History Session - 2003 Meeting, Madrid, Spain

Abstracts which were presented during ESPU-EUA History of Pediatric Urology Meeting.

Moderators: S.N. Cenk Buyukunal (ESPU), Dirk Schultheiss (EAU)


Dirk Schultheiss, Hannover (Germany)

Historical review of the management of childhood urolithiasis in Hungary

Miklos Merksz, Budapest (Hungary)

In ancient times the only urinary stones detected and treated were bladder stones. Until the end of the Middle Ages doctors did not treat bladder stones at all, as it was considered unworthy of a doctor.
Travelling lithotomists were working in ancient Egypt, Greece, and later, in Italy the term lithotomist itself is derived from the Greek word "lithotomos".
In Hungary, as in other countries, barbers carried out bladder stone operations.
When researching the treatment of urinary stones in children in Hungary, I relied primarily on old handbooks, to give a short overview of the treatment of paediatric urinary stones from the mid 17th century to the beginning of the 20th century. These are all Hungarian handbooks written by Hungarian doctors.
FERENC PÁPAI PÁRIZ (1649-1716) wrote the first medical handbook in Hungarian, entitled Pax corporis in 1690. He was He wrote about renal stones: "renal pain can have various causes, primarily stones, which in Hungarian are known as arena, while the Latin term is calculus." He gave a detailed description of the signs and symptoms of renal colic.
JÓZSEF CSAPÓ was the chief physician of the town of Debrecen for 30 years, and wrote the first Hungarian paediatric manual in 1771. Bladder stones are mentioned in 3 chapters of his short manual: the ones concerning incontinence, urinary retention and bladder stones. Of the stone itself, he pondered "whether the wise will ever invent an ailment to vitiate stones, who is to know?. " An English girl named Joanna Stephens did in fact conceive a medicine: the fine powder of burned sea snails, mixed with calcareous water and a third constituent, and this solution was to be injected into the bladder. Of the operations, Csapó wrote the following: "Lithotomy in small children is dangerous". He was aware of the fact that Peter Franco had instituted epicystotomy, or as it is known in latin: sectio alta, in 1561.
Á GOST SCHÖPF MEREI published the second Hungarian paediatric handbook in 1847. He founded the first hospital for children in Hungary in 1839, with 12 beds. The Poor Children's Hospital Society was relocated to a new building in 1846. During the first 8 years 13,000 children were treated, and 400 operations were performed, including 27 lithotomies.
JÁNOS BALASSA was an extraordinary surgeon, the first Professor of Surgery and the most renowned personality of the Hungarian field of surgery in the 19th century. He wrote the first article in the first edition of the first Hungarian medical journal, the Medical Weekly in 1857
incidentally, this article was about bladder stones: About "Urinary Stones In Our Country". He observed that urinary lithiasis was the disease of children and the poor. He suggested that the primary cause of urinary stones was nutritional.
JÁNOS BÓKAI was a famous Professor of Paediatrics and the founder of a famous dynasty of doctors. He was the successor of Schöpf Merei as the director of the Hospital for Poor Children. Balassa wrote that at the time he operated 53 children at St. Rochus Hospital, 49 children with urinary lithiasis were operated at the Poor Children's Hospital, thus the Department of Surgery and the Paediatric Hospital shared patients almost equally. At the Clinic of Paediatrics the operation was by lateral lithotomy, and lithotripsy was performed very rarely (as this is difficult in children due to the small calibre of the urethra). After his death, his son, JÁNOS BÓKAY JR, who continued the work begun by his father, succeeded him. He was also interested in urinary calculi, and lithotomies continued at his Clinic. In 1894 Bókai Jr. published a large-scale study on the origins of stones, using statistical demographical and geographic data. According to his statistics he tried to look for predestining factors.
The first Hungarian Professor of Urology was GÉZA ANTAL (1846-1889) lived only 43 years but his work is everlasting. He founded the first Department of Urology in 1884 and became the first Professor of Urology at the University. He used lateral lithotomy, midline lithotomy, as well as sectio alta and modified version of these operations. In 1888 he wrote that he preferred the closure of the wound on the bladder. This was a novelty, but the abdominal wound was still unclosed. He devised a modification of the sectio alta. He used cystoscopes, as described in his handbook of 1888, which included cystoscopic illustrations.
His successor was GÉZA ILLYÉS, who conducted the first roentgenographic imaging of the ureter by installing a silver wire. This happened in the "modern ages" of the 20th century. The cystoscope, X-ray and retrograde pyelography lead us to the well-known procedures performed through the last century.

Ritual Circumcision in Africa

Johan J. Mattelaer, Kortrijk (Belgium)

In this paper we will focus on the traditional circumcision in central, western, eastern and southern Africa, where circumcision was and is still practised, with the exception of three areas.
Circumcision is used to mark the entrance into manhood and is regarded as the most solemn occasion in the life of every male.
Circumcision in Africa was already described by O.Dapper in 1668.
In a traditional African circumcision , we can generally describe three phases:

1. The first phase consists of preparatory observances by the candidates and leads up to the circumcision operation. They begin to wear the emblems of a candidate.
Mostly they shave their heads, have a night of drinking beer, bath ritually in the morning of the circumcision and appear before the operator.

2. The second phase concerns the lives of the circumcised boys in the etumbi or gnoma, or the hut of seclusion, where they stay while their wounds are healing and for a further period of time during which they are instructed in both practical and theoretical knowledge. At the initiation camp, the boys are taught practical skills such as making household items and hunting.

3. The third phase, finally, begins with the feast of coming out of the hut of seclusion and is followed by a series of further rites and festive occasions.
Usually the circumcised boys burn the banana leaves they have slept on, sometimes the whole hut and camp. They wash off the white clay they have worn while in the camp and exchange their old clothing for new. Mostly they prepare a variety of ornaments that they will wear at the feast of return. They perform the dances and sing the traditional songs they have learned during the seclusion period.

Although traditional circumcision still exists in several places, today more and more young men are going to the hospital to have surgical circumcision. Another pattern is one in which the initiation schools continue and circumcision occurs when the boys are trucked from the schools into town and to the hospital in groups.

Ethical principals and practice in paediatric urological operations in Ottoman Empire

S.N. Cenk Buyukunal, Istanbul (Turkey)

Great care was taken for the children's right during Ottoman Empire.
There were some certain rules and certification system for those who were going to be a surgeon. A certified surgeon should have enough basic training,knowledge for modern surgical techniques, enough medical education to prepare the surgical creams, solutions and ointments. Urolithiasis was one of the most frequent surgical condition which had to be treated by the surgeons.
According to the Ottoman rules an informed consent had to be prepared before every surgical procedure.In these consents the name of the child and the surgeon, name of the disease, proposed surgical technique and surgeons fee had to be mentioned. In this text surgeon promised that he was going to do his best and cure his patient. These consents had to be signed by the surgeon, parent(s), witness and judge.
These consents were very important in case of severe complications and death and it was very useful both for the surgeon and the patient.
This report underlines the level of children's rights during Ottoman period and gives an idea about the surgical practice and training system centuries ago in Anatolia.

H.H. Young and the dawn of paediatric urology

Anthony J. Casale, Indianapolis (USA)

Hugh Hampton Young is considered the father of American Urology and pioneered formal urology residency training, the Journal of Urology, and the finest comprehensive urology textbook of its day. He was also a force at the dawn of pediatric urology and contributed to the understanding and initial treatment of posterior urethral valves, anatomic incontinence due to bladder neck incompetence, and multiple genital anomalies such as epispadias and intersex. He was an innovator but his greatest contribution may have been his ability to organize and present the current state of the art in genitourinary surgery. He was a keen observer of European Urology and carried on a dialogue with his European colleagues during his long career.