A History of Excellence
Simple Perineal Prostatectomy for Benign Disease
At a time when open simple prostatectomy had a 20-percent mortality, Hugh Hampton Young developed specialized instruments and perfected the perineal approach, reducing mortality to 2 percent.
Radical Prostatectomy for the Cure of Cancer
Based on observations from performing simple prostatectomies, Hugh Hampton Young realized that it was possible to remove the entire organ. This was the beginning of an era of surgical management that continues to the present.
1913 (Document): Transurethral Prostatectomy
Hugh Hampton Young's "punch" procedure was the first endoscopic surgical procedure for the treatment of benign prostatic enlargement and the precursor of the modern transurethral prostatectomy.
Founding of the Journal of Urology
The American Urological Association absorbed the Journal in 1921 and it became the AUA’s official scientific publication. For the next seven decades, all of the editors were Brady faculty or prior trainees: Hugh H. Young (1917–1945); J. A. Campbell Colston (1946–1965); Hugh J. Jewett (1966–1977); William W. Scott (1977–1983); Herbert Brendler (1983–1985); and John T. Grayhack (1985–1994).
Hugh Hampton Young was among the first to administer interstitial radiotherapy for the treatment of prostate and bladder cancer.
1929 (Document): Posterior Urethral Valves
Hugh Hampton Young was among the first to clinically recognize, name and classify posterior urethral valves in children.
1946 (Document): Clinical Staging of Bladder Cancer
Hugh J. Jewett developed the first clinical staging of bladder cancer, created the basis for our modern-day staging of bladder cancer and developed a prognostic model that could be easily shared among physicians and patients.
1948 (Document): Research as an Integral Part of the Brady Residency
William W. Scott pioneered the first mandatory year of research during the urology residency, revolutionizing academic urology by creating surgeon/scientists.
1975 (Document): Discovery of Nuclear Matrix Protein
Donald S. Coffey. Isolation and recognition of a substructure to the mammalian cell nucleus (the nuclear matrix) that organizes genome functions into discrete regions. Figure from JAMA; 2006;296(4):445-448.
1977 (Document): Functional Reconstruction for Bladder Exstrophy
Robert D. Jeffs’ surgical approach to treating bladder exstrophy revolutionized the field, where urinary diversion was the standard treatment. Johns Hopkins remains the worldwide leader in the treatment of bladder exstrophy.
1979 (Document): Anatomy and Surgical Technique for Control of the Dorsal Vein Complex
Patrick C. Walsh. Before this discovery and change in surgical technique, radical retropubic prostatectomy was often associated with life-threatening hemorrhage. Based on these anatomic observations, a technique for ligation and division of the dorsal vein complex made it possible to perform surgery under direct vision, resulting in a safer, more complete cancer operation. Postoperative mortality fell from 2 percent to 0.2 percent.
1981 (Document): Discovery of the Cavernous Nerves
Patrick C. Walsh and Pieter J. Donker. Prior to this discovery, all men who underwent a radical prostatectomy were impotent. However, this study demonstrated the location of the cavernous nerves, which was previously unknown. Because the cavernous nerves were shown to be outside the prostate, this study provided the basis for a surgical technique for their preservation.
1982 (Document): First purposeful nerve-sparing radical retropubic prostatectomy
Patrick Craig Walsh. Based on recognition that the capsular arteries and veins of the prostate (neurovascular bundle) provided the intraoperative landmark for identification of the microscopic cavernous nerves, and characterization of the fascial coverings of the prostate, a surgical technique was described that preserved sexual function.
Mapping of alpha-1 adrenoreceptors in the prostate
Herbert Lepor and Ellen Shapiro. The detection and characterization of adrenergic receptors in the prostate provided the foundation for a radically different approach to benign prostatic hyperplasia management, and served to engage techniques, experimental approaches, and expertise common in the neurosciences for urologic research.
Hypothermia and Circulatory Arrest for Excision of Renal Cell Carcinoma
Fray Francis Marshall. This was the first time hypothermia and circulatory arrest were used during the excision of renal cell carcinoma with tumor-thrombus above the diaphragm and into the right atrium. The pioneering procedure made it possible for the first time to remove these extensive tumors more safely and more completely.
1986 (Document): Campbell's Textbook of Urology
Patrick C. Walsh. Walsh was Editor-in-Chief from 1986–2002 (5th, 6th, 7th and 8th editions), during which time it expanded to encompass four volumes and 4,000 pages, becoming the definitive Urology textbook in the world. In recognition for his efforts, the book was renamed Campbell-Walsh Urology. Alan Partin has been an editor since 2002.
First proof that familial aggregation of prostate cancer had a genetic basis
This ushered in technologies and paradigms of molecular genetics to the prostate cancer field.
Discriminating the Role of Nitric Oxide in Penile Erection
Arthur L. Burnett identifies and documents nitric oxide as a physiologic mediator and neurotransmitter of erectile function.
1993 (Document): Preoperative Nomogram to Predict Pathologic Stage (The Partin Tables)
Based on three findings – Gleason score, clinical stage, and PSA – this nomogram made it possible for the first time preoperatively to predict what the pathologic stage would be after the prostate had been removed, i.e., the probability of cure.
1994 (Document): Prediction of Insignificant Tumor
The first criteria to identify ideal candidates for expectant management.
1995 (Document): Laparoscopic live donor nephrectomy
Developed by a transplant surgeon, Lloyd Ratner, and a Brady urologist, Louis Kavoussi. This new advance had a profound impact on the field of transplantation. Compared to the standard open surgical approach, LDN results in less postoperative surgical pain, a shorter hospital stay, and quicker recovery. Consequently, the availability of this less-invasive surgical technique enhanced the willingness of family and friends to donate.
2012 (Document): HOXB13 Mutation
HOXB13 is the first mutation responsible for increased risk of prostate cancer in families. Figure from the New England Journal of Medicine, 2012; 366,141-9.
In 2015, the Brady Urological Institute celebrated a centennial of urologic clinical excellence.