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Leicester Urology Department

Leicester General Hospital

Roman Leicester

There was a settlement in Leicester nestled between two branches of the river Soar before the Romans came. They fortified this area calling it Ratae Corieltauvorum, meaning the ramparts of the Corieltauvi, the Celtic people of that area. The Romans were well versed in medicine and surgery, but to date, no Roman urological instruments have been excavated in Great Britain.

Left - remains of a Roman bathhouse in Leicester

 

 

Medicine in Mediaeval Leicester

We know the names of several Leicester doctors from the mediaeval period. In 1196, William Medicus is recorded in the first merchant guild roll of Leicester paying his pledges to the Guild on entry of 1 shilling and then a further 2 shillings. In 1232 Robert the leech (an ancient name for doctor) held tenements in Fullers Street, now Soar Lane and around 1251 – 55 Richard the leech was a witness to a grant of land from William Ordriz to the mayor and burgesses, probably for the building of the guildhall.

The huge and impressive Leicester Abbey owned an extensive medical library including John Gaddesden’s Rosa Anglia, Issac Judeas’ Urinas, Avicenna, Averadros, Galen, Lanfranc, Gilbert and Constatinus.

There were several hospitals in Leicester founded in mediaeval times. These however, were for the care of the elderly or chronic sick, such as St Edmund’s for Lepers (also known as The Spital) founded by William the Leper (son of Robert Earl of Leicester) on Belgrave Road. The Trinity Hospital (right) was founded by Henry Plantagenet Earl of Lancaster and Leicester in 1330 for 50 old men and 50 old women. It still stands and is now part of De Montford University. It is thought that the famous mediaeval surgeon John of Ardern was surgeon to the Earl.

The C18th

William Cheselden (1688 - 1752) the famous C18th surgeon and lithotomist was born in Somerby, near Burrow on the Hill, Leicestershire. He was apprenticed to a Leicester surgeon called Mr Wilkes before moving to London to train further and become a great surgeon and anatomist.

The Leicester Royal Infirmary, an C18th Voluntary Hospital was founded in 1771. we know that the Infirmary owned a Herteloupe Table - for performing lithotrity in the C19th.

Urology in Leicester

Like many UK departments Leicester began with no dedicated urology at all. In the 1930s, all general surgeons in Leicester carried out some urological. In particular, Colonel John Barrett and Ernest Frizelle. John Cridlan Barrett (left) was Senior Surgeon at the Leicester Royal Infirmary (LRI) and spearheaded the building of a daycase theatre, where the first dedicated provision of Urology began. He was Leicester’s first BAUS member in 1953.

Barrett was awarded the Victoria Cross for his actions aged 21 in Pontruet, France in 1918. Advancing towards a trench containing numerous machine guns, and in spite of being wounded, he gained the trench, disposed of the guns and led his men back to safety. His VC is on display at the Newarke House Museum in Leicester.   

 

 

Ernest Frizelle (Fritz) was a man of many talents and  was very much a ‘general surgeon’ but his urological interests are shown by his use of the cystoscope (the definition of a urologist then). His personal scope is in the hospital museum. A keen historian, he published two histories of the Leicester Royal Infirmary.

Following WWII, the first general surgeon to become increasingly specialised was Paul Hickinbotham.

“I had been Resident Surgical Officer in Bradford in 1942 where I came into contact with Henry Hamilton-Stewart who was a member of the “Punch Club” and so did a lot of cold punch work. This involved removal of part of an enlarged prostate using an endoscope through the urethra and a cold-cutting device. This was my first introduction to the technique. Later…I got study leave to go to Newcastle and learn the Cold Punch technique with John Swinney.” 

 

Mr Hickinbotham's final operating list.

[L-R Lola Dalby, Sr Barrett, Naji (OPA), Dr King (Anaesthetist), Paul Hinkinbotham]

 

 

 

 

Mr Hickinbotham was joined by John Gordon-Smart in 1965 and together their work became predominantly urological. In the late 1960s, Mr Smart was tasked by the Regional Board to develop a urological department. This was a trend pushed nationally from BAUS. Finally in 1977, the Leicestershire Area Urological Service commenced at the Leicester General Hospital. It consisted of 53 adult beds and 3 children’s beds, seven inpatient operating lists, 3 daycase lists at the LRI, and 3 outpatient clinics along with peripheral activity at Loughborough and Melton Mowbray. It was staffed by 2 consultants, 2 registrars, 2 senior house surgeons and 2 PRHOs.

In 1977 it was finally agreed that the urologists would cease all general surgery.

 

 

John Flynn (standing left) and Tim Terry (next to him) watching a renal Ultrasound

 

 

 

 

In 1981, a third urologist, John Flynn, was appointed and David Osborn joined the department in 1983 when Mr Hickinbotham retired. In this period, there was a dramatic rise in clinical activity with a doubling of outpatient attendances, inpatient numbers and emergency admissions. In 1990, Tim Terry came on board to form a four-person department offering the treatment of BPH, bladder tumours and stone disease. In this era, open prostatectomy was almost entirely replaced by TURP and open surgery for renal, ureteric and bladder calculi was replaced by ESWL, PCNL and ureteroscopy.

 

 

David Osborne (in the suit) on a urology ward round in the 1980's.

 

 

 

 

 

Mr Smart retired in 1992 and was replaced by Davinder Sandhu who offered all manner of core urology and went on to become heavily involved in postgraduate education. In the years that followed, Mr Terry led a number of firsts in the department including the first radical prostatectomy, the first ileal neobladder and the first male to female gender reassignment surgery. Roger Kockelbergh joined the department in 1996 and went on to champion the development of uro-oncology, becoming national lead clinician for urological cancer and recruited to a number of landmark trials.

J Kilian Mellon was appointed the first Foundation Chair of Urology at the University of Leicester in 2000 spearheading the academic unit within the department. Paul Butterworth was appointed in 2000, offering the then-new technique of nerve-sparing prostatectomy. Senior lecturer Leyshon Griffiths followed soon after in 2003, cementing close links with Leicester Medical School.

In 2005, Duncan Summerton arrived with the remit to develop andrology and penile cancer services. Masood Khan (stones and endourology) followed shortly afterwards in 2006 along with Jonathan Goddard (andrology, penile cancer and bladder pain) in 2008. 2014 saw the purchase of the first da Vinci robot and the appointment of John Beatty to perform robotic prostatectomy along with Mr Butterworth.

The last decade has seen the era of superspecialisation. The majority of newer appointments to the department have arrived subspeciality fellowship-trained including functional and reconstructive surgery (Jaskarn Rai 2016 and Pravisha Ravindra 2021), stones and endourology (Jerry Raju 2020) and open cystectomy and complex renal surgery (Ben Jackson 2016 and Jayne Douglas-Moore 2018). In recent years, robotic services have expanded to offer robotic partial nephrectomy and robotic cystectomy with intracorporeal diversion.

The Urology department at the University Hospitals of Leicester NHS Trust now consists of 13 consultants, offering a comprehensive regional subspecialist service in Uro-oncology, Stones, Endourology, Andrology, Functional and Reconstructive Urology. Based at the Leicester General Hospital, they are supported by 14 nurse specialists and a dedicated team of 9 trainees, fellows and specialty doctors along with junior doctors and nursing staff. Over the years, countless trainees have passed through the department and gone on to be consultants, both in the UK and abroad.

None of this would ever be possible without a stellar team of clinical nurse specialists, currently numbered at 14, along with a dedicated nursing team, undeniably the bones of the department and whose contributions would take up several posters on their own. The clinical team are supported by administrative, secretarial and managerial staff, many of whom have spent their entire careers in the department. 

Finally, the innumerable trainees who have rotated through the department, either as registrars, trust grades, junior and senior clinical fellows, research fellows or junior doctors, have supported the day to day running of one of the busiest departments in the country, with the highest number of emergency urological admissions nationally, whilst being exposed to a huge number and variety of training opportunities. In such challenging times, the importance of surgical mentorship has never been more apparent and is a principle that guides the department today as it continues to grow from strength to strength.

This history of Leicester Urology was mainly taken from a presentation by Miss Jayne Douglas-Moore to the EAU History Office at their Leicester meeting in October 2018 and the Leicester's BAUS 'Poster from all departments' 2022, by Miss Pravisha Ravindra.

 

 

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