Urology
The development of Urology in Scotland from the 17th century has been documented by Jonathan Goddard and Bernard Ferrie in “The Origins of Urology in Scotland”, published in 2017 by the British Association of Urological Surgeons, BAUS.
David Newman, Pioneer
Initially trained as a general surgeon, David Newman (1853-1924) can be considered the first ‘honorary’ urologist in Glasgow. He pioneered various surgical procedures on the urinary tract, including ‘nephroraphy’ (the fixation of the overly mobile kidney) and open ureteric stone removal surgery.
Newman was credited as being the first person in the world to illuminate the human bladder using an electric light bulb, which we now take for granted in routine practice.
Modern Urology
Modern Urology in Glasgow was kick-started by two pioneering urologists. Walter Galbraith (1889-1960) founded the urology department at the Western Infirmary. He was an early pioneer of trans-urethral resection of the prostate gland (TURP) which progressively replaced open transvesical prostatectomy.
He was also President of the Royal Faculty of Physicians and Surgeons of Glasgow, and later Vice-President of the Royal College of Surgeons of Edinburgh.
Arthur Jacobs established a urology unit at the Royal Infirmary, first as a general surgeon and subsequently as a urologist. The unit opened in 1936, and is considered to be the first independent urology unit in Scotland, and by some criteria, in the UK. His interests included genito-urinary tuberculosis. He also introduced renal dialysis in Scotland in 1958, securing funding from a grateful patient for a rotating drum dialysis machine in the Royal Infirmary and a new dialysis department run by Arthur Kennedy. He was President of the Royal Faculty of Physicians and Surgeons of Glasgow from 1958 to 1960 (read more).
Both Galbraith and Jacob played leading national roles, as presidents of the Urological Section of the Royal Society of Medicine and of the British Association of Urological Surgeons.
Surgery
Development of Urology as a surgical discipline in Glasgow brought about training opportunities for young talents, including Willie Mack (1908-1970), Tom Chapman (1903-1966) and Helen Wingate (1895-1985).
Mack replaced Galbraith as surgeon in charge at the Western Infirmary in 1954. His interests included tuberculosis, bladder cancer and male infertility. He was a founder member of BAUS and its president in 1970.
Chapman set up the urology practice at the Victoria Infirmary. He learned the new technique of punch prostatectomy at the Mayo Clinic in 1938, and developed a special unit for this at Hairmyres Hospital.
Wingate was also a founding member of BAUS (as one of only two female members at that time), and significantly contributed in shaping modern urology at the Royal Infirmary and Redlands Hospital for Women.
At the Royal Infirmary, in the 1950s William Barr Stirling developed trans-lumbar aortography in diagnosis of renal and suprarenal tumours. From the 1960s, surgical aspects of renal dialysis were developed with Professor Arthur Kennedy. Norman Struthers led the Infirmary’s team in the first renal transplant in Glasgow. Subsequent renal transplant surgeons are listed in the Nephrology section (see Nephrology).
Roy Scott brought the first lithotripter to Glasgow for percutaneous nephrolithotomy (endoscopic stone removal from the bladder). The use of shock (sound) waves to break up stones within the urinary tract has minimised the need for major open surgery in many patients when the renal tract stones failed to pass naturally. Subsequently Gareth Jones was appointed to treat stone disease across Glasgow.
Scott led the largest prevalence study of renal stone disease in a random population (Cumbernauld). He studied Cadmium toxicology affecting renal function; and developed biodegradable membranes, in conjunction with the University of Strathclyde.
Research and Development
At the Western Infirmary, David Kirk contributed to and organized clinical trials in prostate cancer. He was lead investigator in the large Medical Research Council trial of immediate versus delayed hormonal treatment; investigated the role of strontium 89 in metastatic disease; and contributed to the STAMPEDE trial of radiotherapy. Jointly with Stan Kaye and Martin Russell (see Oncology) he developed a supra-regional service for surgery of advanced testicular cancer, treating patients from most of Scotland. Michael Aitchison developed the treatment of renal cancer, before moving to London.
The value of specialist nurse practitioners was recognized, initially at the Western Infirmary in the assessment of patients with prostatic disease. This developed into teams of nurse practitioners taking on much of the routine assessment and follow up of urology patients with a variety of conditions.
Specialised reconstructive urology was developed by Graeme Conn at the Southern General Hospital; later joined by Michael Palmer at the Western Infirmary/Gartnavel Hospital. Michael Fraser developed specialist andrology services. Eric Glenn, who developed a urology unit at the Southern General Hospital in 1972, was for several years secretary of the International Continence Society.
Following its tradition in embracing cutting edge technologies of the time, Glasgow urology used fibreoptic technologies, enabling the performance of minimally invasive surgical procedures, ranging from diagnostic cystoscopy (bladder inspection), to transurethral resection procedures. Urology has also led the ‘revolution’ in the introduction of robot-assisted surgery, with particular utility in radical surgery for prostate cancer (radical prostatectomy).
Since the first robot-assisted radical prostatectomy was performed over 15 years ago, it is now widely accepted as the surgical approach of choice for surgical management of prostate cancer. Additional applications of robot-assisted surgery continue to be explored in ongoing clinical studies worldwide.
In the past two decades, Urology continued to thrive as a highly innovative specialty. Collaborative efforts in research and development with other disciplines brought about transformative advances. For instance, multidisciplinary clinical trials with oncologists and translational scientists helped to explore and optimise novel combination treatments for patients with advanced bladder and kidney cancer, including the use of novel chemotherapy agents, targeted therapy and immunotherapy.
The organisation of urology services across Glasgow was facilitated by the formation of a unified management structure within the Greater Glasgow Health Board. As a result, the Department of Urology in Greater Glasgow is supported by a team of some twenty consultant urological surgeons, and can be considered one of the largest units in the UK. The ‘merge’ of several smaller independent units in Glasgow allowed impactful subspecialisation of urological surgery within Glasgow, creating the required infrastructure and opening up exciting opportunities for clinical and translational research.
Academic urology was formally established in 2006 with laboratory and clinical research led by Hing Leung. It is supported by tripartite collaboration between NHS Greater Glasgow and Clyde, the University of Glasgow and the Cancer Research UK Beatson Institute. More recently, urology played a key role in the formation of the Cancer Research UK Glasgow Cancer Centre.
Moving forward, members of the urology team will continue to seek team based translational research aimed at delivering transformative changes in clinical practice. We will also seek to build on our excellent track record in training talents for future generations of urological surgeons, as the pioneering urologists in Glasgow have done so well in the past.
Professor Hing Leung, Roy Scott, David Kirk and Bernard Ferrie