A living history: how a century of research is still relevant in today’s practice

Celebrating 100 years of The Journal of Urology®

Shortly after the publication of its first issue in February 1917, The Journal of Urology-Medical, Surgical and Experimental – now The Journal of Urology® – had to contend with challenging circumstances. In April 1917, the US declared war on Germany and the journal's associate editor applied for service abroad. Despite the challenge, the journal flourished, and three years later it became the official publication of the American Urological Association (AUA).

Over the last 100 years, the journal has published groundbreaking research across all fields of urology, including prostate cancer, fertility and kidney disease. Far from collecting dust, these studies are as alive today as they were when they were first published – their results, commentaries and recommendations continue to inform new research and guidelines.

To help today's clinicians and researchers access the information, the full collection of backfiles is now available digitally on ScienceDirect and on jurology.com. The collection includes some of the best research ever published in urology.

In celebration of the centennial and to highlight some of the seminal works, the journal published a special Centennial Supplement, in which the Editor of The Journal of Urology, Joseph Smith, has hand-picked a selection of original articles is published alongside commentaries by some of today's leading urologists.

Going back through 100 years, I've been able to see the evolution of our specialty, and the way The Journal of Urology has stayed with that, said Smith.

Pioneering in prostate cancer

By the time Hugh Hampton Young of Johns Hopkins Hospital in the US published his article "The Ultimate Results in the Treatment of Carcinoma of the Prostate by the Radical Removal of the Prostate, Vesical Neck and Seminal Vesicles" in 1933, it had already been 28 years since he performed the first radical perineal prostatectomy (RPP). He describes the first case in the article:

In 1905 a patient came to me with a very hard prostate, which I recognized as carcinoma. It did not extend beyond the capsule nor along the urethra, into seminal vesicles nor bladder, and it seemed to me that a radial operation could be carried out without much difficulty… Drawing up a plan for such an operation I presented it to my chief, Dr. Halsted, to whose radical fancy it at once appealed.

The operation was a success, encouraging him to "carry out the operation in every case which seemed appropriate, and similarly good results were obtained."

In his commentary on the article, Herbert Lepor notes: "I am always amazed when reading articles of historical interest just how thoughtful many of our predecessors were without the advantage of fancy diagnostic and technological advances available today."

Despite a mortality rate of 10 percent, which would be extremely high by today's standards, Young paved the way for the development of a procedure that is now commonly used: about 100,000 prostatectomies are performed every year in the US. In the article, Young suggests physicians should be more aware of prostate cancer:

If practitioners could be taught to make rectal examinations much more frequently, and be suspicious of every markedly indurated prostate, even when only a small nodule is present, many patients would be brought to early radical operation and ultimate cure.

Publishing his results undoubtedly had an impact on that awareness.

The foundations of fertility knowledge

When male infertility is suspected, the man provides a semen sample so that the sperm can be tested: their number, shape and motility are all assessed. Today this test is carried out frequently and the results are compared to figures widely agreed to indicate infertility, such as a sperm density of 20 million/mL, below which conception is unlikely.

Values like this are built on research; one of the key articles contributing to our understanding of male infertility was written in 1951 by John Macleod and Ruth Gold. "The Male Factor in Fertility and Infertility. II. Spermatozoƶn Counts in 1000 Men of Known Fertility and in 1000 Cases of Infertile Marriage" was the "second in a series designed to analyze every aspect of semen quality in terms of the fertility of the donor."

MacLeod, a professor in the Departments of Anatomy, and Obstetrics and Gynecology at Cornell University Medical College, paid close attention to the data in the paper, which is so rich it is still usable today. In his commentary, Craig Niederberger highlighted the rigor of the paper:

The Journal article itself is masterful. To say that it holds up to time is an understatement: the study design, execution, rigorous statistical analysis and explanations with caveats still serve as a model to which few modern published studies ascend.

Niederberger explains that figures such as sperm density of 20 million/mL were foundational for clinical male for clinical male reproductive medicine:

This number and others revealed by their work would find their way as consensus values into the first 4 editions of the WHO laboratory manual for the examination and processing of human semen, the de facto standard for performing and interpreting semen analyses.

Making waves in kidney research

In the early 1980s, a new technique for treating kidney stones was sending shock waves – not just through the stones themselves, but also through the community.

In a concise article of just four pages, entitled "First Clinical Experience with Extracorporeally Induced Destruction of Kidney Stones by Shock Waves," Christian Chaussy and his colleagues introduced shock wave lithotripsy – using shock waves to break down kidney stones so they can pass out of the body. According to Manoj Monga, the technique met at first with skepticism, criticism and pessimism, despite the clearly successful results. The article begins:

We performed extracorporeally induced destruction of kidney stones on 72 patients. No complications have resulted from the tissue exposure to high energy shock waves.

The brevity with which the authors shared their results is indicative of their clarity, as Monga explains:

No discussion needed as the implications were clear. Urology was about to change.

Despite the initial controversy, shock waves took hold among practitioners and were a big hit with patients: today, shock wave therapy is one of the most requested – and most commonly carried out – procedures in the treatment of kidney problems.

Mining a century of groundbreaking research

These are just three of hundreds of seminal papers published in The Journal of Urology over the last century. As Badrinath Konety, one of the journal's Associate Editors, said in the reflections video: "It is one of the oldest journals in the entire field, that has over the last century published some of the most remarkable pieces of literature in the field of urology."

The journal continues to publish groundbreaking research in all areas of urology, and new authors continue to be published alongside some of the pioneers in the field. To find out how to join them, and to visit the back files, go to jurology.com.