20 YEARS OF CHANGE IN UROLOGY (1970-1990)

Major changes that have occurred in urology over the last twenty years include the identification of a reliable marker for cancer of the prostate, i.e., the prostate specific antigen, and of a hormone that is characteristic of some cancers of the testis (BHCG). Ultrasonography is an accurate means for diagnosing renal tumors and is useful for guiding biopsies of the prostate. CT scans have superseded renal arteriography and MRI is helpful in patients with deep enlarged lymph nodes. The ureter and renal cavities can now be investigated endoscopically. Tumors of the prostate can be removed endoscopically but also destroyed by cold (-180-degrees-C) or heat (microwaves). Extracorporeal shock waves can be focused on renal or ureteral stones in order to destroy them. Potent (and aggressive) chemotherapy regimens are being used in malignant tumors of the urinary bladder, prostate or testis, including involved lymph nodes and metastases. A variety of prosthetic devices are available: penile stents, artificial urethral sphincters, ureteral stents, and intraureteral meshes to prevent recurrent stenosis. These methods have reduced the field of open surgery that remains, however, necessary in some indications including some forms of renal lithiasis, malignant renal tumors, renal artery anomalies, renal transplants (of cadaver kidneys), and replacement of the bladder and ureter by segments of bowel.