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Tobias Goodman and the New England origins of ureteroscopy
Joseph E. Yared, MD, Vernon M. Pais, MD.
Dartmouth Hitchcock Medical center, Lebanon, NH, USA.
BACKGROUND: 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 highlight the creative spark that is critical to advance in medical science and 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. However, 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. He was in fact selected to deliver the Latin Oration at his 1962 commencement. After graduating from residency at Boston Medical Center, he started solo practice in Westerly, Rhode Island. 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. He remained in Westerly for his entire career, and since retirement 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. Dr Goodman’s contributions point to the very beginning of endourology, years before the term had even been coined.
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