History of Urology
Diseases of the genitourinary tract have been recognized for thousands of years. The mummified body of a child, probably at least 5000 years old and discovered in Egypt, was found to contain a large bladder stone. Circumcision was probably the first surgical procedure ever performed on a regular basis and bladder stones were recognized by Hippocrates.
“Stone cutters”, or travelling lithotomists, practised bladder stone removal throughout Europe in the 17th century. The diarist Samuel Pepys graphically described removal of his bladder stone by a lithotomist & survived the ordeal; many were not so lucky. However, urology as a specialty in its own right was only instituted in 1890 with the appointment of Felix Guyon in Paris as the first Professor of Urology.
No history of the development of urology is complete without mention of the contribution made by equipment companies. The mainstay of urology has always been telescopic examination of the urinary tract which was, until the 1950s, necessarily crude. Early attempts at transmitting light down rigid telescopes were nothing if not innovative, ranging from candles to battery-driven lamps, but were fraught with the dual problems of clarity & reliability.
The crucial breakthrough, in the mid-1950s, was the development of the Hopkins® rod lens system. This revolutionized urology by providing robust, versatile, reliable & sterilizable endoscopic equipment and “cold” light sources which allowed high-quality visualization of the interior of the urinary tract. The later addition of fibreoptic (flexible) endoscopes and endoscopic video cameras further enhanced operative urology. Such equipment was instrumental in the establishment of urology as a bona fide specialty in the 20th century.
The Status of British Urology
The speed at which urology has developed in the 20th century has been astonishing, even to those working in the field; current work patterns bear little resemblance to those from only 10 years ago. 50% of all congenital abnormalities are urological & 25% of GP consultations are for urological disorders. Stone disease remains common in developed and pre-industrialized countries whilst prostate disease affects 75% of men over the age of 50.
The ageing population will, as they live longer, become more likely to develop systemic diseases which have direct or indirect urological sequelae. For example, urological tumours have now become one of the leading causes of cancer death in the male population. Urologists, therefore, have a constantly-changing role to play by combining the science of urology with developments in techniques, diagnostics and treatment (both invasive and noninvasive).
The Cambridge Urology Department
British urology in its current form came into being in 1945; before then, it barely existed as a specialty in its own right, being practised only by a few enthusiastic general surgeons. Urological procedures were normally carried out by surgeons who may, or may not, have had specific training in such procedures. However, it was becoming clear that urology had a stand-alone role to play and that there was a specific need to train specialist urological surgeons.
A group of surgeons, therefore, addressed this issue by founding the British Association of Urological Surgeons in 1945; they oversaw the development of the specialty in the UK but, more importantly, paved the way for highly-trained surgeons to perform urological procedures to a high degree of competence.
Old Addenbrooke’s Hospital
Foremost amongst this group of surgeons was John Withycombe whose career was inextricably linked with the foundation of British urology. John had trained as a general surgeon but had always had an interest in urological surgery and, specifically, in diseases of the urachus on which he had written his MS thesis.
In 1950, he was appointed as Consultant Urological Surgeon to the United Cambridge Hospitals with a brief to set up a new Department of Urology. John worked single-handed from Bowtell and Goode wards, supported by his vastly-experienced ward sister Diane Wharton and her staff nurse, Jenny Rush; the latter was subsequently to take on the pivotal role of Ward Sister when the department moved to the New Hospital.
New Addenbrooke’s Hospital
By 1964, it was clear that old Addenbrooke’s Hospital was too small to cope with the surgical workload it was attracting under the aegis of the enthusiastic young Professor of Surgery, Roy Calne. A new hospital was, therefore, planned on a green field site in Hills Road.
John Withycombe was instrumental in designing the new department. The New Site opened in 1969, initially housing only the Neurosurgical block and the Accident Department. Building, however, proceeded rapidly and the new Urology Department was opened in 1972. John personally supervised the design of the new department and his original concept from 1964 remains largely unchanged to this day, a massive tribute to his foresight.
The Early Years
In 1973, a second Consultant Urologist, Bob Whitaker, was appointed to the staff. Bob had trained under John Blandy, one of the founding fathers of British urology, at the London Hospital and brought with him a specific expertise in endoscopic surgery as well as a research interest in obstruction of the upper urinary tract; the “Whitaker test” remains in the armamentarium of most urologists practicing today. From this point, the foundations of the current department were laid. Bob shared John Withycombe’s passion for endoscopic urology and for top-quality training of his junior staff. He also shared John’s artistic talents and, between them, they produced hundreds of immaculately painted surgical operation notes as well as numerous formal watercolours, many of which are still on display in the Clinical School at Addenbrooke’s. Bob now teaches anatomy in the University of Cambridge and supervises medical students in his alma mater, Selwyn College.
More Recent Changes
In 1979, John Withycombe retired to Devon and Patrick Doyle joined Bob Whitaker as John’s replacement. Patrick had trained in Southampton & Portsmouth and his special expertise complemented Bob’s. As a result of Patrick’s appointment, Bob Whitaker was able to spend more of his time practicing paediatric urology in which he had already established himself as an international authority.
Nigel Bullock was appointed as a third Consultant Urologist in 1985 specifically to manage stones and andrological problems. Nigel had trained with Patrick Doyle & Bob Whitaker and, in essence, took over Bob’s adult practice, allowing Bob to focus exclusively on paediatric urology. Nigel also instituted the foundations of clinical audit, which are still employed today, and designed the department’s clinical information system.
Andrew Doble was appointed to a 4th Consultant post in 1993. Andrew trained in Leeds/Bradford and rapidly contributed his expertise in shared-care for prostate disease, chronic pelvic pain, prostate cancer & renal cancer; he was also instrumental in recruiting Moira Burrows & Philippa Sounes, as pioneering urology specialist nurses. Philippa helped to establish the British Association of Urological Nurses before she moved on to enjoy marriage and a new Nurse Practitioner post in Basingstoke.
Bob Whitaker retired due to ill-health in 1989 and was replaced as a Paediatric Urologist initially by Pierre Mouriquand and later, when Pierre left for a post at Great Ormond Street, by Martyn Williams who has been in post since 1995.
Tragically, Patrick Doyle collapsed and died suddenly in 1998 whilst attending a meeting in Jersey. Chris Anderson was appointed as a locum to replace Patrick for 1 year and, in 1999, Bill Turner was appointed as a permanent replacement.
Bill trained in Oxford, Yorkshire & Switzerland, bringing with him specific expertise in bladder cancer, radical pelvic surgery and the management of female incontinence. Shortly after his appointment, Bill took on the onerous mantle of Clinical Director for the department.
From 2000 until 2003, the department went through a difficult time with a rapidly increasing workload and inadequate infrastructure. However, in 2003, the arrival from Newcastle of Professor David Neal to the new Chair of Surgical Oncology, with John Kelly as Lecturer/Consultant re-established the research base of the department. With the construction of a new Cancer Research UK base on the Addenbrooke’s site, the opportunities for research in urological oncology have continued to grow significantly.
In parallel with this research, as a result of excellent support from the Trust, the clinical department has also developed at a dramatic pace. Nimish Shah, Tev ‘Aho, Oliver Wiseman, Vincent Gnanapragasam, Nikesh Thiruchelvam, Christof Kastner, Alex Colquhoun and Suzanne Biers have been appointed to Consultant posts over the past few years, bringing the total complement of adult urologists to 13.
These appointments have allowed the department to develop 23-hour stay surgery, Holmium laser prostatectomy, laser treatment for stones, laparoscopic urology, robotic radical prostatectomy and advanced treatments of male and female incontinence.
Recently, Steven Connolly has joined the department to replace John Kelly as Lecturer and Honorary Consultant. Professor John Kelly is a now a Consultant at UCHL.
What of the Future?
The department is continuing to develop and it is likely that further appointments will be needed as we work to ensure that patients can be admitted promptly. We are now working in “teams” with specific expertise in clinical areas; this has meant that waiting times can been brought down to politically-acceptable levels.
The new Addenbrooke’s Treatment Centre houses all of our inpatient activity and has increased our bed complement significantly; new Operating Theatres in the Centre have increased our operative capacity even further.
Our next objective is to update our aging, outpatient clinic and to introduce multi-Consultant, one-stop clinics for the majority of patients. This will require a commitment to multi-disciplinary working by all the supporting departments but will save a large number of unnecessary outpatient visits for our patients.
Our department is committed to move forwards and we have a clear intention to make Addenbrooke’s Urology Department one of the leading units in the world for clinical & academic urology.