- Email: [email protected]
The history of diagnosis and therapy of urethral valves
454
453 THE HISTORY VALVES
OF DIAGNOSIS
AND
Kreutzer Niklas’, Gharib Mostafa*, Engelmann ‘Department ‘Department Germany
THERAPY
OF URETHRAL
Moll Friedrich’, AxeI>,
Udo’
of Urology, University of Cologne, of Paediatric Surgery, Children’s Hospital
Cologne, Germany, of Cologne, Cologne,
INTRODUCTION & OBJECTIVES: Posterior urethral valves have first been described in 1717 by Morgagni. There have been many publications about the progresses in treatment since then. MATERIALS
& METHODS:
GENITOURINARY
We reviewed the literature of the past 300 years.
RESULTS: Morgagni’s case was a 50-year-old patient in which the autopsy revealed the diagnosis of the irregular urethra. Further case reports were presented by Langenbeck, Valpeau, Budd and Pickard. Tolmantschew wrote a longer report about the valves in 1870. In 1912 Young was the first to diagnose a valve in a living adult patient with a cystoscope. He also was first to attempt the resection of the valves. The Young classification is still in use to describe the pathological type of valves. Many hypothesis about the pathoembryology of the posterior urethral valves were set up (Bazy, Lowsley). Until today there is still no generally accepted assertion. After a time period of 40 years the posterior valves were recognised as a severe problem of boys in the newborn period and after. In the early Seventies Hendren, Churchill and Parkhouse/Woodhouse published results of bigger series and there was a growing discussion about the best treatment. The treatment options differed between high-diversion. vesicostomy and, later, primary resection of the valves. The upcoming ultrasound technology made earlier diagnosis and therapy possible. Even today the best way of treatment is unclear, even though most of the recently published reports favour the earlier approach. CONCLUSION: Until today boys with posterior ureteral valves represent a major problem in paediatric urology. Even today some of the patients will have deterioration of kidney function. As a view into the future the prenatal therapy has been introduced (Harrison, Sholder) but an extremely high mortality keeps the method from becoming commonly accepted.
TUBERCULOSIS
HISTORICAL
Frank Monika2, Hercher
IMPACTS
Dirko’, Marx Franz Josef’, Karenberg
‘Department of Urology, Cologne Medical Centre, *Department of the History of Medicine and Medical Cologne, Cologne, Germany
Cologne, Germany, Ethics, University of
There is evidence that the kidneys have been invaded by tuberculosis known as consumption for centuries. Throughout human history, successive epidemics and devastating pestilences have punctuated and scarred the populations of the world. The illness is a metaphor of destructive thinking on a society level, an example of the development of modern scientific medicine and further on a model of the change to organ-related thinking, which is typical for urology at the end of the 191h century. During the 1700’s in Europe, tuberculosis infections reached epidemic proportions, and almost one fourth of the deaths in Great Britain at that time was caused by consumption. It was just 1761 when G. Morgagni (1682.1771) mentioned in his epoch-making publication “De sedibus et causis morborum” the scars within the kidneys. Up to 1882 there was no general concern about the infectious nature of the disease although Villemin (1827.1892) showed in experiments (1X62- 1868) that tuberculosis could be transferred from humans to cattle or rabbits. In 1872 Peters of New York was the first who performed a nephrectomy on a shrunken kidney caused by tuberculosis. As Julius Cohnheim (1839.1884) of Breslau-Leipzig presented his elimination theory and proposed the hematogenous transport like G. Ekehom (1 X57- 1938) in 1908 F. Guyon ( 183 I- 1920) postulated the infection by ascension within the ureter from the bladder. Up to the discovery of the antituberculosis drugs, starting with Streptomycin in 1943 by S. Waksman (I 888 -1973) the basis of therapy was nephrectomy with a rate of cure about 50% over all. Scientific and medical contributions will be described as an example of the time related influences growing urology, as a speciality had to pass through.
456
455 CHILI: SPICING Woehr Markus’, ‘Urology, Karlsruhe,
EVOLUTION
UP UROLOGY
Echtle Dieter*, Bader Pia2, Frohneberg
University of Mainz, Karlsruhe, Germany
Mainz,
Germany,
DetlefZ *Urology,
OF INDEPENDENT
Fazakas Zsolt’, Kapronczay
UROLOGY
Karoly’,
IN HUNGARY
Romics lmre’
Klinikum ‘Department
of Urology, Semmelweis
‘Semmelweis INTRODUCTION & OBJECTIVES: The origins of the chili plant cannot be traced to India, as is generally assumed, but to Mexico, where it was grown as early as X00 BCE. Long before it came to India, chili spiced up the previously bland food of 16”’ century central Europe.
Library
University.
and Archives
Budapest, Hungary for the History
of Medicine.
Budapest, Hungary Authors
give an overview
development MATERIALS & METHODS: Chili plants belong to the Solanaceae family and Capsicum species. The most common kinds are the Capsicum annum L. and Capsicum frustescens L. The degree of the spiciness of a chili pod is indicated in “Scovilles”. The active ingredient is E-methyl-N-vannilyl-6-nonenamid (capsaicin), which was first synthesised in 1923 by Nelson and Dawson. Chili pods were widely used in traditional medicine. Especially in Central America and the Caribbean, it was made into a paste to treat tonsillitis or diphtheria; mixed into beverages to cure flatulence, loss of appetite or even cholera; administered as a plaster against lumbago and rheumatism; and when mixed with cinnamon and sugar it served to soothe the excesses of alcohol. In the 19”’ century it was used in England to treat bronchitis and rheumatism (Sawyer 1891), and in Africa its antiseptic properties helped improve wound healing.
Museum,
on the procedure
of independent
and influencing
In the middle of 19”’century, as all over the world, urological performed
people of the
urology in Hungary.
in surgical departments.
The most influencing
was J&m Balassn (18 18.1868) professor surgeon, interested in genito-urinary a school of surgery, educated
interventions
were
person in our country
of surgery, a brilliant and innovative
interventions.
In his department
the leading generation
of Hungarian
he created urologists.
Jdzsef Kova’cs (1832- 1897), G&a Anrul (1846.1889), L&z/d Far-km ( 1X471913). Balassa’s
successor,
surgeons specialised
Jozsef Kovacs,
in urological
has clearly
foreseen
diseases and encouraged
the need for
his colleague.
Geza
Antal in his career. GCza Antal became the first professor of urology in Hungary RESULTS: Annis first described the effect of capsaicin on the urothelium of dogs in 1962; this allowed voiding to be provoked like a reflex. In the bladder of rats, a vanniloid receptor could be determined, although it is still unclear whether such a receptor exists in humans. The first clinical application as treatment of a hyperreflexive bladder dates back to 1989 (Maggi et al). In 1992 the first successful therapy of detrusor instability by means of intravesical instillation was documented (Fowler et al). There remains, however, the disadvantage of the initial exacerbation of the symptoms and the treatment, which is usually considered painful. CONCLUSION: The introduction of capsaicin in the field of neuro-urology is an exciting development, which offers hope to patients with therapy-resistant detrusor instability. The efficacy of less painful substances, which resemble capsaicin, is to be demonstrated in further studies. Chili will thus continue to stimulate the senses in the both the kitchen and among urologists. European
Urology Supplements 1 (2002) No. 1, pp. 116
in 1883. That year the first urological
department
set up at the Szt. Rokus Municipal
Hospital
urological
independent
from surgery was
and in many places in Hungary
diseases were treated in separated wards.
Organisation
of independent
111yLi?,(1X70-195
urology, however,
is attributed
to Professor
G&l
I ). He became the head of a 120.bed urology department
19 13. In 1920, his department
was appointed
to be the Urology Department
in of
the Peter Pazmany University of Sciences, forming the second independent university department in the world. This institute had a pioneering role in the development
of European
Urology
both in scientific
and educational
aspects.
His department’s international reputation is well represented by the inscriptions in our guest book of leading urologists from all over the world.
453 THE HISTORY VALVES
OF DIAGNOSIS
AND
Kreutzer Niklas’, Gharib Mostafa*, Engelmann ‘Department ‘Department Germany
THERAPY
OF URETHRAL
Moll Friedrich’, AxeI>,
Udo’
of Urology, University of Cologne, of Paediatric Surgery, Children’s Hospital
Cologne, Germany, of Cologne, Cologne,
INTRODUCTION & OBJECTIVES: Posterior urethral valves have first been described in 1717 by Morgagni. There have been many publications about the progresses in treatment since then. MATERIALS
& METHODS:
GENITOURINARY
We reviewed the literature of the past 300 years.
RESULTS: Morgagni’s case was a 50-year-old patient in which the autopsy revealed the diagnosis of the irregular urethra. Further case reports were presented by Langenbeck, Valpeau, Budd and Pickard. Tolmantschew wrote a longer report about the valves in 1870. In 1912 Young was the first to diagnose a valve in a living adult patient with a cystoscope. He also was first to attempt the resection of the valves. The Young classification is still in use to describe the pathological type of valves. Many hypothesis about the pathoembryology of the posterior urethral valves were set up (Bazy, Lowsley). Until today there is still no generally accepted assertion. After a time period of 40 years the posterior valves were recognised as a severe problem of boys in the newborn period and after. In the early Seventies Hendren, Churchill and Parkhouse/Woodhouse published results of bigger series and there was a growing discussion about the best treatment. The treatment options differed between high-diversion. vesicostomy and, later, primary resection of the valves. The upcoming ultrasound technology made earlier diagnosis and therapy possible. Even today the best way of treatment is unclear, even though most of the recently published reports favour the earlier approach. CONCLUSION: Until today boys with posterior ureteral valves represent a major problem in paediatric urology. Even today some of the patients will have deterioration of kidney function. As a view into the future the prenatal therapy has been introduced (Harrison, Sholder) but an extremely high mortality keeps the method from becoming commonly accepted.
TUBERCULOSIS
HISTORICAL
Frank Monika2, Hercher
IMPACTS
Dirko’, Marx Franz Josef’, Karenberg
‘Department of Urology, Cologne Medical Centre, *Department of the History of Medicine and Medical Cologne, Cologne, Germany
Cologne, Germany, Ethics, University of
There is evidence that the kidneys have been invaded by tuberculosis known as consumption for centuries. Throughout human history, successive epidemics and devastating pestilences have punctuated and scarred the populations of the world. The illness is a metaphor of destructive thinking on a society level, an example of the development of modern scientific medicine and further on a model of the change to organ-related thinking, which is typical for urology at the end of the 191h century. During the 1700’s in Europe, tuberculosis infections reached epidemic proportions, and almost one fourth of the deaths in Great Britain at that time was caused by consumption. It was just 1761 when G. Morgagni (1682.1771) mentioned in his epoch-making publication “De sedibus et causis morborum” the scars within the kidneys. Up to 1882 there was no general concern about the infectious nature of the disease although Villemin (1827.1892) showed in experiments (1X62- 1868) that tuberculosis could be transferred from humans to cattle or rabbits. In 1872 Peters of New York was the first who performed a nephrectomy on a shrunken kidney caused by tuberculosis. As Julius Cohnheim (1839.1884) of Breslau-Leipzig presented his elimination theory and proposed the hematogenous transport like G. Ekehom (1 X57- 1938) in 1908 F. Guyon ( 183 I- 1920) postulated the infection by ascension within the ureter from the bladder. Up to the discovery of the antituberculosis drugs, starting with Streptomycin in 1943 by S. Waksman (I 888 -1973) the basis of therapy was nephrectomy with a rate of cure about 50% over all. Scientific and medical contributions will be described as an example of the time related influences growing urology, as a speciality had to pass through.
456
455 CHILI: SPICING Woehr Markus’, ‘Urology, Karlsruhe,
EVOLUTION
UP UROLOGY
Echtle Dieter*, Bader Pia2, Frohneberg
University of Mainz, Karlsruhe, Germany
Mainz,
Germany,
DetlefZ *Urology,
OF INDEPENDENT
Fazakas Zsolt’, Kapronczay
UROLOGY
Karoly’,
IN HUNGARY
Romics lmre’
Klinikum ‘Department
of Urology, Semmelweis
‘Semmelweis INTRODUCTION & OBJECTIVES: The origins of the chili plant cannot be traced to India, as is generally assumed, but to Mexico, where it was grown as early as X00 BCE. Long before it came to India, chili spiced up the previously bland food of 16”’ century central Europe.
Library
University.
and Archives
Budapest, Hungary for the History
of Medicine.
Budapest, Hungary Authors
give an overview
development MATERIALS & METHODS: Chili plants belong to the Solanaceae family and Capsicum species. The most common kinds are the Capsicum annum L. and Capsicum frustescens L. The degree of the spiciness of a chili pod is indicated in “Scovilles”. The active ingredient is E-methyl-N-vannilyl-6-nonenamid (capsaicin), which was first synthesised in 1923 by Nelson and Dawson. Chili pods were widely used in traditional medicine. Especially in Central America and the Caribbean, it was made into a paste to treat tonsillitis or diphtheria; mixed into beverages to cure flatulence, loss of appetite or even cholera; administered as a plaster against lumbago and rheumatism; and when mixed with cinnamon and sugar it served to soothe the excesses of alcohol. In the 19”’ century it was used in England to treat bronchitis and rheumatism (Sawyer 1891), and in Africa its antiseptic properties helped improve wound healing.
Museum,
on the procedure
of independent
and influencing
In the middle of 19”’century, as all over the world, urological performed
people of the
urology in Hungary.
in surgical departments.
The most influencing
was J&m Balassn (18 18.1868) professor surgeon, interested in genito-urinary a school of surgery, educated
interventions
were
person in our country
of surgery, a brilliant and innovative
interventions.
In his department
the leading generation
of Hungarian
he created urologists.
Jdzsef Kova’cs (1832- 1897), G&a Anrul (1846.1889), L&z/d Far-km ( 1X471913). Balassa’s
successor,
surgeons specialised
Jozsef Kovacs,
in urological
has clearly
foreseen
diseases and encouraged
the need for
his colleague.
Geza
Antal in his career. GCza Antal became the first professor of urology in Hungary RESULTS: Annis first described the effect of capsaicin on the urothelium of dogs in 1962; this allowed voiding to be provoked like a reflex. In the bladder of rats, a vanniloid receptor could be determined, although it is still unclear whether such a receptor exists in humans. The first clinical application as treatment of a hyperreflexive bladder dates back to 1989 (Maggi et al). In 1992 the first successful therapy of detrusor instability by means of intravesical instillation was documented (Fowler et al). There remains, however, the disadvantage of the initial exacerbation of the symptoms and the treatment, which is usually considered painful. CONCLUSION: The introduction of capsaicin in the field of neuro-urology is an exciting development, which offers hope to patients with therapy-resistant detrusor instability. The efficacy of less painful substances, which resemble capsaicin, is to be demonstrated in further studies. Chili will thus continue to stimulate the senses in the both the kitchen and among urologists. European
Urology Supplements 1 (2002) No. 1, pp. 116
in 1883. That year the first urological
department
set up at the Szt. Rokus Municipal
Hospital
urological
independent
from surgery was
and in many places in Hungary
diseases were treated in separated wards.
Organisation
of independent
111yLi?,(1X70-195
urology, however,
is attributed
to Professor
G&l
I ). He became the head of a 120.bed urology department
19 13. In 1920, his department
was appointed
to be the Urology Department
in of
the Peter Pazmany University of Sciences, forming the second independent university department in the world. This institute had a pioneering role in the development
of European
Urology
both in scientific
and educational
aspects.
His department’s international reputation is well represented by the inscriptions in our guest book of leading urologists from all over the world.