Standing on the Shoulders of Giants

Isaac Newton famously wrote in 1676: “If I have seen a little further it is by standing on the shoulders of Giants.” In this issue of the SIU Journal we introduce a new feature article that we will include regularly going forward: Giants in Urology. In medicine and surgery, we have a certain reverence for the pioneers who established the practices we incorporate into daily practice—but at the same time we have a short collective memory of those who have gone before us. Icons in the field who drift into retirement are quickly forgotten by the next generation of urologists emerging from training. For this reason, we wanted to feature some of these giants. We are certainly not the first urologic journal to do so, but, aligned with the mission of the SIUJ, we will do this from a global perspective, showcasing giants from around the world, including those whose impact was perhaps appreciated only regionally.

Our first giant is Rudolf (“Rudy”) Hohenfellner, the long-time chairman of the Department of Urology at the Johannes Gutenberg University in Mainz, Germany. Reading this contribution from Jan Fichtner and Margaret Fisch reveals that this giant was himself influenced by giants that preceded him—and Hohenfellner has without question spawned multiple giants himself (the authors included). The legacy of passing on skills, techniques, and wisdom to one’s own trainees and junior faculty is without doubt a key feature of any giant in the field. Hohenfellner is like a godfather figure in German urology, as many chairs across the country started their careers under his tutelage. His surgical innovation has influenced many urologists around the world, benefitted not only all the patients he cared for but also all those cared for by his former trainees.

I am myself one of the many trainees influenced by Rudy Hohenfellner. I had no idea who he was at the time, but he was the inspiration for me to pursue a career in urology. My first urologic experiences were his weekly lectures in the middle years of medical school. He regularly brought patients to his lectures and interviewed them with his thick Viennese accent to allow the students to learn from the individual medical histories and experiences of the patients. Urinary diversion was a regular feature in his lectures (Mainz is after all where he developed the Mainz pouch), and this was part of the inspiration for me to do an elective in urology. About 25 years later, I still do a lot of urinary diversion (although not the Mainz variety). As I finish a continent cutaneous reservoir or an orthotopic neobladder, I often wonder how we get away with these extensive reconstructive surgeries. At least we have decades of positive experiences on which to build, but imagine the early pioneers of urinary diversion like Hohenfellner who were developing the techniques that we have all since adopted. Perhaps more importantly, Hohenfellner instilled in his trainees many other lessons that were critical to the budding surgeon: discipline, technical excellence, scientific rigor, innovation, and devotion to the patient. I like to say that I might not do what I do today if I had not encountered Rudy Hohenfellner in the late 1990s in Mainz.

I am reminded of a conversation I had with a very prominent Canadian urologist a few years ago on a subway in Washington DC. He was lamenting that the meeting to which we were both traveling used to attract many of the major “icons” (his term) in the field, but that he had noticed a gradual decline in this pattern over the years. What he did not recognize is that he had become an icon himself, and the urologists that he viewed as icons were mostly retired. There are many giants, and giants will come and go. Every urologist will have a different perspective on who is a giant in their region of the world and in their area of subspecialty practice. The impact of any given giant may be quite varied, including especially clinical research, translational research, biomarker and drug development, surgical innovation, modification of standard clinical practice, or exemplary leadership. Some giants will have contributed specifically to the success of urological organizations like the SIU, or to different urologic journals.

We therefore invite contributions from urologists around the world. Share with us the inspiration your mentor has imparted to others. We would like to capture in the pages of the SIU Journal some of the main achievements of these giants, the quintessence of their personalities, and their legacy to our field. Who are the giants are in your urologic sphere? Upon whose shoulders do you stand?