History of the Department of Urology Mayo Clinic Rochester

Why in the world Rochester, Minnesota? The vision of Urology (Drs Millet and Braasch) The inception of Post Graduate Punch (Braasch-Bumpus) Resectoscope Controversy regarding urologists Division of Urology becomes and Post graduate Medical Education Medical Education (Fellowships) becoming open surgeons at the Mayo Clinic Department of Urology in 1970 The father of Mayo Clinic, Dr. William Worrall Mayo, was born in at the Mayo Clinic Dr. Hermon Bumpus modifi ed the Braasch resectoscope by adding Eccles, England, and studied medicine at Manchester, Glasgow At the turn of the 20th century, the practice of urology was Dr. Leo Burger, who had modifi ed the cystoscopic lens to both a Bugbee electrode to the resectoscope to control bleeding and by The debate on the defi nition of what constitutes a urologist that began in 1939 Dr. Ormond Culp (chair of the division-department from 1962-1972) and London before immigrating to the United States in 1845. He limited to the treatment and complications of gonorrhea, improve visualization and Drs. Hugh Hampton Young and the development of a closed loop fl uid irrigation system that combined in the British Medical Journal came to a head in 1947, when the American Board pushed for and received separation of the Division of Urology from initially worked as a pharmacist at Bellevue Hospital in New York syphilis, genitourinary tuberculosis, bladder calculi, urinary JT Geraghty of Johns Hopkins to gain expertise in treating Dr. Will and Charlie Mayo were among the fi rst physicians to recognize temperature control of the irrigating fl uid with maintenance of water of Urology denied two graduates of the Mayo Urology Residency to sit for board the Department of General Surgery in 1970. The separation from and as a tailor in Lafayette, Indiana, prior to completing his medical incontinence and urinary retention. The Mayo Brothers however prostatic and urogenital lesions. He learned the technique of the need for post-graduate medical education, encouraged by their pressure by a circulating pump. The later modifi cations, a entirely new certifi cation “due to failure from being trained to do open urologic surgery”. At the Department of General Surgery was cleared by the Mayo Board degree at Indiana Medical College in 1850. Upon graduation he was had a different vision. As dedicated general surgeons, they retrograde cystography and pyelography using a silver solution, father to routinely take sabbaticals for educational purposes. Although concept at that time, were adapted to improve aseptic technique and that time all members of the Department of Urology, Drs. Thompson, Emmett, of Governors and was based upon the unique endoscopic skills of employed at the University of Missouri, medical department where he knew that the surgical techniques employed were based upon a process developed by German surgeons Drs. Lichtenberg and they early on encouraged the staff to do likewise, they soon realized reduce postoperative complications during prostatic resection. The Cook, Pool and Greene were world renown for their expertise in transurethral the urologist, the prestige of the division, and the concept that a contracted malaria. His goal upon leaving Missouri was to “drive until accurate diagnosis and that the diagnosis of urologic conditions Volecker and currently employed at Hopkins. this would not be practical in the long term and sought to enhance development of the Braasch-Bumpus punch resectoscope in 1927 surgery; indeed, they had developed or enhanced techniques for transurethral department would allow recognition of the increased national and I get healthy, die, or see no one with malaria”. Rochester, Minnesota, were in their infancy. post-graduate medical education on regional levels. With this in (Further modifi ed by Dr. Gershom Thompson in 1935) was however removal of ureteral and bladder stones, treatment of bladder tumors and benign international stature of the urologic practice. Following his educational journey, he returned to Rochester became his home town based upon job opportunity as a military mind, Dr. Will took several of his sabbaticals to observe post-graduate directly competing with the “hot loop” resectoscope developed in prostate disease but were blocked by the Mayo General Surgery Department It was the vision of Dr. William Mayo, who in 1898, asked Dr. where he developed a diagnostic and operative cystoscope surgeon for the regional US Army draft board and the only county in medical training throughout the US and Europe during the 1907-1914 1920 by Dr. John Caulk of St Louis. Although the two methodologies from performing open surgery. With the recognition that the Board of Urology Melvin Millet, (a graduate of the University of Minnesota, 1895 that perfected the ability to introduce ureteral catheters Minnesota without a natural lake (no malaria). time period. During these visits he observed that interns and resident competed against each other for the next 40 years, the hot loop had changed their criteria for membership in 1947 and that they were not going with an additional year of training in urology in London) to through separate ports that were within the cystoscope, thus Innovation in the assistants were treated like “fl unkies” to the staff physician performing resectoscope would eventually win out. to recognize any physician who trained at Mayo Clinic to be eligible for board join their staff. Dr. Millet was to be the third associate outside enabling canalization of the ureteral orifi ces under direct the “scut work” with little formal education or the opportunity to learn certifi cation in urology, an intense concern arose that Mayo Clinic would lose of the brothers. Dr. Will requested that Dr. Millet dedicate vision. With minor modifi cations, the Braasch cystoscope Treatment of Urinary Calculi surgical techniques with “hands on experience” surgery usually being national and international prestige. Although the Department of General Surgery his practice to diagnosis and treatment of the diseases of the that he developed and failed to patent was the predominant taught by observation alone. In 1915 Dr. Will Mayo developed several adamantly fought against urologists becoming open surgeons, the Mayo Board of Out of the rubble comes a gem urinary tract. As the habit of the brothers they sent Dr. Millet to cystoscopic instrument used from 1910 to 1970. During this 3-year formalized fellowships (post internship and residency) at Mayo Governors bypassed their veto in 1950 and personally hired Dr. Ormond Culp on Beginning in 1967 the Departments of Urology and Nephrology Germany to evaluate the cystoscope that was then being used time span, Dr. Braasch recognized that the colloidal silver Defending the TURP, Defi ning the TUR Clinic in the various specialties. The fellowships developed followed staff. Dr. Culp had completed his residency at Johns Hopkins Hospital under Drs. became world famous with arguably one of the fi rst metabolic stone by Dr. Maximilian Nitze and to review another new technology, solution used for retrograde pyelography was associated with Mayo Clinic emerged from the rubble of a tornado that struck a formalized educational plan, with all of the “fellows” having to syndrome and the Division of Mayo Hugh Hampton Young, Hugh Jewett and William Scott, had practiced endoscopic clinics in the world that combined the efforts of the two departments the X-ray machine by Dr. William Roentegen. Their purpose sterile abscess formations in the renal cortex if the solution Rochester, Minnesota, in August of 1883. The twister killed more spend time in the areas of clinical diagnosis, research +/- surgery, and and open urologic techniques in the US Army Medical Corp during WWII and had in the management of stone disease. Dr. Lynwood Smith for decades was to see if the combination of these two methodologies had had infi ltrated into the renal parenchyma. He subsequently than 24 individuals and injured another 40. This incident prompted +/- endoscopy (depending on specialty). Weekly didactic and patient Urology helping establishment of Urology been on the urology staff at Henry Ford Hospital in Detroit. Urology subsequently led the efforts from nephrology, and although a variety of urologists applicability to a urologic practice. became a major advocate to pursue the development of better the Head Mother, Sister Alfred Moes from a local convent to approach management conferences were mandatory and built into the schedule. became the third recognized surgical sub-specialty at Mayo Clinic allowed to do worked with Dr. Smith, it was Dr. Joseph Segura that eventually led techniques and different solutions for use in the radiographic as a separate fi eld from General Surgery Dr. William W. Mayo to establish a hospital for Rochester. Dr. WW Dr. Millet returned to Mayo Clinic with the concept of how to The fi rst fellowships at the clinic were offered in the 1915-1916 open surgical procedures following orthopedic and plastic surgery. the Department of Urology in this fi eld. In 1981 Dr. Segura attended assessment of the genitourinary tract. He published the fi rst Mayo then 63 years of age, envisioned that his sons Dr. William combine these two modalities for the diagnosis of genitourinary school year and became an instant success. a urological conference in England and reviewed a case presentation comprehensive collection of genitourinary radiographic studies on how a group of German physicians had inserted a guide wire from J. Mayo (University of Michigan, 1883) and Dr. Charles H. Mayo problems. Dr. Millet was the fi rst physician to develop a From 1932-1947 urologists at Mayo Clinic performed between 800- entitled “Pyelography” that became a instant classic in 1915. the back into the kidney and sequentially dilated up the tract 2 mm (Northwestern University, 1888) would take over his practice. His technique to use water instead of air as the medium for 1000 TURP’s per year. The sheer numbers of the procedure performed He published the fi rst pyelographic images of genitourinary per week over a 5 week time span until they reached 10 mm. They vision however was more than just taking over the practice; he believed cystoscopy. Unfortunately, before he could capitalize on the at Mayo Clinic by the Division of Urology was having a major impact on tuberculosis, renal carcinoma, urothelial carcinoma, UPJ and Excretory Urography (Intravenous pyelography), then introduced a ultrasonic lithotripter to break up and remove that medicine would be at a cross roads at the beginning of the 20th knowledge he had gained during his sabbatical, Dr. Millet Accidental Discovery of Genitourinary the regional general surgeons and prompted signifi cant national and UVJ obstruction. Dr. Braasch was the fi rst Chairman of the a renal stone. Upon his return to Rochester, Dr. Segura contacted century and that success in a medical practice would only come about developed acute renal failure, that resulted in his untimely international controversy at general surgical conferences throughout the Department of Urology and the Mayo Clinic Division (section) of Urology at Mayo Clinic, serving in this Dr. David Patterson (Urology) and Dr. Andrew LeRoy (Interventional by collaboration between physicians. He instilled into his sons that death at age 38 in 1907. Radio-opacity of 10% Sodium Iodide this time period. Open criticism aimed directly at Mayo Clinic Division capacity from 1914-1939. Despite an outstanding career Radiology) and discussed with them the concept of rapid dilation of a physician will need to perpetually seek for creativity with a goal of Urology repetitively occurred at national and international surgical Shortly after Dr. Millets death, Dr. Will invited Dr. William with the publication of > 200 peer review papers, being the The discovery that sodium iodide was a radio-opaque substance that would allow the percutaneous tract, a practice that had already been adapted by Dr. toward the establishment of new and better diagnostic and surgical Due to the infl uence of Dr. Braash, members of the Department of meetings. This criticism came to a head when a written open challenge F. Braasch to join the then 11-man Mayo group practice. president of multiple organizations including the American imaging of the genitourinary tract was incidentally noted within the division of LeRoy for placement of nephrostomy tubes. Dr. Segura subsequently techniques. He therefore encouraged the two brothers to establish a Urology were always seeking better ways to visualize the genitourinary occurred in the British Medical Journal in early 1939. Specifi cally the Will’s vision was that Dr. Braasch would become the expert in Urologic Association, the Association of Genitourinary Urology at Mayo Clinic during the treatment of syphilis in 1920 and the fi ndings suggested same-day treatment of renal calculi by the percutaneous joint practice, where each would practice for 9 months and then travel system. In this regard, Dr. Earl Osborne, a urology fellow at Mayo editorial piece in that journal stated that Mayo urologists embraced diagnostic and therapeutic endoscopic methodology leaving any Surgeons, and the Minnesota State Medical Association, serving published in 1923. Although extensive work to fi nd alternative substances to route. Over the next year this triumvirate performed slightly greater for 3 months, Dr. Charlie would travel in the spring, Dr. Will in the Clinic, decided to take radiographic studies of the abdomen after the the TURP as a procedure because it was the only way they could open surgery needed on the genitourinary tract to the general on the Mayo Board of Governors and receiving the prestigious opacify the genitourinary tract that were less toxic than sodium iodide were than 1000 cases in an 18-month time span from 1981-1982 fall. These 3-month sabbaticals would be spent traveling to areas to intravenous injection of 10% sodium iodide solution, a then current be considered a surgeon because they lacked open surgical skills. surgeons. Dr. Braasch, a trained internist and pathologist, with “Keyes Award for outstanding contributions to Urology”, performed within the department for numerous decades, the eventual ideal becoming one of the pioneering centers for management of urinary learn new diagnostic or surgical techniques and bring them back to the treatment for patients with syphilis. Dr. Osborne when reviewing This criticism prompted an in-depth response from Dr. Gershom no experience in endoscopy was intrigued by the concept of Dr. Braasch always believed he did not reach elite status as substance used for the standard IVP, a hydrophilic non-ionic triiodinated contrast tract calculi in the world. Over Dr. Segura's remaining career this practice; arguably the fi rst concept of post-graduate medical education. these fi lms noted that the kidneys and bladder had became opaque. Thompson then chair of Urology at Mayo Clinic. In 1939 he authored how panendoscopy could revolutionize the practice of medicine a urologist while practicing at the Mayo Clinic. As a pure medium was perfected by Nyegaard and Company from Norway. The Department triumvirate, in conjunction with the Mineral and Metabolism Clinic of This habit fostered by Dr. WW Mayo, and practiced by his sons He brought his fi ndings to Dr. Braasch. Dr. Braasch was concerned or coauthored 38 articles in response. Within this series of papers and agreed to join the practice with operative privileges limited endoscopist having not trained in open surgical techniques, he of Urology however had gained expertise in the technique for IVP and was Dr. Smith, came forth with multiple innovations in the medical and brought the concepts of listerism, (antiseptic surgery), new principles that the toxicity of 10% sodium iodide solution, i.e. increased renal Dr. Thompson outlined that use of the TURP for treatment of BPH to the diagnositic and therapeutic endeavors he could perform felt that he was only the handmaiden to the surgeons, never on responsible for the performance and reading of all IVP’s from 1920 until 1969. surgical management of stone disease. Although these individuals of anesthesia, roetengraphy and the cross pollination of new surgical insuffi ciency would make this solution clinically impractical for compared to a single stage suprapubic prostatectomy resulting in a via endoscopic methods. As Millet’s successor, he followed equal footing. Dr. Braasch retired from the clinic in 1946 and Indeed the Department of Urology, together with Kodak developed the process were innovative geniuses, they did miss one pioneering moment when techniques to the region. The adoption of the techniques learned diagnostic use. He however requested that Dr. Rowntree, chairman 75% reduction in hospital stay and a decrease in mortality from then Dr. Will’s suggestion to visit various physicians to learn the died at age 97 in 1975. of nephrotomography at Mayo Clinic from 1960-1962. In 1968, the Board of Dornier asked the Mayo stone group to become one of the fi rst 5 stone elsewhere were then perfected in their practice resulting in unheard of the Department of Medicine, be brought into the study to manage reported national standard of mortality of 30-55% for suprapubic trade of “urology”. During this time span, he spent time with Radiology came to Mayo Clinic and demanded that the performance of IVP’s be centers for the HM3 machine in the world. Although they rejected of low morbidity and mortaility rates. By the mid-1890’s the Mayo complications and then assigned a resident, Dr. Albert Scholl, to the prostatectomy to 1% for TURP. He further delineated that 20% of the Dr. William E. Lower, founder of the Cleveland Clinic, to learn removed from the division of Urology and be given to the Department of Radiology. the initial offer, they returned to Dornier, hat in hand and became the brothers and the hospital they helped establish were gaining regional, project to help Drs. Osborne, Roundtree and Sutherland (Radiology) deaths following a TURP occurred due to hemolysis and an ensuing diagnostic endoscopy of the genitourinary tract, Dr. Edwin Beer, Although an intensive internal confl ict arose regarding this request, the Mayo Board 8th center with a HM3 machine in the United States. Due to their national and international recognition as a high-quality medical to study the concept. The presentation of their fi ndings and data at a electrolyte imbalance from fl uid reabsorption, in essence becoming the who had perfected the use of “electric fulguration using a probe of Governors forcibly removed the performance of IVP’s away from the Division of combined endoscopic skill and lithotripsy expertise for the etiology of institution. national meeting in 1920 and their fi nal paper noting the radio-opacity fi rst to describe the TUR syndrome. These articles accomplished two through the cystoscope” to destroy bladder tumors, Urology and gave this to the Department of Radiology in 1969. stone disease, Mayo became one of the leading centers in delineating of sodium iodide published in JAMA in 1923, is noted to be the important events; they prompted the search for non-hemolytic irrigating the long-term complications of lithotripsy and indications for when it foundation for the eventual development of radio-opaque contrast dye. solutions and permanently established urology as a separate fi eld from should be the primary treatment modality employed. The combination general surgery. of surgical skills and metabolic evaluations for the etiology of stone disease has placed Mayo as one of the primary centers for the evaluation and management of stone disease in the US and world. Compiled by D. A. Husmann © 2012 Mayo Foundation for Medical Education and Research History of the Department of Urology Mayo Clinic Rochester

Innovation for IPP and AUS Pushing the horizons for surgical Robotic Assisted Laparoscopic and Treatment of Advanced Prostate Cancer Innovations from the Department of Urology Mayo Clinic- Rochester management of advanced prostate cancer Natural Orifi ce Surgical Techniques In 1971 at the inception of the University of Urologic Forum (eventually the Society and renal cell carcinoma (NOTES) Mayo Clinic Division/Department of Urology has been a leader in • First use of water as a medium for endoscopic evaluation of the bladder, replacing • Establishment of Olmsted County database: all medical records of individuals • Development of Photoselective vaporization of the prostate (PVP) using GreenLight for University Urologists) Dr. Green introduced Dr. Furlow to Dr. Brantley Scott research and treatment of prostate cancer since its inception. Its the use of air for cystoscopy – 1906 living in Olmsted County MN reviewed with prospective data base maintained will laser for treatment of BPH with publication of fi rst pilot study of clinical outcomes serve invaluable for the study of prostatic and renal disease in the future – 1974 Dr. Malek – 1998 (Baylor University, Houston Texas). No one realized at that time the fruition of this laboratories under the guidance of Dr. Don Tindall found that the blood • Development of the Braasch cystoscope, the predominant cystoscopic instrument in use with minor modifi cations from 1910-1970 • PP Kelalis, Lowel King and Barry Belman, publish the fi rst edition of “Clinical • Publication that laser therapy for superfi cial squamous cell carcinoma of the penis relationship. These two giants, over the next two decades, would establish the Prostate Cancer With the advent of robotic surgical techniques arising in the late protein HK-2 is diagnostic for prostate cancer. They were among the • Development of the Braash resectoscope, allowed resection of the prostate with Pediatric Urology” the standard textbook for pediatric urology from 1976 to date provides 5-yr results equivalent to partial penectomy – resulting in validation of fi eld of genitourinary prosthetics and clarify the diagnosis of erectile dysfunction. By the early 1980s, Dr. Horst Zincke began to push the frontiers for 1990’s, the Department of Urology under Dr. Michael Blute, began fi rst to clone the androgen receptor, develop immunohistochemical direct endoscopic visualization, however did not provide for fulguration use limited • Dr. Kelalis adopts and is the second individual to publish results with staged laser therapy for superfi cial squamous cell carcinoma of the penis- Dr. Malek Working together, they would hold the majority of patents on the infl atable penile the acceptable surgical management of prostate cancer. At that time pushing for the clinic to purchase the da Vinci robot. The clinic techniques for androgen receptor antibodies and evaluate their from 1918-1926 bladder reconstruction for bladder exstrophy- epispadias complex, following – 1998 prosthesis and the artifi cial urinary sphincter. Although the initial concept of both most physicians considered advanced prostate cancer inoperable, and balked at the cost of the device and its unproven surgical benefi ts; usefulness in normal and aberrant cellular growth. This research • Development of the tunneled ureteral enteric re-implantation for a non-refl uxing techniques described by Dr. R. Jeffs – 1978 • Development of in-situ vaccination to activate T-cells against prostate cancer using CTLA-4 Dr. Kwon – 1999 of these devices arose from Dr. Scott, Dr. Furlow would do an integral portion at the time of surgery if lymph node-positive disease was found, the subsequently the purchase of the robot was hung up in multiple Mayo effort was greatly enhanced by the award of an NIH SPORE grant for anastomosis for urologic reconstruction primarily used for ureterosigmoidostomy – • Dr. Kelalis named as the sole pediatric urologist to the National Wilms Tumor the Coffey-Mayo method – 1911 Study – 1979-1991 • Publication of long-term results using GreenLight PVP for BPH Dr. Malek – 2000, of their modifi cations, holding patents on the modifi cation for use of the Keith procedure was abandoned and radiation therapy, hormonal therapy, or Clinic committees. In 2002 Dr. Blute did an end run to the situation prostate cancer research in 1992. Since this time numerous research • Published fi rst comprehensive collection of genitourinary radiographic studies, • Defi ned the clinical signifi cance of carcinoma in situ of bladder, Departments of studies eventually resulted in clearance of GreenLight PVP for treatment of BPH needle to aid in placement of the penile cylinders, the development of the penile a combination of both were administered. Dr. Zincke, reviewing the having a private donor give the money for the purchase of the robot fi ndings and clinical application for the treatment of advanced prostate Pyelography – Dr. Braasch – 1915 Urology and Pathology – 1980 by the government in 2002 and become the predominant surgical method for treatment of BPH by 2004 rear tip extenders, (enabling a reduction in inventory from 16-20 different penile Olmsted County data base in 1982, noted that if no more than two and having the robot delivered to central receiving area. The clinic carcinoma has come forth from the departmental laboratories that • Radio-opacity of 10% Sodium Iodine noted to result in visualization of the • Development of photodynamic therapy for carcinoma in situ- Drs. Farrow prosthetic lengths to one basic size with adding length by the use of the rear lymph nodes were involved with the disease process, and if radical subsequently did not have much choice but to accept the situation. were greatly aided and enhanced by the collaborative efforts of the genitourinary tract, founding work for the development of radio-opaque contrast (Pathology) and Benson (Urology), although this was a prevalent way to treat CIS • Mayo Clinic (Rochester - Arizona and Florida) become the fi rst multicenter stackable standardized extensions), the Furlow insertion tool for placement of prostatectomy was completed and postoperative hormonal therapy Dr. Blute then entrusted the development of robotic surgery to Dr. Departments of Biochemistry and Molecular Biology, Immunology, solutions – 1920-23. of the bladder in the 1980’s the advent of effect chemo and immunotherapy designated comprehensive cancer center by NCI – 2002 Matthew Gettman, who had just arrived on staff from a fellowship in • Development of the Braasch-Bumbus punch resectoscope – 1928 supplanted its usefulness. Department of Urology and Pathology – 1980 • B7-H1 T-cell identifi ed as regulator for kidney cancer and that immune-regulation the penile prosthesis, the development of secondary activation techniques, the initiated, the 5-year survival of the patient population was 88%. This Medical Oncology and Pathology. Specifi cally, the discovery of two correlate with clinical outcomes Dr. Kwon – 2002 moving of the AUS from the initial location with placement at the bladder neck compared to comparable patient populations where the procedure was endourology. Although faced with a daunting task, Dr. Gettman proved proteins, SKP-2 and FOX01 that allow androgen-dependent prostate • Development of a endoscopic closed loop resectoscope; with temperature and • Development of “Rapid” same day percutaneous nephrolithotomy: Drs. Segura, pressure controlled irrigation system for prostate resection – 1928 Patterson and LeRoy, Departments of Urology and Radiology, 1981-1000 cases • Multiple fi rsts in robotic-assisted laparoscopic and natural orifi ce surgical to the bulbar urethra (Drs. Furlow and Barrett), development in techniques that abandoned and either hormonal or radiotherapy given where the 5-year up to the challenge, and over the next several years numerous robotic cancer cells to survive in androgen-free environments – 2005. The performed in an 18-month time span from inception in 1981-1982. techniques (NOTES) techniques – 2002-2012 or NOTES procedures were either fi rst performed at or refi ned at Mayo • Popularized TURP as the defi nitive treatment for BPH compared to suprapubic would reduce infection rates of prosthetic devices to < 1%, the development of survival was 35%. Dr. Zincke’s fi nding sparked heated debate on the development of and the clinical application for anti CTLA-4 monoclonal prostatectomy – 1932-1947 • First to perform cavernosal reconstruction with graft material (Gortex) for - Pyleoplasty using da Vinci robotic system- Dr. Gettman – 2002 Clinic. reconstruction of the penis with Peyronie’s disease. – Dr. Furlow – 1983 techniques to salvage infected prosthetic devises (Drs. Furlow and Barrett), and the appropriate treatment of regional advanced prostate cancer. antibodies in clinically advanced prostatic cancer Drs. Thompson, • Defi ned the TUR syndrome – 1947 - Laparoscopic radical cystectomy with orthtopic ileal neobladder – description of urinary undiversion with use of simultaneous bladder augmentation Karnes, Frank, Blute, Kwon – 2008. The development of a specifi c • Discovery that intermittent UPJ obstruction can be unmasked by the use of Lasix, Dr. Gettman-2005 Most institutions were wary of such aggressive treatment for limited • Pyleoplasty (fi rst) using da Vinci robotic system – • Popularization of endoscopic surgery resulting in the recognition of urologists as development of the diuretic IVP- 1983 (Dr. Malek) test later supplanted by use of and AUS placement (Drs. Barrett and Kramer). In addition to the outstanding clinic for the diagnosis and treatment of clinically advanced prostate the defi nitive surgeon for genitourinary system over general surgeons – 1947 - Robotic-assisted laparoscopic sacral colpopexy- Drs. DiMarco, Chow, metastatic prostate cancer and balked at the recommendations Dr. Gettman-2002 diuretic renograms. Gettmann, Elliot – 2004 innovations for IPP and AUS, Dr. Furlow worked with Dr. Scott to develop MMPI test cancer, Dr. Kwon – 2010. Based on clinical fi ndings from this clinic, • Development of the Culp –DeWeerd spiral fl ap pyeloplasty for UPJ obstruction for completion of the radical prostatectomy and hormonal therapy • Laparoscopic radical cystectomy with orthotopic ileal neobladder – • Development of salvage procedures for infected AUS and IPP – Dr. Furlow for the differentiation of psychogenic versus organic erectile dysfunction and the Mayo became the fi rst facility to obtain FDA approval of C-11 Choline – 1951 - Robotic-assisted partial nephrectomy- Dr. Gettman – 2005 as adjunct therapy. Although not universally accepted, Zincke’s Dr. Gettman-2005 • Clarifi cation of the neuroanatomy of the prostate, prostatic apex and external development of the Nocturnal Penile Tumescence and Rigidity test. Together they PET scan for detection of recurrent prostate cancer Departments of • Published ”Clinical Urology- An Atlas and Textbook of Roentgenologic Diagnosis” - Evaluation of multiple hemostatic agents for management of bleeding statistics-based conclusions along with the documented excellent sphincter, Dr. Myers (Urology and Dr. Cahill (Anatomy) – 1984 complications following laparoscopic and robotic surgery – Dr. Gettman – 2005 lobbied the US government and insurance agencies to recognize organic erectile • Robotic-assisted laparoscopic sacral colpopexy – Urology, Pathology and Radiology (Dr. Kwon) – 2011. the classic textbook for genitourinary radiographic abnormalities from 1951-1985 technical surgical results of Drs. Zincke and Robert Myers for patients • Establishment of Dornier lithotripsy, one of fi rst 10 in the United States – 1985 - Initial experiences and outcomes on natural orifi ce translumenal endoscopic dysfunction as a medical diagnosis allowing for the coding and billing for the Drs. DiMarco, Chow, Gettmann, Elliot-2004 • Culp hypospadias repair (release of penile chordee and tubularization of the undergoing radical prostatectomy, drew patients seeking hope for Indeed, based largely on the success of the urology research efforts, urethral plate from the site of the hypospadias to the cornonal sulcus, the repair • Development of fi rst prospective data base for prostate cancer, 1985 onward, surgery in urology ( NOTES)- Dr. Gettman – 2005-2012 diagnosis and treatment of this disorder. • Robotic-assited partial nephrectomy – Dr. Gettman-2005 (Note: retrospective data placed in databank from 1967-1985) – 1985 Dr. Zincke treatment of their cancer to the clinic. The outstanding work of Drs. Mayo Clinic (Rochester - Arizona and Florida) become the fi rst not carried into glans due to increased incidence of fi stula and stricture) – 1959 - Robotic-laproscopic; ureterolysis for retroperitoneal fi brosis- (Urology) and Dr. Fleming (Medical Statistics and Epidemiology) Drs. Chow and Gettman – 2010 Zincke and Myers established Mayo Clinic as one of the premier • Evaluation of multiple hemostatic agents for management of multicenter designated comprehensive cancer center by the NCI in • Cecil-Culp repair of urethral strictures and urethral fi stulas following traumatic urethral injuries or failed hypospadias repairs – 1959 • Refi nement of multiple ureteroscopic techniques and development and patenting • Initiation of studies evaluating simulation training on resident performance, institutions for the treatment of prostate cancer. bleeding complications following laparoscopic and robotic surgery – 2002. of Segura stone basket- Drs. Segura and Patterson – 1987 • Co-developed with Kodak for the process for nephrotomography 1960-1962 multiple reports evaluating the affect of simulation training on resident Dr. Gettman-2005 • Described stone clearance rate for percutaneous nephrolithotomy was superior to performance – Dr. Gettman 2002- to date The development and fruition of prospective Renal Cell Carcinoma • Establishment of arguably the fi rst combined nephrology-urology center for the • Initial experiences and outcomes on natural orifi ce translumenal ECSWL for stones > 2 cm, Drs. Segura, Patterson and Leroy – 1987 • First center to demonstrate that intravesical chemo-instillation after transurethral Dr. Reza Malek in 1972 reviewed pathologic fi ndings on patients management and metabolic evaluation of urinary stone disease (Dr. Lynwood data bases: Olmsted County database, Prostate, endoscopic surgery in urology (NOTES) – Dr. Gettman-2005-2012 Smith) – 1967 • Development of penile revascularization for erectile dysfunction using dorsal vein resection of superfi cial bladder cancer reduces recurrence- Dr. Zincke – 2004 undergoing nephrectomy for renal cell carcinoma at Mayo Clinic arterialization- Dr. Furlow – 1987 • Discovery of two proteins, SKP-2 and FOX01 that allow androgen-dependent • Robotic-laparoscopic; ureterolysis for retroperitoneal fi brosis – • Modifi cation of the Braash cystoscope by Dr. Greene to provide fi ber-optic Renal and Bladder Cancer databases published on the fi ndings that the majority of the renal cell carcinomas illumination, patented and marked by American Cystoscope Makers – 1970 • Dr. Kelalis and Malizia document Tefl on, used as a injectable bulking agent prostate cancer cells to survive in androgen- free environments – Dr. Tindall – then removed by nephrectomy could have been managed by partial Drs. Chow and Gettman-2010 for vesico-ureteral refl ux and urinary incontinence, has a dangerous migration 2005 to date • University Urologic Forum initiated by Drs. Furlow and Greene, this will eventually problem (lungs, lymph nodes and brain) that may lead to signifi cant clinical side nephrectomy. Dr. Malek subsequently recommended that partial become the Society for University Urologists – 1972 • B7-H1 evaluation of methods, diagnosis and prognosis for treatment of multiple effects – 1989 cancers: Combined efforts Department of Urology and Pathology): Dr Kwon – There is no doubt that we stand on the shoulders of the giants who preceded us. nephrectomy should be the procedure of choice in the management • Co-development of the artifi cial urinary sphincter (AUS), and infl atable penile • Initial papers presented on the incidence and progress of BPH in Olmsted County 2005 to date prosthesis (IPP) between Dr. Brantley Scott ( Baylor University) and Dr. Furlow The initial prospective database started at Mayo Clinic was by the Department of of renal cell carcinomas. His concept was rapidly adopted by Dr. MN, fi rst of hundreds of epidemiology articles on urological and nephrologic • Clinical application of anti CTLA-4 monoclonal antibodies in clinically advanced Photovaporization of prostate (Mayo), Mayo was the second center to place both AUS and IPP and still holds diseases using this demographic database- Dr. Lieber – 1989 Medical Statistics and Epidemiology in 1974. This data base contains all medical Horst Zincke, who chose to do partial nephrectomy on all renal cell patents on Furlow penile insertion tool to measure corpora internal diameter prostatic cancer Drs. Thompson, Karnes, Frank, Blute, Kwon – 2008 to date records of individuals living in Olmsted County, Minnesota, with data acquired cancer patients whenever technically possible. Although criticized and length, IPP patent redesign to accommodate preloaded Keith needle for • Department of Urology Laboratories - One of the fi rst laboratories to clone the • Defi nition of Oncofetal protein IMP3 as a novel molecular marker that predicts for this approach at the time, the use of partial nephrectomy for placement of IPP and rear tip extenders – 1970-1973 androgen receptor gene, develop immunohistochemical assays for the androgen metastasis of papillary and chromophobe renal cell carcinoma Dr. Kwon – 2008 in a prospective fashion. Dr. Horst Zincke, observing the wealth of information Dr. Reza Malek became enamored with the concept of how lasers could receptor in fresh and pathologic tissues, investigate the modulation of androgen the management of renal cell carcinoma at Mayo Clinic became the • Co-development with Baylor University and Mayo Clinic of MMPI testing and • Development and evaluation of BioScore: Prognostic algorithm for renal cell found within the Olmsted county prospective data base, originated the concept of affect the practice of urology and began experimenting with their use proteins in embryology, androgen responsive and nonresponsive tissues; Drs. standard of care since 1980. Over the ensuing decades, controversy nocturnal penile detumense tests for accurate diagnosis of erectile dysfunction; Tindall, Young and Husmann – 1989 - to date carcinoma Drs. Boorjian, Kwon and Leibovich combined effort Departments of genitourinary-specifi c oncologic prospective databanks. Together with Dr. Fleming and refi nement beginning in the early 1990’s. In 1998 Dr. Malek this work will eventually be the basis used to have erectile dysfunction be Urology and Pathology – 2009 continues to surround this concept, and only with the accumulation of • NIH Sore Grant for Prostate Carcinoma Investigations; Dr Tindall – 1992-2012 (Medical Statistics and Epidemiology) they began the prostate cancer prospective published the fi rst clinical outcomes of patients with BPH treated by recognized as a medical condition with appropriate diagnostic codes. 1970-1975 • Use of inhibitors of B-7-CD28 co-stimulation in urologic malignancies – Dr. Kwon data base in 1985. Subsequently Dr. Blute, together with Dr. Leibovich, founded additional data will this debate that began in 1972 be answered. • Departments of Pathology and Urology establish and document the clinical • Refi nement in the management of renal cell carcinoma IVC thrombus that – 2009 photoselective vaporization of the prostate (PVP) using Greenlight laser. dropped the then mortality rate of 9% to 3%- Drs. Zincke and Blute – 1992 and maintained the renal cell cancer data base, and Dr. Blute, together with Dr. usefulness of exfoliative urinary cytology in the practice of clinical urology • B-7-H1 expression, signifi cance and immunotherapeutic applications – Drs. The subsequent refi nements in surgical techniques and his publication – 1971-1979 • Recommendation for age adjusted values for PSA – Dr. Osterling – 1993 Frank, founded and maintained the bladder cancer data base beginning with Thompson, Cheville, Leibovich, Kwon, combined effort Departments of Urology of the clinical long-term results using GreenLight PVP for BPH in 2000 • Mayo clinic surgeons (Drs. Malek and Zincke) become some of the fi rst surgeons • Establishment of prospective renal and bladder cancer databases, Dr. Blute and Pathology 2011 to date both of these prospective data banks in 1994. Each data base has independent eventually resulted in clearance of GreenLight PVP for treatment of to advocate for partial nephrectomy to replace total nephrectomy in all cases – 1994 • First facility to obtain FDA approval of C-11 Choline PET scan for detection observers entering the data, and are associated with a urologist, pathologist, BPH by the government in 2002. This technique subsequently became where this is possible – 1972 • Discovery that blood protein HK-2 is diagnostic for prostate cancer Drs. Tindall of recurrent prostate cancer Departments of Urology, Pathology and Radiology appropriate PhD scientist and statistician assigned to the project. Since these data the predominant surgical method for treatment of BPH by 2004. and Young – 1995 – 2011 bases were fi rst mined for information in 1982, they have led to > 300 peer-review and cited papers and numerous advances in the management of benign prostatic hyperplasia, prostate, renal and bladder cancer. © 2012 Mayo Foundation for Medical Education and Research Compiled by D. A. Husmann