Login to Access Video or Poster Abstract: FRII-05
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Introduction

Ureteroscopy is one of the most commonly performed procedures in current urologic practice, although rigid ureteroscopy was unheard of until the very recent past. Its origins has direct New England ties. Although the first documented “ureteroscopy” is attributed to Hugh Hampton Young who performed inadvertent endoscopy of the ureter in a 2 month old child with posterior urethral valves, this 1929 report was essentially relegated to anecdote that lacked any practical application.50 years later, in a small New England town, diagnostic and therapeutic ureteroscopy were born with the first planned rigid ureteroscopy and the introduction of ureteroscopic-guided intervention.

Methods

A comprehensive search of Medline was undertaken to assess all published articles describing ureteroscopy prior to 1980. References of identified papers were also reviewed to identify the earliest published accounts of rigid ureteroscopy. Upon identifying the initial reported ureteroscopy, the author was interviewed to better understand the context surrounding the inception of ureteroscopy.

Results

The first report of planned rigid ureteroscopy was in 1977. The procedure was performed by Dr. Tobias M. Goodman at Westerly Hospital. Dr. Goodman attended Browne and Nichols school in Cambridge, MA, then matriculated to Harvard College where he was an accomplished scholar in Classic Languages. After graduating from residency at Boston Medical Center, he started solo practice in Westerly, RI. At the time, blind stone-basketing was standard practice, but he recounts unease with the imprecise nature of blind manipulation. Thirty years prior to the AUA recommendation against blind-basketing, he proposed to several patients an improved, directly visualized approach to management of ureteral pathology. With a reputation as a physician who “knew how to stay out of trouble,” his patients eagerly agreed. Using a pediatric cystoscope with a standard bridge and an 11Fr sheath, he accessed, visualized and fulgurated a distal ureteral tumor. He developed techniques for diagnostic ureteroscopy and stone extraction, publishing the first series of rigid ureteroscopy in 1977. He subsequently developed patents for a ureteroscope, a 3-way endoscopic valve and Uroshiol for treatment of bladder cancer. Since retirement, he has authored 2 non-medical books: Out of the Attic and Ancient purple. He still resides in Westerly, RI where he is a guest columnist for the Westerly Sun.

Conclusions

Dr Tobias Goodman is a urologic pioneer who serves as an example of the creative thinking that has allowed the dramatic progress we continue to enjoy.

Funding

none