive study that served to convince me and many others that it was possible and probably preferable to standard open exploration.1 The importance of this Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Urology, Detroit Medical Center, Detroit, MI; and the Michigan State College of Osteopathic Medicine, Detroit, MI Address correspondence to: Richard A. Santucci, M.D., F.A.C.S., HON FC Urol(SA), Department of Urology, Detroit Medical Center, 4160 John R. Suite 1017, Detroit, MI 48201. E-mail: [email protected] Submitted: October 1, 2014, accepted (with revisions): October 2, 2014
ª 2014 Elsevier Inc. All Rights Reserved
finding cannot be underestimated as it paved the way for conservative therapy of even severe renal injuries to become the standard of care, and emboldened surgeons planetwide to consider nonoperative management of a wide range of renal injuries including even selected renal gunshots. To this day, this article is cited widely as the definitive answer on just how to treat even severe renal stab wounds.
BREAKTHROUGH TESTOSTERONE IN PATIENTS WITH ADVANCED PROSTATE CANCER NEGATIVELY AFFECTS SURVIVAL Chris was the primary author in a phase III study determining the relative efficacy of the androgen antagonist triptorelin pamoate (ELIGARD; TOLMAR Pharmaceuticals, Inc) and the LHRH agonist leuprolide acetate (Lupron; Abvie).2 During this careful study, an unexpected result was found: a lower incidence of testosterone breakthrough appeared to translate into a longer survival rate in patients with metastatic prostate cancer. This article was on the forefront of understanding the dangers of testosterone breakthrough during early treatment for advanced prostate cancer. It was emblematic of Chris’ research efforts; they were deep and wide and often illuminated important new ideas in our field.
INEFFICACY OF REPEAT URETHRAL STRICTURE DILATIONS AND URETHROTOMY Chris’ article describing his vast experience with the treatment of urethral stricture with dilation or urethrotomy told us all that “the Emperor has no clothes” and that these treatments are less effective than previously believed.3 Despite the worldwide popularity of these techniques, he showed that repeat dilation or urethrotomy had poor performance characteristics, leading us to the more modern conclusion that urethroplasty is the proper treatment of strictures after failed dilation. In this study, there were three very important conclusions: (1) a third urethral dilation had a 0% success rate, so endlessly repeat dilations or urethrotomies are useless, (2) urethrotomy appears to be more effective than dilation, (3) dilation or urethrotomy is quite ineffectual against even moderately long strictures >2 cm, penile urethral http://dx.doi.org/10.1016/j.urology.2014.10.001 UROLOGY 84: 1253e1254, 2014 0090-4295/14
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strictures, and panurethral strictures. For these patients, early urethroplasty is preferable. No remembrance of Chris would be complete without emphasizing the sheer breadth of his interests and knowledge. It is little known that Chris published a novel, and that the novel was made into a film in South Africa. He once rode the entire 5700 miles of TransSiberian railway, only because he believed that it was to be mothballed by the Russian Federation and would no longer exist. He felt he wanted to experience it before it disappeared forever. Chris was a voracious reader, and his communications were rife with literary references. You had better be ready to digest the meaning of “Vogon” (“Vogons” are a fictional alien race from the planet Vogsphere in The Hitchhiker’s Guide to the Galaxy. Vogons are described as “one of the most unpleasant races in the galaxy” and are used as the galactic government’s bureaucrats.4 Any earthside unpleasant bureaucrat could be accused of being a Vogon in Chris’ vernacular.); “Yahoo” (A “Yahoo” is a legendary being in the novel Gulliver’s Travels (1726) by Jonathan Swift. Swift describes them as being filthy and with unpleasant habits, thus representing the distasteful materialism and ignorant elitism Swift sometimes encountered during his life. Hence the term “Yahoo” has come to mean “a crude, brutish, or obscenely coarse person.”5 It was a serious thing indeed to be accused of being a Yahoo in Chris’ world.); or “Dalek” (The “Daleks” are a fictional extraterrestrial
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race of mutants principally portrayed in the British science fiction television program Doctor Who. Daleks came to view themselves as the supreme race in the universe and began a conquest of universal domination and extermination. Various storylines portray them as having had every emotion removed except hate.6 God help you if you have been compared with a Dalek in Chris’ hagiography.) when you spoke to Chris or interpreted his e-mails. Being around Chris was an adventure and you never knew where the conversation was going to take you. I will miss him. We will all miss him.
References 1. Heyns CF, De Klerk DP, De Kock ML. Nonoperative management of renal stab wounds. J Urol. 1985;134:239-242. 2. Heyns CF, Simonin MP, Grosgurin P, et al; South African Triptorelin Study Group. Comparative efficacy of triptorelin pamoate and leuprolide acetate in men with advanced prostate cancer. BJU Int. 2003;92:226-231. 3. Heyns CF, Steenkamp JW, De Kock ML, Whitaker P. Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful? J Urol. 1998;160:356-358. 4. Vogon. Available at: http://en.wikipedia.org/wiki/Vogon. Accessed October 7, 2014. 5. Yahoo (Gulliver’s travel). Available at: http://en.wikipedia.org/wiki/ Yahoo_(Gulliver’s_Travels). Accessed October 7, 2014. 6. Dalek. Available at: http://en.wikipedia.org/wiki/Dalek. Accessed October 7, 2014.
UROLOGY 84 (6), 2014
NONOPERATIVE MANAGEMENT OF RENAL STAB WOUNDS IS POSSIBLE AND PREFERABLE Although Chris was not the first researcher to suggest that nonoperative management of selected stab wounds may be possible, his “prospective” trial in 54 patients was the definitive study that served to convince me and many others that it was possible and probably preferable to standard open exploration.1 The importance of this Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Urology, Detroit Medical Center, Detroit, MI; and the Michigan State College of Osteopathic Medicine, Detroit, MI Address correspondence to: Richard A. Santucci, M.D., F.A.C.S., HON FC Urol(SA), Department of Urology, Detroit Medical Center, 4160 John R. Suite 1017, Detroit, MI 48201. E-mail: [email protected] Submitted: October 1, 2014, accepted (with revisions): October 2, 2014
ª 2014 Elsevier Inc. All Rights Reserved
finding cannot be underestimated as it paved the way for conservative therapy of even severe renal injuries to become the standard of care, and emboldened surgeons planetwide to consider nonoperative management of a wide range of renal injuries including even selected renal gunshots. To this day, this article is cited widely as the definitive answer on just how to treat even severe renal stab wounds.
BREAKTHROUGH TESTOSTERONE IN PATIENTS WITH ADVANCED PROSTATE CANCER NEGATIVELY AFFECTS SURVIVAL Chris was the primary author in a phase III study determining the relative efficacy of the androgen antagonist triptorelin pamoate (ELIGARD; TOLMAR Pharmaceuticals, Inc) and the LHRH agonist leuprolide acetate (Lupron; Abvie).2 During this careful study, an unexpected result was found: a lower incidence of testosterone breakthrough appeared to translate into a longer survival rate in patients with metastatic prostate cancer. This article was on the forefront of understanding the dangers of testosterone breakthrough during early treatment for advanced prostate cancer. It was emblematic of Chris’ research efforts; they were deep and wide and often illuminated important new ideas in our field.
INEFFICACY OF REPEAT URETHRAL STRICTURE DILATIONS AND URETHROTOMY Chris’ article describing his vast experience with the treatment of urethral stricture with dilation or urethrotomy told us all that “the Emperor has no clothes” and that these treatments are less effective than previously believed.3 Despite the worldwide popularity of these techniques, he showed that repeat dilation or urethrotomy had poor performance characteristics, leading us to the more modern conclusion that urethroplasty is the proper treatment of strictures after failed dilation. In this study, there were three very important conclusions: (1) a third urethral dilation had a 0% success rate, so endlessly repeat dilations or urethrotomies are useless, (2) urethrotomy appears to be more effective than dilation, (3) dilation or urethrotomy is quite ineffectual against even moderately long strictures >2 cm, penile urethral http://dx.doi.org/10.1016/j.urology.2014.10.001 UROLOGY 84: 1253e1254, 2014 0090-4295/14
1253
strictures, and panurethral strictures. For these patients, early urethroplasty is preferable. No remembrance of Chris would be complete without emphasizing the sheer breadth of his interests and knowledge. It is little known that Chris published a novel, and that the novel was made into a film in South Africa. He once rode the entire 5700 miles of TransSiberian railway, only because he believed that it was to be mothballed by the Russian Federation and would no longer exist. He felt he wanted to experience it before it disappeared forever. Chris was a voracious reader, and his communications were rife with literary references. You had better be ready to digest the meaning of “Vogon” (“Vogons” are a fictional alien race from the planet Vogsphere in The Hitchhiker’s Guide to the Galaxy. Vogons are described as “one of the most unpleasant races in the galaxy” and are used as the galactic government’s bureaucrats.4 Any earthside unpleasant bureaucrat could be accused of being a Vogon in Chris’ vernacular.); “Yahoo” (A “Yahoo” is a legendary being in the novel Gulliver’s Travels (1726) by Jonathan Swift. Swift describes them as being filthy and with unpleasant habits, thus representing the distasteful materialism and ignorant elitism Swift sometimes encountered during his life. Hence the term “Yahoo” has come to mean “a crude, brutish, or obscenely coarse person.”5 It was a serious thing indeed to be accused of being a Yahoo in Chris’ world.); or “Dalek” (The “Daleks” are a fictional extraterrestrial
1254
race of mutants principally portrayed in the British science fiction television program Doctor Who. Daleks came to view themselves as the supreme race in the universe and began a conquest of universal domination and extermination. Various storylines portray them as having had every emotion removed except hate.6 God help you if you have been compared with a Dalek in Chris’ hagiography.) when you spoke to Chris or interpreted his e-mails. Being around Chris was an adventure and you never knew where the conversation was going to take you. I will miss him. We will all miss him.
References 1. Heyns CF, De Klerk DP, De Kock ML. Nonoperative management of renal stab wounds. J Urol. 1985;134:239-242. 2. Heyns CF, Simonin MP, Grosgurin P, et al; South African Triptorelin Study Group. Comparative efficacy of triptorelin pamoate and leuprolide acetate in men with advanced prostate cancer. BJU Int. 2003;92:226-231. 3. Heyns CF, Steenkamp JW, De Kock ML, Whitaker P. Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful? J Urol. 1998;160:356-358. 4. Vogon. Available at: http://en.wikipedia.org/wiki/Vogon. Accessed October 7, 2014. 5. Yahoo (Gulliver’s travel). Available at: http://en.wikipedia.org/wiki/ Yahoo_(Gulliver’s_Travels). Accessed October 7, 2014. 6. Dalek. Available at: http://en.wikipedia.org/wiki/Dalek. Accessed October 7, 2014.
UROLOGY 84 (6), 2014