History The History of Urology in Cleveland, Ohio - Cleveland Clinic
History The History of Urology in Cleveland, Ohio - Cleveland Clinic
History The History of Urology in Cleveland, Ohio - Cleveland Clinic
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<strong>History</strong><br />
<strong>The</strong> <strong>History</strong> <strong>of</strong> <strong>Urology</strong> <strong>in</strong> <strong>Cleveland</strong>, <strong>Ohio</strong><br />
Kamran P. Sajadi and Howard B. Goldman<br />
INTRODUCTION <strong>Urology</strong> <strong>in</strong> <strong>Cleveland</strong>, as <strong>in</strong> the rest <strong>of</strong> the country, has evolved greatly over the past century.<br />
<strong>The</strong> recent pass<strong>in</strong>g <strong>of</strong> Resnick and Novick warrants a review <strong>of</strong> <strong>Cleveland</strong>’s rich urological<br />
history.<br />
MATERIALS AND We reviewed historical and scientific literature and <strong>in</strong>terviewed <strong>Cleveland</strong> urologists.<br />
METHODS<br />
RESULTS Lower jo<strong>in</strong>ed his cous<strong>in</strong> Crile as pr<strong>of</strong>essor at Case Western Reserve University (CWRU) before<br />
they c<strong>of</strong>ounded the <strong>Cleveland</strong> Cl<strong>in</strong>ic (CC) <strong>in</strong> 1921. Goldblatt at CWRU discovered renovascular<br />
hypertension, lead<strong>in</strong>g Poutasse at CC to develop renovascular arteriography and bypass<br />
surgery. Kolff brought his greatest <strong>in</strong>vention, dialysis, to the United States when he jo<strong>in</strong>ed CC.<br />
Straffon put CC’s renal transplant program on the map through his success with deceased donor<br />
transplants. Persky, renowned at radical prostatectomies, chaired urology at CWRU for nearly 30<br />
years and tra<strong>in</strong>ed 6 future university department chairpersons. Resnick succeeded him and<br />
became one <strong>of</strong> the em<strong>in</strong>ent figures <strong>in</strong> urology; an authority on numerous subjects, president <strong>of</strong> the<br />
American Urological Association and American Board <strong>of</strong> <strong>Urology</strong> (ABU) and Editor <strong>of</strong> the<br />
Journal <strong>of</strong> <strong>Urology</strong>. Novick, who became chairman at CC <strong>in</strong> 1985, was the consummate renal<br />
surgeon; he was adept at renal revascularization and transplantation, but his greatest surgical<br />
<strong>in</strong>novation was the partial nephrectomy. He likewise held many positions, <strong>in</strong>clud<strong>in</strong>g president <strong>of</strong><br />
the ABU.<br />
CONCLUSIONS <strong>Cleveland</strong> has been a driv<strong>in</strong>g force <strong>in</strong> the evolution <strong>of</strong> urology <strong>in</strong> the last century. Resnick and<br />
Novick led a golden age <strong>of</strong> urology for several decades until their recent untimely<br />
pass<strong>in</strong>gs. UROLOGY 76: 1293–1297, 2010. © 2010 Elsevier Inc.<br />
<strong>Urology</strong> <strong>in</strong> <strong>Cleveland</strong>, as <strong>in</strong> the rest <strong>of</strong> the country,<br />
has evolved greatly over the past century.<br />
Toward the end <strong>of</strong> the 19th century, open surgeries<br />
<strong>of</strong> the kidneys, bladder, and prostate were <strong>in</strong>itially<br />
the prov<strong>in</strong>ce <strong>of</strong> certa<strong>in</strong> general surgeons. 1 With the development<br />
<strong>of</strong> endoscopic techniques and the formation<br />
<strong>of</strong> the American Urological Association (AUA) <strong>in</strong> 1902,<br />
the specialty <strong>of</strong> urology grew exponentially over the next<br />
100 years. In the last 3 years, however, the urological<br />
community has lost 2 giants <strong>in</strong> Andrew Novick and<br />
Mart<strong>in</strong> Resnick, two <strong>Cleveland</strong>ers whose contributions<br />
to the field are <strong>in</strong>calculable. <strong>The</strong>ir recent pass<strong>in</strong>g warrants<br />
a review <strong>of</strong> <strong>Cleveland</strong>’s rich urological history.<br />
MATERIAL AND METHODS<br />
We reviewed historical references cover<strong>in</strong>g urology and those<br />
cover<strong>in</strong>g medic<strong>in</strong>e <strong>in</strong> the <strong>Cleveland</strong> area. Some were obta<strong>in</strong>ed<br />
by literature search and others based on recommendations from<br />
local urologists. Pert<strong>in</strong>ent publications by urologists were reviewed.<br />
We <strong>in</strong>terviewed several prom<strong>in</strong>ent <strong>Cleveland</strong> urolo-<br />
From the Glickman Urological and Kidney Institute, <strong>Cleveland</strong> Cl<strong>in</strong>ic Foundation,<br />
<strong>Cleveland</strong>, <strong>Ohio</strong><br />
Repr<strong>in</strong>t requests: Kamran Sajadi, Glickman Urological and Kidney Institute, <strong>Cleveland</strong><br />
Cl<strong>in</strong>ic Foundation, Q10–1 9500 Euclid Avenue, <strong>Cleveland</strong>, OH 44195. E-mail:<br />
kpsajadi@gmail.com<br />
gists, among them Dr. Sanford Luria, Dr. D. Karl Montague,<br />
and Dr. Anthony Thomas, for their personal perspectives.<br />
RESULTS<br />
Frank Weed and George Crile, Sr. are credited with<br />
perform<strong>in</strong>g the first nephrectomy <strong>in</strong> <strong>Cleveland</strong> <strong>in</strong> 1890 at<br />
St. Alexis Hospital. 1 Crile went on to jo<strong>in</strong> the faculty at<br />
Case Western Reserve University (CWRU) and was later<br />
jo<strong>in</strong>ed there by his cous<strong>in</strong>, William Lower. 1,2 Lower spent<br />
a year <strong>in</strong> Berl<strong>in</strong> and Paris to learn urology, which he<br />
brought back to <strong>Cleveland</strong> <strong>in</strong> 1910, as an associate pr<strong>of</strong>essor<br />
at CWRU and staff physician at Lutheran and<br />
Mount S<strong>in</strong>ai hospitals. Lower—whom Will Mayo later<br />
called “the lead<strong>in</strong>g American urologist <strong>of</strong> that day”—was<br />
active <strong>in</strong> the AUA <strong>in</strong> its early years and would go on to<br />
serve on its board. 2 After WWI, Lower, Crile, and their<br />
partners Frank Bunts and John Phillips founded the<br />
<strong>Cleveland</strong> Cl<strong>in</strong>ic (CC) <strong>in</strong> 1921. After a fire destroyed the<br />
Cl<strong>in</strong>ic <strong>in</strong> 1929, kill<strong>in</strong>g 123 people, <strong>in</strong>clud<strong>in</strong>g Phillips,<br />
Crile and Lower rebuilt, and Lower went on to become<br />
the CC’s first urology chairman. Both CC and CWRU<br />
established urology resident tra<strong>in</strong><strong>in</strong>g programs <strong>in</strong> 1939,<br />
and the first graduate <strong>of</strong> CC’s program, Charles Higg<strong>in</strong>s,<br />
went on to become its second department chairman.<br />
Harry Goldblatt emigrated from Canada and, after<br />
serv<strong>in</strong>g <strong>in</strong> the American armed forces, jo<strong>in</strong>ed the faculty<br />
© 2010 Elsevier Inc. 0090-4295/10/$36.00 1293<br />
All Rights Reserved doi:10.1016/j.urology.2010.05.039
<strong>in</strong> the department <strong>of</strong> pathology at CWRU <strong>in</strong> the 1920s. 3<br />
Goldblatt’s primary <strong>in</strong>terest was the role <strong>of</strong> ren<strong>in</strong> <strong>in</strong><br />
hypertension, which he explored through animal models.<br />
4 In his dog experiments, he used a clamp he fashioned<br />
on the renal arteries to produce hypertension. Our<br />
modern understand<strong>in</strong>g <strong>of</strong> renovascular hypertension<br />
(RVH) is based on Goldblatt’s now-famous “two kidney,<br />
one clip” and “one kidney, one clip” models <strong>in</strong> the 1930s<br />
and early 1940s. 4,5 His later work purify<strong>in</strong>g ren<strong>in</strong> for<br />
experimental activities led other scientists to elucidate<br />
the rema<strong>in</strong>der <strong>of</strong> the ren<strong>in</strong>-angiotens<strong>in</strong>-aldosterone pathway.<br />
3,5 One such scientist was Irv<strong>in</strong>e Page, who <strong>in</strong> 1939<br />
had wrapped a dog’s kidney <strong>in</strong> cellophane to produce<br />
hypertension, produc<strong>in</strong>g a model <strong>of</strong> what is now called<br />
“Page’s Kidney.” 6 He established a hypertension research<br />
program at CC <strong>in</strong> 1945, where he extensively researched<br />
and described the role <strong>of</strong> angiotens<strong>in</strong>. 7<br />
<strong>The</strong>re rema<strong>in</strong>ed a significant gap between the groundbreak<strong>in</strong>g<br />
basic science work <strong>of</strong> Goldblatt and the successful<br />
surgical management <strong>of</strong> patients with RVH. At CC,<br />
Higg<strong>in</strong>s hired renal surgeon Eugene Poutasse, a man<br />
whom William Kiser <strong>of</strong> CC would later describe as “a<br />
fearless guy ...Hewould just bl<strong>in</strong>dly stick a needle <strong>in</strong>to<br />
the aorta at the level <strong>of</strong> the kidney. Most people <strong>in</strong> those<br />
days thought that this would kill a patient ...” 2 With his<br />
translumbar aortography, Poutasse reported a large series<br />
<strong>of</strong> renal arteriograms <strong>in</strong> 1957. 8 He performed the first<br />
renal endarterectomies and became a pioneer <strong>in</strong> renovascular<br />
bypass surgery. 2,8 At the time, Higg<strong>in</strong>s had become<br />
nationally known. He performed the first transureteroureterostomy<br />
<strong>in</strong> a human, advocated for and performed<br />
many ureterosigmoidostomies for children with exstrophy,<br />
and, most famously, promoted the “acid-ash” diet for<br />
patients with nephrolithiasis. 2 He would later go on to be<br />
president <strong>of</strong> the AUA. 2<br />
Dutch physician Willem Kolff <strong>in</strong>itially became <strong>in</strong>terested<br />
<strong>in</strong> renal failure after watch<strong>in</strong>g a patient die <strong>of</strong><br />
uremia and worked for many years on develop<strong>in</strong>g an<br />
“artificial kidney.” 9 He developed many hemodialysis mach<strong>in</strong>es<br />
and ultimately performed the first successful dialysis<br />
<strong>in</strong> 1943, <strong>in</strong> German-occupied Holland. After the<br />
war, he performed dialysis on a woman <strong>in</strong> a uremic coma<br />
who awakened and lived. 9 He came to the United States<br />
<strong>in</strong> 1950 and became the director <strong>of</strong> the CC Department<br />
<strong>of</strong> Artificial Organs. 2 With the development <strong>of</strong> the Qu<strong>in</strong>ton-Scribner<br />
Teflon Silastic shunt, chronic dialysis became<br />
a reality, and Dr. Kolff’s work is credited with<br />
help<strong>in</strong>g countless patients.<br />
<strong>The</strong> 1950s saw the first human kidney transplants, but<br />
renal transplantation boomed <strong>in</strong> the late 1950s and early<br />
1960s after the <strong>in</strong>troduction <strong>of</strong> azathiapr<strong>in</strong>e and other<br />
immunosuppressive agents. 10 Ralph Straffon (Fig. 1) became<br />
chairman <strong>of</strong> urology at CC <strong>in</strong> 1963 and <strong>in</strong>itiated<br />
the first renal transplantation program <strong>in</strong> <strong>Cleveland</strong>, <strong>in</strong>itially<br />
with liv<strong>in</strong>g donors. He recruited 3 more urologists<br />
to jo<strong>in</strong> his transplant team, each <strong>of</strong> whom would later<br />
make their names <strong>in</strong> different ways. Bruce Stewart was a<br />
Figure 1. Ralph A. Straffon.<br />
technically gifted surgeon who would later specialize <strong>in</strong><br />
male <strong>in</strong>fertility and rema<strong>in</strong> at the cl<strong>in</strong>ic until his untimely<br />
death from prostate cancer at age 53. 2 Clarence<br />
Hewitt was an expert on testis tumors who at the time<br />
had the largest series <strong>of</strong> retroperitoneal lymphadenectomies<br />
<strong>in</strong> the country (Sanford Luria, oral communication,<br />
September 2009). William Kiser would later become the<br />
CEO <strong>of</strong> CC. 2<br />
Transplant surgeons at the time were disappo<strong>in</strong>ted with<br />
the results <strong>of</strong> deceased donor renal transplants (DDRT).<br />
Straffon, however, was frustrated by the lack <strong>of</strong> liv<strong>in</strong>g donors<br />
and sought to resuscitate the role <strong>of</strong> DDRTs <strong>in</strong> transplantation.<br />
Straffon’s team published the largest successful<br />
series <strong>of</strong> DDRTs at the time. 2 Dr. Kolff, one <strong>of</strong> the key<br />
nephrologists <strong>of</strong> the team, performed dialysis on the recipients<br />
until their grafts became functional. 9 Today, CC rema<strong>in</strong>s<br />
a high-volume renal transplant center, hav<strong>in</strong>g performed<br />
nearly 4000 renal transplants.<br />
George Austen, Jr. tra<strong>in</strong>ed under J. Hartwell Harrison<br />
at Brigham Hospital <strong>in</strong> Boston. 1 He stayed on as faculty<br />
urologist at Harvard until he came to CWRU <strong>in</strong> 1952. 11<br />
For the 7 years he stayed at CWRU, he developed the<br />
first successful series <strong>of</strong> radical prostatectomies <strong>in</strong> <strong>Cleveland</strong>,<br />
perform<strong>in</strong>g them through a per<strong>in</strong>eal approach. 1<br />
Lester Persky (Fig. 2) was also renowned for his radical<br />
per<strong>in</strong>eal prostatectomy skills and became chairman at<br />
CWRU when Austen returned to Boston. 1,11 A <strong>Cleveland</strong><br />
native, Persky ga<strong>in</strong>ed brief fame as a football star at<br />
the University <strong>of</strong> Michigan until a hip <strong>in</strong>jury cut his<br />
athletic career short (D. Karl Montague, oral communication,<br />
September 2009). 12 He received his medical degree<br />
from Johns Hopk<strong>in</strong>s and his surgical and urology<br />
tra<strong>in</strong><strong>in</strong>g <strong>in</strong> Boston before jo<strong>in</strong><strong>in</strong>g the faculty <strong>of</strong> CWRU <strong>in</strong><br />
1951. 12<br />
1294 UROLOGY 76 (6), 2010
Table 1. Sample <strong>of</strong> awards bestowed on selected cleveland urologists<br />
Urologist Awards<br />
Charles C. Higg<strong>in</strong>s AUA, Ramon Guiteras Award, American Association <strong>of</strong> Genito-Ur<strong>in</strong>ary Surgeons<br />
(AAGUS) Keyes Medal<br />
Ralph A. Straffon AUA Hugh Hampton Young Award, AUA Gold Cane Award, AUA Certificate <strong>of</strong><br />
Achievement Award<br />
William Kiser AUA Presidential Citation<br />
Lester Perksy AUA Dist<strong>in</strong>guished Service Award, AUA Gold Cane Award, AUA Certificate <strong>of</strong><br />
Achievement Award<br />
Mart<strong>in</strong> I. Resnick AUA Gold Cystoscope Award, AUA Dist<strong>in</strong>guished Contribution Award, AAGUS Spence<br />
Award, American Foundation for Urologic Diseases Russell Scott Education Award<br />
Andrew C. Novick AAGUS Barr<strong>in</strong>ger Medal, AUA, Roman Guiteras Award, Honorary Fellowship <strong>in</strong> the Royal<br />
College <strong>of</strong> Surgeons <strong>of</strong> Ireland and <strong>in</strong> the Canadian Urological Association, and the<br />
St. Paul’s Medal from the British Association <strong>of</strong> Urological Surgeons<br />
Figure 2. Lester Persky (Courtesy James M. Persky).<br />
Persky served as Chair <strong>of</strong> <strong>Urology</strong> at CWRU for nearly<br />
30 years. Dur<strong>in</strong>g his tenure, he was notoriously hardwork<strong>in</strong>g<br />
and a nationally well-regarded speaker, educator,<br />
writer, and surgeon (D. Karl Montague and Sanford Luria,<br />
oral communication, September 2009). 12 He was<br />
known for hav<strong>in</strong>g a hand <strong>in</strong> every aspect <strong>of</strong> the field, and<br />
was one <strong>of</strong> the most published urologists <strong>of</strong> his time, with<br />
more than 200 scientific papers to his name (D. Karl<br />
Montague, oral communication, September 2009). 12 He<br />
ma<strong>in</strong>ta<strong>in</strong>ed a busy practice, and throughout most <strong>of</strong> the<br />
1960s was the only urologist <strong>in</strong> <strong>Cleveland</strong> perform<strong>in</strong>g<br />
radical prostatectomies, because Straffon at CC was not a<br />
believer <strong>in</strong> the operation (Sanford Luria, oral communication,<br />
September 2009). One <strong>of</strong> his many legacies was<br />
the quantity and quality <strong>of</strong> residents he tra<strong>in</strong>ed dur<strong>in</strong>g his<br />
tenure. Persky was a hard worker and expected the same<br />
<strong>of</strong> his residents (D. Karl Montague, oral communication,<br />
September 2009). He was known to tell tra<strong>in</strong>ees on his<br />
service, “<strong>The</strong> good news is that call is every other night.<br />
Figure 3. Andrew C. Novick.<br />
<strong>The</strong> bad news is you’re go<strong>in</strong>g to miss half the learn<strong>in</strong>g<br />
opportunities.” Many <strong>of</strong> his former students and residents<br />
have gone on to chair urology departments, <strong>in</strong>clud<strong>in</strong>g<br />
Robert Flanigan at Loyola, Jean DeKernion at UCLA,<br />
Mark Soloway at the University <strong>of</strong> Miami, Steven Selman<br />
at the University <strong>of</strong> Toledo, W. Scott McDougal at<br />
Massachusetts General Hospital, and Patrick Walsh at<br />
Johns Hopk<strong>in</strong>s University.<br />
In the early 1970s, Straffon, Stewart, Hewitt, and Kiser<br />
were the only urologists at the CC, but over the next few<br />
decades the department would expand exponentially (D. Karl<br />
Montague and Anthony Thomas, oral communication, September<br />
2009). 2 Straffon recruited two <strong>of</strong> his resident graduates<br />
to jo<strong>in</strong> the faculty: D. Karl Montague <strong>in</strong> 1973 and<br />
Andrew C. Novick (Fig. 3) <strong>in</strong> 1977 (D. Karl Montague,<br />
oral communication, September 2009). At the time,<br />
there was little to no subspecialization <strong>in</strong> urology, and all<br />
the urology faculty were adept <strong>in</strong> all areas <strong>of</strong> the field, but<br />
each began to develop his own niche (D. Karl Montague,<br />
oral communication, September 2009). 2 Stewart began<br />
UROLOGY 76 (6), 2010 1295
focus<strong>in</strong>g on male <strong>in</strong>fertility and his accomplishments<br />
cont<strong>in</strong>ue to be recognized by the American Fertility<br />
Society, which has ma<strong>in</strong>ta<strong>in</strong>ed a Bruce H. Stewart Lectureship<br />
s<strong>in</strong>ce 1972. 2 Lynn Banowski jo<strong>in</strong>ed the CC <strong>in</strong><br />
1972 to direct renal transplantation (D. Karl Montague,<br />
oral communication, September 2009). D. Karl Montague,<br />
who also tra<strong>in</strong>ed <strong>in</strong> prosthetics with Brantley Scott<br />
<strong>in</strong> Houston, rema<strong>in</strong>s on the faculty as one <strong>of</strong> the world’s<br />
experts <strong>in</strong> urological prosthetics.<br />
Andrew C. Novick emigrated from Montreal <strong>in</strong> 1972<br />
and jo<strong>in</strong>ed the faculty upon completion <strong>of</strong> his residency<br />
at CC <strong>in</strong> 1977. 13 Novick was widely regarded as one <strong>of</strong><br />
the world’s most accomplished renal surgeons (D. Karl<br />
Montague, oral communication, September 2009). 2,13<br />
He began his career <strong>in</strong> renal transplantation and renovascular<br />
surgery, cont<strong>in</strong>u<strong>in</strong>g the CC’s strong tradition <strong>in</strong><br />
these fields, which cont<strong>in</strong>ued well <strong>in</strong>to an era where<br />
these operations are largely the doma<strong>in</strong> <strong>of</strong> vascular and<br />
general surgeons (D. Karl Montague, oral communication,<br />
September 2009). 2 In the 1980s, he developed a<br />
keen <strong>in</strong>terest <strong>in</strong> nephron-spar<strong>in</strong>g surgery for renal cell<br />
carc<strong>in</strong>oma, and reported excellent results for both <strong>in</strong> vivo<br />
and extracorporeal or “bench” partial nephrectomies. 14<br />
His experience with partial nephrectomies <strong>in</strong> solitary<br />
kidneys later demonstrated a relationship between the<br />
amount <strong>of</strong> renal mass lost and development <strong>of</strong> prote<strong>in</strong>uria<br />
and glomerulopathy, validat<strong>in</strong>g Barry Brenner’s hyperfiltration<br />
theory. 15 Straffon became the chair <strong>of</strong> the Division <strong>of</strong><br />
Surgery at CC <strong>in</strong> 1983, and urological oncologist James<br />
E. Montie chaired the Department <strong>of</strong> <strong>Urology</strong> until Novick<br />
was named chairman <strong>in</strong> 1985. 2 Novick at the time<br />
was chair <strong>of</strong> a department with 7 staff urologists. His<br />
23-year tenure saw the department grow <strong>in</strong>to the Glickman<br />
Urological and Kidney Institute, currently home to<br />
43 staff urologists. 13 A product <strong>of</strong> the residency program<br />
himself, he oversaw the program as it developed from a<br />
regional to a nationally renowned academic powerhouse,<br />
recognized as one <strong>of</strong> the top two programs <strong>in</strong> the country.<br />
16 By recruit<strong>in</strong>g basic science researchers, he elevated<br />
the role <strong>of</strong> laboratory research <strong>in</strong> the department and<br />
<strong>in</strong>corporated a research year <strong>in</strong>to the residency program.<br />
Novick himself authored more than 500 peer-reviewed<br />
research articles and 104 book chapters, and served on<br />
the American Board <strong>of</strong> <strong>Urology</strong> (Table 1). 13 His “proudest<br />
pr<strong>of</strong>essional achievement,” however, was his development<br />
<strong>of</strong> and success with Glickman Urological and Kidney<br />
Institute. 13 Unfortunately, shortly after the Institute<br />
moved to its present location <strong>in</strong> the Glickman Tower,<br />
Novick died <strong>of</strong> complications <strong>of</strong> lymphoma. 13 His pass<strong>in</strong>g<br />
on October 18, 2008 was a shock<strong>in</strong>g and distress<strong>in</strong>g<br />
surprise to many, because he had ma<strong>in</strong>ta<strong>in</strong>ed his vigorous<br />
work ethic and cl<strong>in</strong>ical stam<strong>in</strong>a until the end (Anthony<br />
Thomas, oral communication, September 2009). 15<br />
In 1981, CWRU recruited Mart<strong>in</strong> I. Resnick (Fig. 4)as<br />
chairman to succeed Persky, a position he would hold<br />
until his pass<strong>in</strong>g 26 years later. His areas <strong>of</strong> expertise were<br />
broad. He wrote extensively <strong>of</strong> the role <strong>of</strong> ultrasonogra-<br />
Figure 4. Mart<strong>in</strong> I. Resnick.<br />
phy <strong>in</strong> urology and was politically active <strong>in</strong> ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g<br />
the role <strong>of</strong> the urologist <strong>in</strong> the performance <strong>of</strong> these<br />
procedures. 17 He had an <strong>in</strong>terest <strong>in</strong> nephrolithiasis that<br />
began as a medical student at Bowman Gray School <strong>of</strong><br />
Medic<strong>in</strong>e and he later published on the biochemical<br />
pr<strong>of</strong>iles <strong>of</strong> stone-formers and the role <strong>of</strong> macromolecules<br />
<strong>in</strong> renal stone formation. 17,18 In the past 30 years, the<br />
management <strong>of</strong> stones has moved from large, open surgeries<br />
to endoscopic, extracorporeal, and percutaneous<br />
approaches, and Resnick recognized the importance <strong>of</strong><br />
def<strong>in</strong><strong>in</strong>g renal and renovascular anatomy <strong>in</strong> obta<strong>in</strong><strong>in</strong>g<br />
access for the latter. 17 In the management <strong>of</strong> prostate<br />
cancer, Resnick was well-regarded as an expert <strong>in</strong> the<br />
per<strong>in</strong>eal approach to radical prostatectomy (D. Karl<br />
Montague and Anthony Thomas, oral communication,<br />
September 2009) . 14,15<br />
Resnick ma<strong>in</strong>ta<strong>in</strong>ed an impressive presence on the<br />
national urology scene. He served as secretary and then<br />
as president <strong>of</strong> the AUA, president <strong>of</strong> the ABU, and<br />
editor <strong>of</strong> the Journal <strong>of</strong> <strong>Urology</strong>. 17 He had an enthusiasm<br />
for urological education early on and he established a<br />
resident exchange program between CC and CWRU,<br />
and later, nationally, he developed the AUA’s “Young<br />
Leadership Program.” 11,17 In early 2006, he was diagnosed<br />
with acute myeloid leukemia, but despite his illness<br />
and treatment regimen, he rema<strong>in</strong>ed active <strong>in</strong> practice<br />
and with his editorial duties at the Journal. 19 Sadly, Dr.<br />
Resnick passed away on June 24, 2007.<br />
CONCLUSION<br />
<strong>Cleveland</strong> urology has been not only a microcosm <strong>of</strong><br />
American urology, but one <strong>of</strong> the major driv<strong>in</strong>g forces for<br />
1296 UROLOGY 76 (6), 2010
the evolution <strong>of</strong> the field <strong>in</strong> the 20th and early 21st<br />
centuries. <strong>The</strong> growth, specialization, and subspecialization<br />
<strong>of</strong> the field have been echoed <strong>in</strong> <strong>Cleveland</strong>, especially<br />
at CC and CWRU. Moreover, many contributions<br />
to and milestones <strong>in</strong> the understand<strong>in</strong>g and management<br />
<strong>of</strong> genitour<strong>in</strong>ary disease occurred <strong>in</strong> <strong>Cleveland</strong>. Renovascular<br />
hypertension, hemodialysis, renal transplantation,<br />
nephron-spar<strong>in</strong>g surgery, and surgical management <strong>of</strong><br />
prostate cancer were either <strong>in</strong>troduced or excelled at by<br />
physicians <strong>in</strong> <strong>Cleveland</strong>. In particular, Resnick and Novick<br />
led a golden age <strong>of</strong> urology for nearly 30 years, and<br />
urology—both locally and nationally—is better for hav<strong>in</strong>g<br />
had them.<br />
References<br />
1. Chambers DA. <strong>Urology</strong>. In: Brown KL, ed. Medic<strong>in</strong>e <strong>in</strong> <strong>Cleveland</strong> and<br />
Cuyahoga County; 1810-1976. <strong>Cleveland</strong> Acad Med. 1977:435-440.<br />
2. Bowles MD, Dawson VP. Surgery, Subspecialization and Science: a<br />
<strong>History</strong> <strong>of</strong> <strong>Urology</strong> at the <strong>Cleveland</strong> Cl<strong>in</strong>ic 1921-2000. <strong>Cleveland</strong>:<br />
<strong>History</strong> Enterprises, Inc.; 2000.<br />
3. Goldblatt H. In: VanTassell DD, Grabowski JJ, eds. <strong>The</strong> encyclopedia<br />
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Accessed March 2010.<br />
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by means <strong>of</strong> renal ischemia. J Exp Med. 1934;59:347-379.<br />
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cellophane per<strong>in</strong>ephritis. JAMA. 1939;113:2046-2048.<br />
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Mem Natl Academy Sci. 1995;68:237-250.<br />
8. Poutasse EF, Dustan HP. Arteriosclerosis and renal hypertension:<br />
Indications for aortography <strong>in</strong> hypertensive patients and results <strong>of</strong><br />
surgical treatment <strong>of</strong> obstructive lesions <strong>of</strong> renal artery. JAMA.<br />
1957;165:1521-1525.<br />
9. Academy <strong>of</strong> Achievement. Willem Kolff <strong>in</strong>terview: pioneer <strong>of</strong><br />
artificial organs. November 15, 1991 http://www.achievement.<br />
org/autodoc/page/kol0<strong>in</strong>t-4. Accessed February 2010.<br />
10. Barry JM, Jordan ML, Conl<strong>in</strong> MJ. Renal transplantation. In: We<strong>in</strong><br />
AJ, Kavoussi LR, Novick AC, et al, eds. Campbell-Walsh <strong>Urology</strong>,<br />
9th Eds. Saunders; 2006.<br />
11. Austen G Jr. <strong>The</strong> class <strong>of</strong> 1930. Pr<strong>in</strong>ceton Alumni Weekly. June 3,<br />
1992. Available at: http://paw.pr<strong>in</strong>ceton.edu/memorials/68/16/<br />
<strong>in</strong>dex.xml. Accessed February 2010.<br />
12. Paid notice: deaths: Persky, Lester, MD. New York Times, January 2,<br />
2002.<br />
13. Montague DK. In memory <strong>of</strong> Andrew Carl Novick (1948-2008).<br />
<strong>Urology</strong>. 2009;73:1-2.<br />
14. Novick AC, Streem S, Montie JE, et al. Conservative surgery for<br />
renal cell carc<strong>in</strong>oma: a s<strong>in</strong>gle-center experience with 100 patients.<br />
J Urol. 1989;141:835-839.<br />
15. Novick AC, Gephardt G, Guz B, et al. Long-term follow-up after<br />
partial removal <strong>of</strong> a solitary kidney. N. Engl. J. Med.. 1991;325:<br />
1058-1062.<br />
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